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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604134
Report Date: 08/25/2020
Date Signed: 08/25/2020 02:08:49 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:PACIFICA SENIOR LIVING VISTAFACILITY NUMBER:
374604134
ADMINISTRATOR:ENCISO, KARENFACILITY TYPE:
740
ADDRESS:760 E BOBIER AVETELEPHONE:
(760) 691-1027
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:252CENSUS: 128DATE:
08/25/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Administrator, Karen Enciso TIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Eva Torres conducted a virtual case management visit via FaceTime to follow up on a report that was submitted by the facility on 08/20/20. LPA identified herself, spoke with Administrator, Karen Enciso, and disclosed the purpose of the phone call.

During the meeting, LPA obtained details surrounding the incident in question and requested records.

An exit interview was conducted with Administrator, Enciso and the Licensee’s Rights (LIC9058 01/15) along with a copy of this report was provided to Administrator, Enciso 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: 08/25/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2020
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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