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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604134
Report Date: 11/10/2021
Date Signed: 11/10/2021 06:12:57 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 EAST BOBIER DRIVETELEPHONE:
(760) 946-6055
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:252; 252CENSUS: 111DATE:
11/10/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:25 PM
MET WITH:Karen Enciso, Executive DirectorTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA) Carmen Lopez and County of San Diego Nurse Contractor, Robert Montillano with the HAI Program, conducted an on-site HAI assessment visit. LPA and SD County Nurse identified themselves and discussed the purpose of the visit with Executive Director Karen Enciso, Resident Service Director Loida Venturina, and Maintenance Director Mike Mccoy.

The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's mitigation protocols to include disinfection, testing, vaccination, and screening protocols as well as the use of personal protective equipment (PPE). During today's visit, the team interviewed the Executive Director and conducted a walk-though of the facility. A debriefing was conducted with the Executive Director, Resident Service Director, and Maintenance Director at the conclusion of the visit.

During today's visit, no deficiencies were cited. An exit interview was conducted with the Executive Director Enciso to whom a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided via electronic mail. An electronic receipt of confirmation was requested upon receipt of the documents.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:

DATE: 11/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/10/2021
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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