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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604726
Report Date: 07/30/2024
Date Signed: 07/30/2024 05:54:56 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/22/2024 and conducted by Evaluator Sabel Martinez
COMPLAINT CONTROL NUMBER: 08-AS-20240722104503
FACILITY NAME:SUNSET COAST ASSISTED LIVING 3FACILITY NUMBER:
374604726
ADMINISTRATOR:TAPIA, CHRISTINEFACILITY TYPE:
740
ADDRESS:4886 DOLIVA DRTELEPHONE:
(619) 481-4862
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY:6CENSUS: 6DATE:
07/30/2024
UNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Caregivers Tahi Fakava and Sandra Austria, and Administrator Christine TapiaTIME COMPLETED:
06:10 PM
ALLEGATION(S):
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Uncleared staff working at facility
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced complaint investigation visit to investigate the above allegation. The LPA introduced himself and disclosed the purpose of the visit to Caregiver Tahi Fakvaa, who was the only caregiver at the facility at the time of the visit. Caregiver Sandra Austria arrived during the visit and assisted the LPA.

Review of records, along with a search in the Department's Guardian System revealed Staff # 1 (S1). Did not have an active Criminal Background clearance. This deficiency was cited in an LIC 9099D form and a civil penalty of $500 was assessed in an LIC 421BG form.

A plan of correction was jointly formulated with Administrator Christine Tapia, who arrived during the visit.

An exit interview was conducted with Administrator Christine Tapia, to whom a copy of this report, LIC 811 Confidential names list, LIC 9099D, and Licensee/Appeals Rights (LIC 9058), were provided.
Substantiated
Estimated Days of Completion: 90
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
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.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 08-AS-20240722104503
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: SUNSET COAST ASSISTED LIVING 3
FACILITY NUMBER: 374604726
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/30/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/30/2024
Section Cited
CCR
87355(e)(1)
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87355 Criminal Record Clearance(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility:(1) Obtain a California clearance or a criminal record exemption as required by the Department or This requirement was not met as evidenced by:
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Administrator agreed to have not have (S1) work, nor reside at the facility unitl a background clearance was obtained. S1 left the facility, therefore, the POC was cleared on today's date.
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Baed on review of records, the Department's Guardian system, and interviews, the Licensee did not ensure S1 was background cleared prior to working and residing at the facility.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3