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Department of
SOCIAL SERVICES

Community Care Licensing


HOME CARE ORGANIZATION EVALUATION REPORT

Facility Number: 194700739
Report Date: 03/04/2022
Date Signed: 03/04/2022 10:58:30 AM

Document Has Been Signed on 03/04/2022 10:58 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

HOME CARE ORGANIZATION EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 744 P STREET, MS 09-14-90
SACRAMENTO, CA 95814
FACILITY NAME:MOUNTAINVIEW HOME CARE LLCFACILITY NUMBER:
194700739
ADMINISTRATOR:RENEE RILLORTAFACILITY TYPE:
300
ADDRESS:204 E. SIERRA MADRE BLVDTELEPHONE:
(626) 434-0072
CITY:SIERRA MADRESTATE: CAZIP CODE:
91024
CAPACITY: CENSUS: DATE:
03/04/2022
Case Management - Biennial Required ContinuationUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Renee RillortaTIME COMPLETED:
11:15 AM
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Home Care Services Bureau (HCSB) Analyst, Ramsey Chimienti arrived at the business office of MountainView Home Care LLC on 3/04/2022. Upon arrival, the HCSB analyst identified himself and was greeted by Renee Rillorta. The proper posting of business hours and license was observed. The analyst was then shown to an area where the review of personnel and administrative files could be performed. Upon completion of the file review the analyst discussed the findings of the inspection with Renee and informed her that no discrepancies were found.
LICENSING EVALUATOR NAME: Ramsey Chimienti
LICENSING EVALUATOR SIGNATURE: DATE: 03/04/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

HCS809 (FAS) - (06/04)
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