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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604544
Report Date: 02/23/2024
Date Signed: 02/23/2024 03:05:10 PM


Document Has Been Signed on 02/23/2024 03:05 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:REBECCA TOVESFACILITY TYPE:
740
ADDRESS:3434 BONITA ROADTELEPHONE:
(619) 476-9444
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:145CENSUS: 117DATE:
02/23/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Executive Director Rebecca TovesTIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced case management visit to review a plan of correction. The LPA introduced himself and disclosed the purpose of the visit to Executive Director Rebecca Toves.

During the visit the LPA confirmed and secured documentation to clear a Plan of Correction (POC) cited on 2/21/24. A POC letter was provided to the Executive Director confirming the POC was completed..

An exit interview was conducted with Executive Director Toves. A copy of this report along with Licensee/Appeal Rights (LIC 9058 03/22) were provided to the facility at the conclusion of the visit. The signature below confirms receipt of these documents.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 02/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/23/2024
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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