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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001926
Report Date: 09/20/2022
Date Signed: 09/20/2022 02:11:41 PM


Document Has Been Signed on 09/20/2022 02:11 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:COWAN HEIGHTS HOME CAREFACILITY NUMBER:
306001926
ADMINISTRATOR:ELENA COCAFACILITY TYPE:
740
ADDRESS:19080 SMILEY DR.TELEPHONE:
(714) 538-5219
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY:6CENSUS: 0DATE:
09/20/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:54 PM
MET WITH:Ioan "John" CocaTIME COMPLETED:
02:26 PM
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 On today's date, Licensing Program Analyst (LPA) Rosie Quiroz conducted an unannounced visit to the facility to verify facility closure, and to ensure there are no residents that require care and supervision residing at the facility. LPA Quiroz was greeted by Licensee/Administrator Ioan "John" Coca.

On 12/10/2021, LPA Rosie Quiroz received notification that facility has been vacant since November 22, 2021 and had decided to permanently close the facility at this time. L/AD Ioan "John" Coca indicated last resident residing at the facility moved out on November 21, 2021 and has not admitted any residents since.



On today's visit, LPA Quiroz along with L/AD Coca toured the inside and outside of the facility. No residents in care were observed during today's visit. Based on today's observations, no signs of facility operation at this time.

LPA Quiroz requested facility license as it was part of the closure process. LPA Quiroz informed L/AD Ioan "John" Coca of licensing procedure for future facility operation if desired. L/AD Ioan "John" Coca indicated understanding.


An exit interview was conducted with L/AD Ioan "John" Coca, and a copy of today's facility closure report was provided at exit.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2022
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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