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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604543
Report Date: 07/15/2022
Date Signed: 07/15/2022 11:46:21 AM


Document Has Been Signed on 07/15/2022 11:46 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:PACIFICA SENIOR LIVING ENCINITAS NORTHFACILITY NUMBER:
374604543
ADMINISTRATOR:WATKINS, MELISSAFACILITY TYPE:
740
ADDRESS:480 S EL CAMINO REALTELEPHONE:
(760) 452-0615
CITY:ENCINITASSTATE: CAZIP CODE:
92024
CAPACITY:65CENSUS: 0DATE:
07/15/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Executive Director, Melissa WatkinsTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Sabel Martinez, conducted a scheduled Pre-licensing inspection to observe the physical plant for compliance and conduct a Component III. The facility is undergoing a change of ownership, and is approved for sixty-five (65) non-ambulatory residents. Per Fire Inspection Request received by the Department, the fire clearance was granted by the Encinitas Fire Department, on 1/25/2022.

The LPA was greeted by Executive Director, Melissa Watkins, identified himself and disclosed the purpose of the visit. An overall tour of the facility was conducted inside and out. The LPA observed the facility was being remodeled, there were no direct care staff, and no residents in care. Passageways and recreation rooms/areas were observed to have furniture, maintenance tools, wiring and other items indicative of a remodel. Residents' rooms were not equipped with the required furnishings.

As of today's date, the facility is not ready to be licensed. An exit interview was conducted with Executive Director, Melissa Watkins, to whom a copy of this report along with Applicant/Appeal Rights (LIC9058 01/16) were provided to.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2022
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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