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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604350
Report Date: 10/21/2020
Date Signed: 10/21/2020 06:01:44 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:SUNSET COAST ASSISTED LIVINGFACILITY NUMBER:
374604350
ADMINISTRATOR:TAPIA, PATRICIAFACILITY TYPE:
740
ADDRESS:1697 DONAX AVETELEPHONE:
(619) 882-5003
CITY:SAN DIEGOSTATE: CAZIP CODE:
92154
CAPACITY:6CENSUS: 0DATE:
10/21/2020
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Vanessa Nunez, LicenseeTIME COMPLETED:
11:24 AM
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Licensing Program Analyst (LPA) Dawn Segura conducted a Pre-Licensing Virtual Visit, via video conference, due to COVID-19, to observe the facility for compliance with Title 22, Division 6, of California Code of Regulations and Health & Safety Code. The LPA was joined on the video call by Vanessa Nunez and Patricia Tapia, Licensees.

The LPA and licensees toured the physical plant, and LPA observed the following: resident accommodations, including furnishings, linens, and personal hygiene items; resident bathrooms were equipped with grab bars, non-skid mats, and water temperature measured at 114 and 115.4 degrees Fahrenheit in two bathrooms designated for use by residents; resident and staff records will be located in a locked cabinet; food service, including dishes, utensils, refrigerators, freezers, and adequate food storage and preparation space are present; cleaning and potentially toxic substances are stored in a locked closet; a locked mobile cart is available for storage of medication; a first aid kit and first aid manual are stored in a locked closet; activities, supplies and sufficient space in which to conduct activities are present; fire extinguishers are present; smoke and carbon monoxide detectors are present, were recently inspected, and determined to be operable by fire safety inspector; required facility postings are present and visible in a common area of the facility. According to licensee, there are no guns, weapons, or ammunition stored on the facility property. No swimming pool or body of water was observed on the facility property.

The renewal administrator’s certification for Patricia Tapia is currently being processed and pending approval by the Administrator Certification Unit. Component III was conducted and completed following the pre-licensing physical inspection.

Items reviewed during the visit are in compliance with Title 22, Division 6, Chapter 8, of California Code of Regulations. The licensee was advised that the application is pending management final review and approval. A copy of this report and Applicant Rights (LIC 9058) were provided to Vanessa Nunez via electronic mail. An electronic mail read receipt confirmation was requested to be sent to LPA upon receipt of the documents.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2020
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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