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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603618
Report Date: 08/04/2020
Date Signed: 08/04/2020 02:52:00 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:BROOKDALE CARLSBADFACILITY NUMBER:
374603618
ADMINISTRATOR:HIGHTOWER, SASHAFACILITY TYPE:
741
ADDRESS:3140 EL CAMINO REALTELEPHONE:
(760) 720-9898
CITY:CARLSBADSTATE: CAZIP CODE:
92008
CAPACITY:125CENSUS: 89DATE:
08/04/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH:Administrator, Sasha HightowerTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA) Eva Torres conducted a virtual case management visit via FaceTime to follow up on incident that was reported by the facility on 07/28/20. LPA identified herself, spoke with Administrator, Sasha Hightower, and disclosed the purpose of the phone call.

On 07/28/20, LPA spoke with the Health Wellness Director and requested the facility's records. On the same day, the requested records were received and reviewed. During today's call, LPA spoke with Administrator, Sasha Hightower and discussed the elements of the incident.

An exit interview was conducted with Administrator, Sasha Hightower, and the Licensee’s Rights (LIC9058 01/15) along with a copy of this report was provided to the Administrator via email. A reply email or return receipt from the Administrator will confirm receipt of documents.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Evangelica TorresTELEPHONE: (619) 990-1407
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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