374604350-11-9-2023-08-AS-MGCO-CXF29A-20231109161138

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604350
Report Date: 11/09/2023
Date Signed: 11/09/2023 04:12:17 PM

Document Has Been Signed on 11/09/2023 04:12 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME:	SUNSET COAST ASSISTED LIVING		FACILITY NUMBER:	374604350
ADMINISTRATOR:	TAPIA, PATRICIA		FACILITY TYPE:	740
ADDRESS:	1697 DONAX AVE		TELEPHONE:	(619) 882-5003
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92154
CAPACITY:	6	CENSUS: 5	DATE:	11/09/2023
TYPE OF VISIT:	Required - 1 Year	ANNOUNCED	TIME BEGAN:	11:40 AM
MET WITH:	Administrator, Patricia Tapia		TIME COMPLETED:	03:50 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted an unannounced Required Annual Inspection. The facility file was reviewed prior to the visit. LPA identified herself and was granted entry by Caregiver, Anna Perez Ocampo. LPA met with Administrator, Patricia Tapia, to whom she disclosed the purpose of the visit. According to the facility’s license, the facility has a maximum capacity of six (6) elderly residents ages 60 and above; all of whom may be non-ambulatory; a hospice waiver approved for two (2) residents. During today’s inspection, there were a total of five (5) residents in care, of which two (2) were ambulatory. The facility does not feature a secured perimeter or delayed egress doors. LPA Garcia-Centeno was accompanied by the Caregiver, Anna Perez Ocampo while touring the interior and exterior of the facility. In addition, the residents’ rooms were inspected. The facility was clean and in good repair. Pathways were free of obstruction and slip hazards. The residents’ bedrooms contained the required furnishings. The doors, toilet, and shower were in working order. Extra linens and hygiene supplies were present. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities for the residents in care. The facility’s internal temperature, refrigerator, and freezer temperatures were within the regulatory range. During today’s visit, LPA observed, via measurement with a thermometer, that the hot water temperature from the bathroom faucet accessible to residents was within regulatory range. There were at least 2 days of perishable food, and at least 7 days of non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to residents. Medications were labeled, as required and stored in locked areas. (Continue at LIC809C)

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SUNSET COAST ASSISTED LIVING	FACILITY NUMBER: 374604350
	VISIT DATE: 11/09/2023

NARRATIVE

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(continue from LIC809

Residents and staff confidential records were appropriately maintained electronically and some physical files were available at the facility. No pools or bodies of water were observed on the premises. Per the administrator, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. The fire extinguishers were serviced within the last 12 months. The first aid kit was complete and readily accessible. Required licensing postings were observed in visible areas of the facility.

LPA interviewed staff and residents present during the visit and reviewed staff and residents' records. LPA interviews did not raise any licensing concerns. The residents' files that LPA reviewed contained the required documents. Staff records contained proof of current first aid training. The administrator presented proof of current/active business liability insurance and surety bond as required by Title 22 regulations.

No deficiencies were cited or observed on this date.

The Licensee was provided a copy of her appeal rights (LIC9058 01/16). An exit interview was conducted with Administrator, Patricia Tapia, and a copy of this report was provided at the end of the visit.

SUPERVISOR'S NAME: Denise Powell	TELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno	TELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:	DATE: 11/09/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023

LIC809 (FAS) - (06/04)

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