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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604508
Report Date: 06/05/2023
Date Signed: 06/06/2023 08:53:36 AM


Document Has Been Signed on 06/06/2023 08:53 AM - 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: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:
06/05/2023
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:30 PM
MET WITH: David DaneshforoozTIME COMPLETED:
03:09 PM
NARRATIVE
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An office meeting took place on this day to discuss matters involving the recent bankruptcy filing. Reyna Lacey, Regional Manager (RM); Joel Esquivel, Licensing Program Manager (LPM); and representatives of Contour Opco 1735 S Mission, LLC David Daneshforooz, Jennifer Sternshein, Sam Schwartz, Alex Gonzales, and Ed Westbrook were present during the meeting.

During the meeting the licensee informed the Department that operations would continue at the facility in the normal course of business. The licensee was 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 previously 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 at this time.

RM Lacey advised that further communication with the licensee will be held as needed. The licensee agreed to update the Regional Office as appropriate.

An exit interview was conducted; where this report was reviewed with David Daneshforooz and a copy was provided.
SUPERVISOR'S NAME: Leslie MendivelesTELEPHONE: (951) 782-4137
LICENSING EVALUATOR NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR SIGNATURE:
DATE: 06/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2023
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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