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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604508
Report Date: 11/08/2023
Date Signed: 11/08/2023 05:28:59 PM


Document Has Been Signed on 11/08/2023 05:28 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: DATE:
11/08/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
04:00 PM
MET WITH:Jessica Zepeda, Executive DirectorTIME COMPLETED:
05:30 PM
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On this date Licensing Program Analyst (LPA) Jacqueline Shaw Ross made an unannounced case management visit to this facility. Upon arrival the LPA met with Executive Director, Jessica Zepeda and explained the purpose of the visit. The visit was conducted to check the health and welfare of the residents and staff in care at the facility while the facility goes through bankruptcy proceedings. Executive Director informed LPA that bankruptcy proceedings are moving forward and they received a written notice that an auction is to take place at the end of this month (November 30, 2023). LPA was informed that everything is the same, there has been no disruption in service, and that funding would continue. Staff pay has not been affected, no shortage of food, utility bills remain paid. Residents and their families/representatives are aware of the proceedings and are receiving updates via email. LPA was informed an Ombudsman representative came by two weeks ago to check on the facility as well.

A tour of the facility including the kitchen area was conducted. LPA observed plenty of food both perishable and non-perishable items. Facility appeared clean and functioning with numerous staff on the premises. LPA conducted resident and staff interviews. Pertinent documents were received that include a staff and resident roster, as well as a printout of a letter of bankruptcy proceedings indicating the date of intended auction. No health and safety issues nor discrepancies were observed during today's visit.

A copy of this report was provided to Executive Director Jessica Zepeda.

SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Jacqueline Shaw RossTELEPHONE: 951-248-0314
LICENSING EVALUATOR SIGNATURE:
DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/08/2023
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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