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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604508
Report Date: 02/02/2024
Date Signed: 02/02/2024 10:18:26 AM


Document Has Been Signed on 02/02/2024 10:18 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
RIVERSIDE ASC, 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: 22DATE:
02/02/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Janet Morales-Cruz, Medication TechnicianTIME COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct a health and safety check as the facility is expected to close due to bankruptcy. LPA was greeted and granted entry by Medication Technician (Med Tech) Janet Morales-Cruz. LPA explained the purpose of the visit. The Executive Director Jessica Zepeda was unavailable as Friday is a regularly scheduled day off.

LPA conducted a tour of the facility. The facility was observed to be clean, clutter and odor free. LPA observed for the have running water, electricity, and gas. The facility was nicely decorated for Valentine's day. LPA observed for resident's to be sitting in the common area reading a book by the fireplace and others watching television in the theater. Breakfast was just finished upon LPAs arrival.

LPA observed for the facility food supply to be sufficient, as LPA observed for the facility to have a 2 day supply of perishable and a 7 day supply of non perishable food items. LPA spoke with Kitchen staff and was informed that the facility continues to have two (2) food deliveries a week, on Thursdays and Mondays. The facility has adequate PPE supply that is stored in management office, as well as paper supplies (paper towels and toilet paper). Resident medications are present inside the medication carts.

LPA spoke with staff who confirmed that they are still receiving their paychecks on the anticipated pay days, (biweekly). LPA reviewed the staff schedule: the AM shift (6am-2pm) there are four (4) caregivers, PM shift (2pm-10pm) there are five (5) caregivers scheduled and NOC shift (10pm-6am), there are 3 caregivers scheduled.

The anticipated closure date is unknown at this time, once solidified the residents will be issued a 60 day notice. LPA did not observe any health and safety concerns during the visit.

An exit interview was conducted and a copy of this report was reviewed and provided to Janet Morales-Cruz
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:
DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/02/2024
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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