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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604134
Report Date: 02/17/2022
Date Signed: 02/18/2022 09:14:13 AM


Document Has Been Signed on 02/18/2022 09:14 AM - 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: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: 106DATE:
02/17/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Michael McCoy, Executive Director (A)TIME COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Carmen Lopez conducted a Case Management visit, to conduct an unannounced health and safety check for residents in care. LPA identified herself and was granted entry by Cassidy Waian, Activities Assistant. LPA met with Michael McCoy, Executive Director (A) and disclosed the purpose of the visit.

During today's visit, LPA toured the facility briefly spoke with residents, and reviewed and obtained pertinent documents maintained by the facility. LPA spoke with the Executive Director (A) McCoy regarding eviction procedures and plan of operations. No immediate health or safety concerns were observed. No deficiencies were cited during today’s visit.

An exit interview was conducted with Michael McCoy, Executive Director (A) and a copy of the report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Executive Director (A) McCoy via email. An electronic email receipt confirms the documents were received.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:
DATE: 02/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/17/2022
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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