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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 372008448
Report Date: 04/13/2021
Date Signed: 04/13/2021 06:13:26 PM

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:CASA PACIFICAFACILITY NUMBER:
372008448
ADMINISTRATOR:SARA STEINERFACILITY TYPE:
772
ADDRESS:321 CASSIDY STREETTELEPHONE:
(760) 721-2171
CITY:OCEANSIDESTATE: CAZIP CODE:
92054
CAPACITY:14CENSUS: 14DATE:
04/13/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:11 PM
MET WITH:Administrator- Sara SteinerTIME COMPLETED:
06:09 PM
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Licensing Program Analyst (LPA), Kristina Ryan, conducted an unannounced case management virtual visit, due to the COVID-19 pandemic. LPA identified herself and stated the purpose of the visit to Administrator, Sara Steiner.

On April 12, 2021, the facility self-reported an incident to Adult Protective Services regarding possible abuse between clients.

On today’s date, LPA toured the facility, performed a health and welfare check, requested copies of facility records and interviewed residents and staff. No deficiencies were cited at this time. Further visits and or phone calls may be necessary for the investigation.

An exit interview was conducted with the Administrator, Sara Steiner, to whom a copy of this report, LIC811 Confidential Names list, and the Licensee/Appeal Rights (9058 01/16) were provided via e-mail. An electronic read receipt verifies receipt of these documents.

SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Kristina RyanTELEPHONE: (619) 929-1438
LICENSING EVALUATOR SIGNATURE:

DATE: 04/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/13/2021
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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