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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603793
Report Date: 01/27/2021
Date Signed: 01/28/2021 07:54:50 AM

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:SUNRISE OF SABRE SPRINGSFACILITY NUMBER:
374603793
ADMINISTRATOR:KLEMP, SHAUNA LYNNFACILITY TYPE:
740
ADDRESS:12515 SPRINGHURST DRTELEPHONE:
(858) 391-9160
CITY:SAN DIEGOSTATE: CAZIP CODE:
92128
CAPACITY:100CENSUS: 89DATE:
01/27/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Executive Director Shauna KlempTIME COMPLETED:
12:40 PM
NARRATIVE
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(LPM), Simon Jacob, County of San Diego Nurse Contractors Robert Montillano, Michelle Tapia; California Department Public Health (CDPH), Health Facility Evaluator Nurse (HFEN), Maggie Turner with the HAI Program, conducted an on-site visit. RM, LPM and team identified themselves and discussed the purpose of the visit with Executive Director Shauna Klemp.

The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's disinfection, testing surveillance, and screening protocols as well as the use of personal protective equipment. During today's visit, the team interviewed Executive Director Shauna Klemp. The team conducted a walk-though of the facility. A debriefing was conducted with Executive Director Shauna Klemp at the conclusion of the visit.

During today's visit, no deficiencies were issued. An exit interview was conducted with Executive Director Shauna Klemp and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to the Director Klemp via electronic mail. An electronic receipt of confirmation was requested to be sent by the Director upon receipt of the documents.
SUPERVISOR'S NAME: Kimberly LyonTELEPHONE: (619) 767-2300
LICENSING EVALUATOR NAME: Simon JacobTELEPHONE: (619) 767-2306)
LICENSING EVALUATOR SIGNATURE:

DATE: 01/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2021
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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