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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604508
Report Date: 02/08/2024
Date Signed: 02/08/2024 12:00:42 PM


Document Has Been Signed on 02/08/2024 12:00 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 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: 20DATE:
02/08/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Vice President of Operations- Krystal Jenkins and Executive Director-Jessica ZepedaTIME COMPLETED:
12:00 PM
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On February 8, 2024, an office meeting was conducted regarding the possible closure of the facility. In attendance for the meeting was Regional Manager, Reyna Lacey (RM), Licensing Program Manager (LPM), Jazmond Harris, Licensing Program Analyst (LPA), Javina George, Representative of Contour OPCO, Jennifer Sternshein, Representatives of Cogir Management USA David Eskenazy, Benoit Levesque, Robert Laak, Joel Goldman, Krystal Jenkins, and Jessica Zepeda.

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 Regulation 1569.682 and the Department was informed a closure plan would be submitted in compliance with the Health & Safety Code as appropriate.

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

An exit interview was conducted; where this report was reviewed and provided to Vice President of Operations, Krystal Jenkins and Executive Director, Jessica Zepeda.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2024
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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