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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604542
Report Date: 01/31/2025
Date Signed: 02/01/2025 03:49:08 PM

Document Has Been Signed on 02/01/2025 03:49 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:PACIFICA SENIOR RANCHO PENASQUITOSFACILITY NUMBER:
374604542
ADMINISTRATOR/
DIRECTOR:
MCDONALD, JILLFACILITY TYPE:
740
ADDRESS:12979 RANCHO PENASQUITOS BLVDTELEPHONE:
(858) 215-5820
CITY:SAN DIEGOSTATE: CAZIP CODE:
92129
CAPACITY: 120CENSUS: 71DATE:
01/31/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Executive Director Wes HebnerTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Required Annual Inspection visit. The LPA introduced himself and disclosed the purpose of the visit to Executive Director Wes Hebner. Maintenance Director Mathew Gomez and Business Office Manager Jenny Flores assisted the LPA during visit.

The facility was licensed for a capacity of one hundred twenty (120) non-ambulatory residents, of which ten (10) may be bedridden. The facility also had an approved hospice care waiver for fifteen (15) residents, and the facility's first floor was approved for delayed egress.

During today's visit, the LPA conducted a tour of the interior and exterior of the facility. The facility was clean sanitary and in good repair. Resident bedrooms contained the required furnishings, and the call pendants/signal system tested were operational. Faucets tested delivered water within the required range. Carbon monoxide detectors were tested at random and were also operational.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored.
Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to clients.
Medications were labeled and stored in a locked area.

No pools, nor bodies of water were observed on the premises. Per staff, no firearms nor ammunition were kept at the facility. All pathways were free of obstructions and slip hazards. Review of facility records was initiated, but due to time constraints, an additional visit on a subsequent day in necessary to complete the annual inspection.

An exit interview was conducted with Executive Director Wes Hebner, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058), were provided via email. An email read receipt confirms the documents were received by the Executive Director.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2025
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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