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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336403275
Report Date: 12/08/2021
Date Signed: 12/08/2021 12:37:26 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:PUTTERS LANE ASSISTED LIVINGFACILITY NUMBER:
336403275
ADMINISTRATOR:COCCHIARO, KAREN EILEENFACILITY TYPE:
740
ADDRESS:43307 PUTTERS LANETELEPHONE:
(951) 927-8651
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:6CENSUS: 0DATE:
12/08/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Jesse Gardner arrived unannounced to the facility to conduct an annual inspection. Upon ringing the doorbell, no one answered, and upon inspection of the interior of the home through the windows, LPA observed the facility to be empty and in a rehabilitation condition. LPA did not observe any living conditions inside the residence.

LPA contacted the Licensee Karen Cocciaro via telephone, and LPA was advised that the facility had been closed, and the paperwork had been previously submitted months ago. Ms. Cocciaro advised that if she found the physical copy of the License, she would submit to CCL.
SUPERVISOR'S NAME: Reyna LaceyTELEPHONE: (951) 248-0341
LICENSING EVALUATOR NAME: Jesse GardnerTELEPHONE: (951) 205-2683
LICENSING EVALUATOR SIGNATURE:

DATE: 12/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/08/2021
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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