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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000442
Report Date: 03/03/2021
Date Signed: 03/04/2021 08:55:06 AM

Document Has Been Signed on 03/04/2021 08:55 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:PLEASANT HILLS HOME CAREFACILITY NUMBER:
306000442
ADMINISTRATOR:VIOLETA M. COCISFACILITY TYPE:
740
ADDRESS:1014 DOROTHTY DRIVETELEPHONE:
(714) 257-0207
CITY:BREASTATE: CAZIP CODE:
92821
CAPACITY: 6CENSUS: 0DATE:
03/03/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Violeta CocisTIME COMPLETED:
09:30 AM
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As precautionary measures during the Coronavirus 2019 (COVID-19) pandemic, Licensing Program Analyst (LPA) Albert Marin made an unannounced video-teleconference visit to this facility to conduct a case management. LPA met with Administrator (AD) Violeta Cocis and stated the purpose of this visit.

On February 27, 2021, AD V. Cocis informed Community Care Licensing Division (CCLD) that she would be moving out six residents in care and would be closing out the facility effective March 1, 2021. AD provided LPA Marin a list of residents with their new location.

At 9:09 AM, with the assistance from AD Cocis, LPA Marin conducted a virtual tour of the facility using a video application. LPA visually verified the location of the facility. LPA observed six empty resident's rooms, and common areas. LPA did not observe any resident in care. LPA discussed with AD that she needs to surrender the original copy of the facility license. AD agreed to mail the document to CCLD.

Facility closure will be processed as soon as LPA Marin receives the copy of the license.

LPA Marin conducted an exit interview with AD Cocis. LPA will provide a copy of this report via email; and AD agreed to acknowledge its receipt.
SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Albert Marin
LICENSING EVALUATOR SIGNATURE: DATE: 03/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/03/2021
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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