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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604134
Report Date: 02/01/2021
Date Signed: 02/01/2021 10:38:45 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:PACIFICA SENIOR LIVING VISTAFACILITY NUMBER:
374604134
ADMINISTRATOR:ENCISO, KARENFACILITY TYPE:
740
ADDRESS:760 EAST BOBIER DRIVETELEPHONE:
(760) 691-1027
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:252; 252CENSUS: 0DATE:
02/01/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Karen Enciso, Executive DirectorTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Carmen Lopez conducted a virtual follow-up visit, via video conference, due to COVID-19, to inspect an ancillary facility building that was granted fire clearance by the local fire authority. The initial visit was conducted on 01/26/2021. LPA conducted the visit to observe the structure for compliance with Title 22, Division 6, of California Code of Regulations and Health and Safety Code. LPA conducted the virtual visit with Karen Enciso, Executive Director.

Based upon LPA’s observations, the following items have been provided, to ensure that the facility is in compliance with Title 22, Division 6, Chapter 8, of California Code of Regulations, for approval:

1) Resident accommodations – Facility’s plan to furnish the residents bedroom including a chair, nightstand, lamp or light sufficient for reading are available for resident’s use and located in the respite room. If furnishings are not available, the facility will purchase the item(s) necessary.
2) Clean linens – A storage area is available with clean linens in Building A. The master storage closet area shall be available in the main building with additional supply of linens.
3) Water temperature in in the kitchen measured at 111.2 degrees Fahrenheit. The temperature in the resident’s room measured at 110.5 degrees Fahrenheit. The temperature for the faucets used for grooming measures between 105 – 120 degrees Fahrenheit.

Items reviewed during the visit are in compliance with Title 22, Division 6, Chapter 8, of California Code of Regulations. The Executive Director was advised that the application is pending management final review and approval. An exit interview was conducted with Executive Director Enciso. A copy of this report and Licensee Appeal Rights (LIC 9058 01/16) were provided via email. An electronic mail read receipt confirms receipt of the documents.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 02/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2021
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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