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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604347
Report Date: 06/28/2022
Date Signed: 06/28/2022 12:40:28 PM


Document Has Been Signed on 06/28/2022 12:40 PM - 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:SUNSET COAST ASSISTED LIVINGFACILITY NUMBER:
374604347
ADMINISTRATOR:TAPIA, PATRICIAFACILITY TYPE:
740
ADDRESS:808 THERMAL AVETELEPHONE:
(619) 882-5003
CITY:SAN DIEGOSTATE: CAZIP CODE:
92154
CAPACITY:6CENSUS: 3DATE:
06/28/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:01 PM
MET WITH:Licensee, Patricia TapiaTIME COMPLETED:
12:50 PM
NARRATIVE
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Licensing Program Analyst (LPA) Elizabeth Hamilton conducted an unannounced case management visit at the facility. LPA was greeted at the front entrance by Caregiver, Maria Largo and granted entry after identifying herself. LPA Hamilton explained the purpose of the visit to Licensee, Patricia Tapia.

The purpose of this visit was to discuss the facility’s current admissions agreement. During today’s visit, LPA Hamilton went over the refund section of the admissions agreement with Licensee, Tapia as required information was not included per Title 22 regulations.

A deficiency was cited during today's visit. See LIC 809D page for citation and plan of correction.

An exit interview was conducted with Licensee, Tapia a copy of this report, LIC 809D and Licensee/Appeals Rights (LIC 9058 01/16) was provided to Licensee.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2


Document Has Been Signed on 06/28/2022 12:40 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108


FACILITY NAME: SUNSET COAST ASSISTED LIVING
FACILITY NUMBER: 374604347

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2022
Section Cited

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(5) Refund conditions. (A)Facility policy concerning refunds, including the conditions under which a refund for advanced monthly fees will be returned in the event of a resident’s death pursuant to Health and Safety Code section 1569.652.
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Based on interviews and record reviews the licensee did not include refund conditions in the event of a resident’s death. This posed a potential personal rights risk to one out of three residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 301-9770
LICENSING EVALUATOR NAME: Elizabeth HamiltonTELEPHONE: (619) 929-7590
LICENSING EVALUATOR SIGNATURE:
DATE: 06/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/28/2022
LIC809 (FAS) - (06/04)
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