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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202387
Report Date: 09/15/2021
Date Signed: 09/15/2021 02:56:22 PM

Document Has Been Signed on 09/15/2021 02:56 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:MOUNTAIN VIEW RANCH RES. CAREFACILITY NUMBER:
157202387
ADMINISTRATOR:NANKIL, PATRICK R.FACILITY TYPE:
735
ADDRESS:3046 HINSLEY STTELEPHONE:
(661) 319-3749
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY: 4CENSUS: 4DATE:
09/15/2021
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Patrick Nankil, Administrator TIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) L. Cabrera conducted a case management visit for the purpose of Health & Safety check of residents in care. Inspection was conducted in conjunction with opening a complaint. LPA met with Victoria Tenderro. Administrator Patrick Nankil was called and informed of the inspection.

Facility was toured. Residents were observed. There appears to be sufficient supply of perishable and non-perishable food. Medications and cleaning supplies are locked and inaccessible to residents during inspection. LPA observed Client (C1) and C2 watching television in the living room area, C3 sleeping in his room and C4 participating in a Zoom Meeting in his bedroom.

LPA met with Administrator and obtained copies of Resident (R1) current reports.

No immediate health or safety concerns were observed.

An exit interview was conducted, and a copy of this report was provided.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lady Cabrera
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2021
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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