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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604544
Report Date: 03/21/2023
Date Signed: 03/21/2023 03:35:21 PM


Document Has Been Signed on 03/21/2023 03:35 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: 97DATE:
03/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Emily DeLaBarre, Executive DirectorTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Carmen Lopez 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 Lopez identified herself and was granted entry by Christine Quiros, Receptionist. LPA Lopez stated the purpose and reviewed basic elements of the case management visit with Emily DeLaBarre, Executive Director.

LPA reviewed Title 22, Division 6, Chapter 8, Section 87305 Alterations to Existing Building or New Facilities; Section 87307 Personal Accommodations and Services; 87463 Reappraisal; and 87458 Medical Assessment. No citations were provided during today's visit.

An exit interview was conducted with Executive Director DeLaBarre and a technical advisory was given per Title 22, Division 6, Chapter 8 of the California Code of Regulations. A copy of this report along with the Licensee Appeal Rights (LIC9058 03/22) were provided to Executive Director DeLaBarre at the conclusion of the visit. The signature below confirms the documents were received.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619) 767-2329
LICENSING EVALUATOR NAME: Carmen LopezTELEPHONE: (619) 314-0757
LICENSING EVALUATOR SIGNATURE:
DATE: 03/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/21/2023
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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