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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604523
Report Date: 06/19/2024
Date Signed: 06/19/2024 12:30:48 PM

Document Has Been Signed on 06/19/2024 12:30 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:SEA BREEZE SENIOR LIVINGFACILITY NUMBER:
374604523
ADMINISTRATOR/
DIRECTOR:		LEBODA, MARIEFACILITY TYPE:
740
ADDRESS:5403 AVENIDA FIESTATELEPHONE:
(619) 277-8868
CITY:LA JOLLASTATE: CAZIP CODE:
92037
CAPACITY: 6CENSUS: 5DATE:
06/19/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:10 AM
MET WITH:Administrator Sonya KarpalTIME VISIT/
INSPECTION COMPLETED:
12:40 PM
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Licensing Program Analyst (LPA) Sabel Martinez conducted a Case Management Continuation Required- 1 year inspection visit. The LPA introduced himself, and disclosed the purpose of the visit to Caregiver Heather Tubbs. Licensee Vin Karpal arrived during the visit and assisted the LPA.

During the visit, the LPA reviewed additional records and conducted interviews. The LPA provided technical assistance to the licensee. There were no deficiencies cited during today's visit.

An exit interview was conducted with Licensee Vin Karpal, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058), were provided.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 06/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/19/2024
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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