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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604570
Report Date: 09/09/2026
Date Signed: 09/09/2026 12:13:47 PM

Document Has Been Signed on 09/09/2026 12:13 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:BLUE SKIES OF SAN DIEGO COASTFACILITY NUMBER:
374604570
ADMINISTRATOR/
DIRECTOR:		STREET, ALMINAFACILITY TYPE:
740
ADDRESS:62 AVENIDA DESCANSOTELEPHONE:
(619) 208-7869
CITY:OCEANSIDESTATE: CAZIP CODE:
92057
CAPACITY: 6CENSUS: 6DATE:
09/09/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Administrator Anitha SopacuaTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Arian Golbakhsh and Eryn Kane conducted an unannounced Case Management visit to the facility. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit to Administrator Anitha Sopacua. During today's visit, there were six (6) residents in care.

As LPAs were conducting a tour of the facility, LPAs tested water temperatures at taps accessible to clients. Sink at hallway half-bath tested at 127.9F, sink at the full bathroom tested at 105.6F, and a sink in the private restroom of bedroom #3 tested at 124.5F. Staff immediately turned the water heater settings lower, and LPAs later re-tested tap temperatures, which were 116.2F, 115F, and 111.4F, respectively. One type A deficiency was cited for hot water temperatures being above the required range of 105F to 120F. Details are noted on the attached LIC 809-D.

LPAs also examined bathroom drawers and cabinets and observed cleaning chemicals stored in them. All were unlocked and accessible to residents. Staff immediately moved the chemical items to the locked cabinets in the laundry room. LPAs examined the laundry room and only two of the cabinets had locks, so staff consolidated all chemical items to the locked cabinets. One Type A deficiency was cited for the accessible toxic/chemical items and details are noted on the attached LIC 809-D.

Two (2) deficiencies were cited during the inspection. An exit interview was conducted with Administrator Sopacua to whom a copy of this report and the Licensee/Appeal Rights (LIC 9058) were provided. Their signature below confirms receipt of these documents.
Sabel Martinez
Arian Golbakhsh
DATE: 09/09/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/09/2026
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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Document Has Been Signed on 09/09/2026 12:13 PM - It Cannot Be Edited


Created By: Arian Golbakhsh On 09/09/2026 at 10:58 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: BLUE SKIES OF SAN DIEGO COAST
FACILITY NUMBER: 374604570

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/09/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/10/2026
Section Cited
CCR
87303(e)(2)

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87303(e)(2): "[...] Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C)."
This regulation is not met as evidenced by:
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Staff immediately lowered the water heater settings. Licensee will take daily water temperatures at multiple taps for a period of 5 days and submit the log to LPA by 9/16/26
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Based on LPAs observation, the licensee did not comply with the section cited above in ensuring water temperatures at taps accessible to residents were in the range of 105-120F, which poses an immediate health and safety risk to all persons in care.
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Type A
09/16/2026
Section Cited
CCR87309(a)

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87309(a): " [...] the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, [...] which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage."

This requirement is not met as evidenced by:
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Staff immediately moved all accessible chemical items to locked storage. Licensee will conduct training with staff on regulation 87309 and proper chemical storage and submit proof to LPA by 9/16/26.
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Based on LPAs observation, the licensee did not comply with the section cited above in ensuring toxic chemicals were kept locked and inaccessible to residents, which poses an immediate health and safety risk to all persons in care.
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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.
Sabel Martinez
NAME OF LICENSING PROGRAM MANAGER:
Arian Golbakhsh
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/09/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/09/2026


LIC809 (FAS) - (06/04)
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