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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604542
Report Date: 02/06/2025
Date Signed: 02/19/2025 09:31:46 AM

Document Has Been Signed on 02/19/2025 09:31 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
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:
02/06/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:55 AM
MET WITH:Business Office Manager Jenny FloresTIME VISIT/
INSPECTION COMPLETED:
11:30 PM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Continuation Annual Inspection visit. The LPA introduced himself and disclosed the purpose of the visit to Business Office Manager Jenny Flores.

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 interviews and reviewed facility records. There were no deficiencies cited on today's date. An exit interview was conducted with Flores, to whom a copy of this report, and Licensee Rights (LIC 9058), were provided via email. An email read receipt confirms the documents were received by Flores.
NAME OF LICENSING PROGRAM MANAGER: Lizzette Tellez
NAME OF LICENSING PROGRAM ANALYST: Sabel Martinez
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/06/2025
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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