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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 236803448
Report Date: 09/07/2022
Date Signed: 09/07/2022 11:26:58 AM


Document Has Been Signed on 09/07/2022 11:26 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
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405



FACILITY NAME:MOUNTAIN VIEW ASSISTED LIVINGFACILITY NUMBER:
236803448
ADMINISTRATOR:JEANETTE KINNEYFACILITY TYPE:
740
ADDRESS:1343 S DORA STTELEPHONE:
(707) 462-6212
CITY:UKIAHSTATE: CAZIP CODE:
95482
CAPACITY:64CENSUS: 33DATE:
09/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Jeannette KinneyTIME COMPLETED:
11:45 AM
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At approximately 8:50AM, Licensing Program Analyst (LPA) Chris Arnhold arrived at this facility, unannounced to conduct a case management visit to follow up on areas of concern from previous visits. LPA met with Administrator Jeannette Kinney and toured the facility. LPA observed an activities calendar posted on the wall showing multiple activities planned for the month. During this visit, residents were engaged in a coffee social then a game of bean bag toss, where a competition was started for the month. LPA toured memory care and spoke with Jeannette about future plans for the courtyard use. LPA informed Jeannette that the courtyard should be used for resident use, as long as staff observed residents for heat exposure and ensured plenty of fluids were available.

No citations issued during today's visit.
SUPERVISOR'S NAME: Bethany MoellersTELEPHONE: (707) 588-5040
LICENSING EVALUATOR NAME: Christopher ArnholdTELEPHONE: (707) 588-5084
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2022
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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