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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604350
Report Date: 03/25/2022
Date Signed: 03/28/2022 10:14:08 AM

Document Has Been Signed on 03/28/2022 10:14 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: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: 3DATE:
03/25/2022
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Administrator, Patricia TapiaTIME COMPLETED:
02:45 PM
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Licensing Program Analyst (LPA), Marisela Garcia-Ceteno conducted a Case Management visit regarding increase from two (2) Non-Ambulatory to six (6) Non-Ambulatory for a total facility capacity of six (6) all of which can be Non-Ambulatory. LPA identified herself to Administrator, Tapia and House Manager, Nunez and discussed the purpose of the visit.

Licensee applied for an increase in non-ambulatory status from two (2) to six (6). There is an approved Fire Clearance dated 3-16-2022 for the increase in non-ambulatory status. As of today, there are three (3) residents in care. LPA toured the facility and a had a discussion with Administrator regarding operation.

During the tour, LPA observed the physical plant and residents' accommodations including furnishings, linens and personal hygiene items; resident bathrooms are equipped with cleaning products and paper towels; toxic substances are stored in a locked cabinet in the garage and in the kitchen; medication storage and administration logs are located in a locked cabinet; sufficient space to conduct activities was present; facility posting requirements were present in a common area; the facility administrators certification was current; no pool or other body of water is present on the facility grounds; per the Administrator there are no guns, weapons or ammunition located on the property. Discussed with Administrators continuing operation requirements, record keeping and physical plant compliance.

No deficiencies were issued during this visit.

An exit interview was conducted with Administrator Tapia, and a copy of this report, along with Licensee/Appeal Rights (LIC 9058 01/16), were provided to the Administrator via email. An electronic read receipt confirmation was requested to be sent by Administrator, Tapia upon receipt of the documents.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE: DATE: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/25/2022
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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