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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604134
Report Date: 09/29/2020
Date Signed: 09/29/2020 04:32:13 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: 105DATE:
09/29/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Executive Director, Karen EncisoTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Debbie Correia conducted a case management virtual visit, via Facetime due to COVID-19, to deliver an amended complaint investigation report that was delivered on December 23, 2019. LPA Correia Identified herself to Executive Director (ED) Karen Enciso and explained the purpose of the visit.

The deficiency cited on December 23, 2019 as part of the complaint number 08-AS-20191125100700 has been dismissed.

An exit interview was conducted, and a copy of this report was provided to Execute Director, Karen Enciso via electronic mail. A confirmation of receipt was requested.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2020
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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