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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700471
Report Date: 07/20/2022
Date Signed: 08/03/2022 10:50:15 AM


Document Has Been Signed on 08/03/2022 10:50 AM - It Cannot Be Edited

Document is an Amendment of Original Document on 08/03/2022 10:48 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 520 COHASSET RD., STE. 170
CHICO, CA 95926

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An office meeting was held today, 7/20/2022, via Microsoft Teams to discuss topics listed in this report.

The following Licensing staff were present:
Regional Manager (RM) Alycia Berryman, Licensing Program Manager (LPM) Anthony Perez, and Licensing Program Analyst (LPA) Michael Hood

The following representatives present:
Senior Regional Director of Operations Benoit Levesque, CEO David Eskenazy, Regional Director of Operations Dave Peper, Regional Health Services Director for California Ethelia Hines RN, Interim Executive Director Jessica Zepeda, Attorney Joel S. Goldman, and Facility Consultant Josh Allen RN.

The following topics were covered during today's meeting:
  • General meet and great
  • Improvements in operations for Cogir of Folsom
  • Operations of 3rd floor for Cogir of Stock Ranch
  • COVID-19 vaccine booster implementation

A copy of this report will be provided to the Senior Regional Director of Operations via email. A copy will be signed and returned to CCL. The signature of the Senior Regional Director of Operations on this form acknowledges receipt of this document.
SUPERVISOR'S NAME: Anthony PerezTELEPHONE: (323) 485-4915
LICENSING EVALUATOR NAME: Michael HoodTELEPHONE: 916-531-7341
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2022
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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