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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604544
Report Date: 03/04/2024
Date Signed: 03/04/2024 11:39:38 AM


Document Has Been Signed on 03/04/2024 11:39 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 LIVING BONITAFACILITY NUMBER:
374604544
ADMINISTRATOR:REBECCA TOVESFACILITY TYPE:
740
ADDRESS:3434 BONITA ROADTELEPHONE:
(619) 476-9444
CITY:CHULA VISTASTATE: CAZIP CODE:
91910
CAPACITY:145CENSUS: DATE:
03/04/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Executive Director Rebecca TovesTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Amy Rodgers conducted an unannounced case management visit to review a plan of correction. The LPA introduced herself and disclosed the purpose of the visit to Executive Director Rebecca Toves.

During the visit the LPA confirmed and secured documentation to clear Plan of Corrections (POC) cited on 2/2/2024. POC's letters were provided to the Executive Director confirming the POC's were 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: Denise PowellTELEPHONE: (619) 767-2317
LICENSING EVALUATOR NAME: Amy RodgersTELEPHONE: 619-997-4108
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2024
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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