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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603793
Report Date: 05/30/2023
Date Signed: 05/30/2023 05:06:09 PM


Document Has Been Signed on 05/30/2023 05:06 PM - It Cannot Be Edited

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:JESSICA ZEPEDAFACILITY TYPE:
740
ADDRESS:12515 SPRINGHURST DRTELEPHONE:
(858) 391-9160
CITY:SAN DIEGOSTATE: CAZIP CODE:
92128
CAPACITY:100CENSUS: 73DATE:
05/30/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Executive Director Kimberly Santillian, Assisted Living Coordinator Sandra Valentin, Resident Care Director Jessica ZebroskiTIME COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Assisted Living Coordinator Sandra Valentin and Resident Care Director Jessica Zebroski. LPA then met with Executive Director Kimberly Santillian.

Today's visit was in response to three (3) SOC341 Report of Suspected Dependent Adult/Elder Abuse forms, which licensee self-submitted to the CCLD San Diego Regional Office (received on 04/05/2023), involving Resident #1 (R1), Resident #2 (R2) and Resident #3 (R3), respectively. [See LIC 811 Confidential Names List for a description of person identifiers used in this report].

During today’s visit, LPA performed a facility tour and general welfare check. LPA visually verified that R1, R2, and R3 were safe/uninjured. LPA also collected copies of pertinent resident and employee records and interviewed relevant staff.

No deficiencies were issued during today's site visit. Due to time constraints, a return visit is planned.

An exit interview was conducted with Santillian, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) 767-2351
LICENSING EVALUATOR NAME: Dang NguyenTELEPHONE: (619) 210-9024
LICENSING EVALUATOR SIGNATURE:
DATE: 05/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/30/2023
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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