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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604544
Report Date: 02/07/2023
Date Signed: 02/07/2023 02:57:47 PM


Document Has Been Signed on 02/07/2023 02:57 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
CCLD Regional Office, 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: 98DATE:
02/07/2023
TYPE OF VISIT:CollateralUNANNOUNCEDTIME BEGAN:
10:34 AM
MET WITH:Emily DeLaBarre, Executive DirectorTIME COMPLETED:
02:03 PM
NARRATIVE
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Licensing Program Analyst (LPA) Esther Miller conducted an unannounced visit as part of a separate complaint investigation. LPA was granted entry after identifying herself. LPA discussed the purpose of the visit with Jenifer Brown, Resident Service Coordinator

During today's visit, LPA briefly toured the facility and conducted interviews. Deficiencies were not observed during the visit. An exit interview was conducted with Emily DeLaBarre, Executive Director, and a copy of this report, along with Licensee/Appeal Rights (LIC9058 03/22), were provided.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Esther MillerTELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 02/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/07/2023
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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