374604726-1-26-2026-08-AS-DCOA-DQQ3EF-20260126171102

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 374604726
Report Date: 01/26/2026
Date Signed: 01/26/2026 05:11:44 PM

Document Has Been Signed on 01/26/2026 05:11 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:	SUNSET COAST ASSISTED LIVING 3		FACILITY NUMBER:	374604726
ADMINISTRATOR/ DIRECTOR:	TAPIA, CHRISTINE		FACILITY TYPE:	740
ADDRESS:	4886 DOLIVA DR		TELEPHONE:	(619) 481-4862
CITY:	SAN DIEGO	STATE: CA	ZIP CODE:	92117
CAPACITY: 6		CENSUS: 6	DATE:	01/26/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:00 AM
MET WITH:	Licensee Tapia		TIME VISIT/ INSPECTION COMPLETED:	03:30 PM

NARRATIVE

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Licensing Program Analyst (LPA), Debbie Correia, made an unannounced visit to conduct the required One-Year Inspection. LPA Correia was greeted by Caregiver Valeria Rivera, identified herself, and explained the purpose of the visit. The facility is licensed to serve 6 residents aged 60 and above, all six (6) of whom may be non-ambulatory of which must reside in bedrooms #1, #2, and #4. In January of 2024, the facility was granted a Hospice waiver for six (6) residents in care. Licensee Christina Tapia arrived a short time later, to join the visit.

During today’s visit two (2) of the six (6) residents were present, the remaining four (4) residents were attending Day Program.

A review of records revealed resident records including but not limited to; a current Physician's Report, Resident Appraisal, Needs & Services Plan, Identification and Emergency Information, and Admission Agreement, were current and complete. In addition, personnel records were reviewed for Criminal Record Clearance, required training, Health/TB Screening Report, First Aid and CPR certification, and qualifications that were also current and complete. The facilities last disaster drill was conducted in January of 2026. The facility has a current lease agreement and liability insurance. A review of medication administration records was accurate and complete, and medications were kept in a locked med-cart. Toxins and other hazardous materials were housed in locked cabinets/garage and inaccessible to residents in care.

[Continued on LIC 809C]

NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Debbie Correia
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/26/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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
	VISIT DATE: 01/26/2026

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[Continuation of LIC 809]

LPA Correia, accompanied by Licensee Tapia and caregiver Rivera, conducted a facility tour, and inspected resident rooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Required postings were observed. Resident bedrooms contained the required furnishings. Resident showers were equipped with non-skid flooring and grab bars, and in working order. The temperature at taps used by residents measured at 113.8 degrees Fahrenheit.

The facility doors, windows and screens were in good repair. Extra linens, hygiene supplies, and Personal Protective Equipment (PPE), and night lights in hallways were present. LPA also observed a landline, smoke and carbon monoxide detectors, a fire extinguisher that were present, operational, and/or current, and a First Aid Kit. The facility had an adequately sized common area and a shaded outdoor area for activities and visitation. There were no bodies of water on the facility grounds. Per Licensee Tapia there are there are no firearms or ammunition on the facility premises.

Based on today’s inspection, there are no deficiencies being cited. An exit interview was conducted and a copy of this report, and Licensee Rights - LIC 9058 (rev. 01/16) will be provided to Licensee Tapia, whose signature on this form acknowledges receipt of these documents.

NAME OF LICENSING PROGRAM MANAGER: Robyn Clark
NAME OF LICENSING PROGRAM ANALYST: Debbie Correia
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 01/26/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/26/2026

LIC809 (FAS) - (06/04)

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