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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336407087
Report Date: 04/17/2023
Date Signed: 04/17/2023 12:15:31 PM


Document Has Been Signed on 04/17/2023 12:15 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:COPPER CANYON SENIOR CAREFACILITY NUMBER:
336407087
ADMINISTRATOR:TELECIA COOKEFACILITY TYPE:
740
ADDRESS:37225 JEROME LANETELEPHONE:
(951) 677-1349
CITY:MURRIETASTATE: CAZIP CODE:
92562
CAPACITY:8CENSUS: 7DATE:
04/17/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Telecia Cooke, LicenseeTIME COMPLETED:
12:20 PM
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At 11:00am on the date noted above an office meeting was held. In attendance was Licensing Program Analyst (LPA) Javina George, Licensing Program Manager (LPM) Joel Esquivel and Regional Manager Reyna Lacey who met with the Licensee Telecia Cooke.

The following was discussed:

- substantiated findings given on March 21, 2023, and the details regarding

- ombudsman visit that was made to the facility on December 8, 2021.

-Appeal rights when/after substantiated findings have been issued

An exit interview was conducted, and a copy of this report, and appeal rights were provided to the Licensee Telecia Cooke.

SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:
DATE: 04/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/17/2023
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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