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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604814
Report Date: 07/30/2024
Date Signed: 07/30/2024 01:27:36 PM


Document Has Been Signed on 07/30/2024 01:27 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:COASTAL COMFORTS ASSISTED LIVINGFACILITY NUMBER:
374604814
ADMINISTRATOR:SUBOTIC, LUKAFACILITY TYPE:
740
ADDRESS:7549 VIEJO CASTILLA WAYTELEPHONE:
(760) 707-9192
CITY:CARLSBADSTATE: CAZIP CODE:
92009
CAPACITY:6CENSUS: 2DATE:
07/30/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Licensee Luka SuboticTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Nacole Patterson made an unannounced visit to the facility to conduct a post-licensing inspection. LPA was met by Licensee Luka Subotic and granted entry into the facility and discussed the purpose of the visit.
 
A tour of the facility was conducted inside and out. LPA, accompanied by Licensee Luka Subotic, conducted a general overall inspection, which included, but was not limited to the following: Facility physical plant, food service, care and supervision, medication, record review and facility administration. Administrator Certificate for Luka Subotic expires on 12/24/25.
 
During today's inspection, LPA observed the following: All indoor and outdoor passageways were free from obstructions. No pools or bodies of water were observed. Per Licensee Luka Subotic, there are no firearms or other dangerous weapons in the facility. Poisons and cleaning agents were observed to be inaccessible to clients in care. LPA toured each room in the facility. Rooms designated as client bedrooms had the required furnishings and sufficient lighting available for clients. Licensee provided each client with clean linen in good repair and sufficient hygiene products for personal use. The hot water temperature measured at 105-120 degrees F. The facility had multiple functioning carbon monoxide detectors and multiple smoke detectors. There was an operable fire extinguisher present in the facility. The facility was stocked with a two (2) day supply of perishable and seven (7) day supply of nonperishable food items. Medications were stored in a locked medication cart and were labeled and maintained in compliance with label instructions. Licensee has been approved for liability insurance and is awaiting the physical copy via mail. Licensee will send proof of liability insurance to LPA once the physical copy is received.
 
Based on today's visit, no deficiencies were observed. A copy of this report along with Licensee/Appeal Rights, were provided to Licensee Luka Subotic at the conclusion of the visit; their signature on this form acknowledges receipt of these rights.
SUPERVISOR'S NAME: Jennifer LottTELEPHONE: (619) 346-3976
LICENSING EVALUATOR NAME: Nacole PattersonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2024
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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