Facility Evaluation Report

At approximately 4:15PM, Licensing Program Analyst (LPA) Felias arrived unannounced to conduct a Case Management - Other Visit, and met with Health and Wellness Director, Victoria Mozaffari. Administrator, Dave Peper was unavailable during visit. The purpose of today's visit was to follow up on Change of Administrator paperwork needed as the previous Administrator, Carol Dowell, is no longer with Cogir of San Rafael. At this time, Dave Peper, Regional Director of Operations, is the current Administrator who oversees the facility.

LPA is requesting the following documents in order to process Dave Peper as the current administrator of Cogir of San Rafael:

LIC 308 (Designation of Facility Responsibility)

Active and Current Administrator Certificate

LIC 503 (Health Screening Report - personnel)

LIC 9182 (Criminal Record Exemption Transfer Request)

Copy of Driver's License or Passport that is not expired

Facility to submit Administrator Paperwork documents to Community Care Licensing (CCL) by Friday, 9/23/22