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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604544
Report Date: 10/10/2023
Date Signed: 10/10/2023 03:51:25 PM


Document Has Been Signed on 10/10/2023 03:51 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 LIVING BONITAFACILITY NUMBER:
374604544
ADMINISTRATOR:MARKOVICH, PAULFACILITY TYPE:
740
ADDRESS:3434 BONITA ROADTELEPHONE:
(619) 476-9444
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:145CENSUS: 113DATE:
10/10/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Business Office Manager, Rebecca TovesTIME COMPLETED:
12:15 PM
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Licensing Program Analyst (LPA) Garcia-Centeno opened a complaint investigation and in conjunction conducted a case management visit to the facility to ensure the safety and welfare of the residents in care. LPA Garcia-Centeno identified herself and stated the purpose and reviewed basic elements of the case management visit with Business Office Manager, Rebecca Toves.

LPA reviewed infection control procedures to ensure the health and safety of the residents in care. In addition, LPA requested facility staff to complete the reporting requirements to Community Care Licensing regarding the active COVID-19 outbreak.

An exit interview was conducted with Business Office Manager, Rebecca Toves and a copy of this report along with the Licensee Appeal Rights (LIC9058 03/22) were provided at the completion of the visit.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) -76-2317
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2023
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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