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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604508
Report Date: 06/01/2023
Date Signed: 06/06/2023 03:12:11 PM


Document Has Been Signed on 06/06/2023 03:12 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
RIVERSIDE AC/SC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:COGIR OF FALLBROOKFACILITY NUMBER:
374604508
ADMINISTRATOR:ZEPEDA, JESSICAFACILITY TYPE:
740
ADDRESS:1735 SO MISSION ROADTELEPHONE:
(760) 232-6800
CITY:FALLBROOKSTATE: CAZIP CODE:
92028
CAPACITY:128CENSUS: 36DATE:
06/01/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:David Eskenazy - CEOTIME COMPLETED:
10:47 AM
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An office meeting took place on this day to discuss matters involving the licensee’s current financial situation and a recent bankruptcy filing. Reyna Lacey, Regional Manager (RM); Joel Esquivel, Licensing Program Manager (LPM); Sara Martinez, Licensing Program Analyst (LPA); and representatives of Cogir Management USA David Eskenazy, Elizabeth Chambers, Marc Forsythe, and Benoit Levesque were present during the meeting.

During the meeting the were advised on Health and Safety code 1569.686. The Department was advised that notification to the residents, their legal representatives, and Long-Term Care Ombudsman (LTCO) was given. RM Lacey also advised on 1569.682 and the Department was informed there is no current plan to change the use of the facility.

RM Lacey advised that further communication with the licensee will be held. Cogir Management USA agreed to update the regional office as appropriate.

An exit interview was conducted; this report was reviewed with David and a copy provided.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Sara MartinezTELEPHONE: (951) 248-0314
LICENSING EVALUATOR SIGNATURE:
DATE: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2023
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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