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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604726
Report Date: 01/29/2025
Date Signed: 01/31/2025 08:41:34 AM

Document Has Been Signed on 01/31/2025 08:41 AM - 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:SUNSET COAST ASSISTED LIVING 3FACILITY NUMBER:
374604726
ADMINISTRATOR/
DIRECTOR:
TAPIA, CHRISTINEFACILITY TYPE:
740
ADDRESS:4886 DOLIVA DRTELEPHONE:
(619) 481-4862
CITY:SAN DIEGOSTATE: CAZIP CODE:
92117
CAPACITY: 6CENSUS: 6DATE:
01/29/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Caregivers Jose Angel Rivero and Samantha RiveroTIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an announced Annual Required visit. The LPA introduced himself to Caregivers Jose Angel Rivero and Samantha Rivero. The facility was licensed for a capacity of six (6) non-ambulatory residents. The facility also had an approved hospice waiver for six (6).

During the visit, the LPA conducted a tour of the facility and inspected resident bedrooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order.

Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space to facilitate dining, laundry, and resident activities.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to residents. Medications were labeled and stored in a locked medication cart. No pools, nor bodies of water were observed on the premises.


Due to time constraints, an additional visit on a subsequent day is required to complete the annual inspection.

An exit interview was conducted with Samantha Rivero. A copy of this report and the Licensee/Appeal Rights (LIC9058) were emailed to Administrator Christine Tapia.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Sabel Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 01/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/29/2025
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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