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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603793
Report Date: 06/01/2023
Date Signed: 06/01/2023 12:46:35 PM


Document Has Been Signed on 06/01/2023 12:46 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: 72DATE:
06/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Resident Care Director Jessica ZebroskiTIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case management to correct/amend a prior licensing visit report. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Resident Care Director Jessica Zebroski.

During today's visit, LPA formally amended a prior facility evaluation report and discussed the changes made with the licensee. Licensee agreed to remove any copies of the prior report they have, substituting/replacing with the amended report.

During today's visit, no deficiencies were observed or cited.

An exit interview was conducted with Zebroski, to whom a copy of the amended report, this report, 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: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2023
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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