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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 312700003
Report Date: 06/08/2023
Date Signed: 06/08/2023 03:20:46 PM


Document Has Been Signed on 06/08/2023 03:20 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
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:MONTCLAIR VILLA INCFACILITY NUMBER:
312700003
ADMINISTRATOR:STEFAN, RADU BOGDANFACILITY TYPE:
740
ADDRESS:5602 MONTCLAIR CIRTELEPHONE:
(916) 415-1274
CITY:ROCKLINSTATE: CAZIP CODE:
95677
CAPACITY:6CENSUS: 5DATE:
06/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Radu Bogdan StefanTIME COMPLETED:
01:30 PM
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On 6/8/2023 LPA Tryon visited the facility to perform an annual visit using the CARE Tool. LPA was greeted by licensee/Administrator Radu.

LPA toured the facility including common areas, kitchen, yard, bedrooms, bathrooms, storage areas, office, laundry.

The home is very clean, well-furnished, in good condition and nicely decorated. No hazards were noted throughout the home. The yard has plenty of seating in shaded areas.

Food supplies were reviewed and are more than adequate to meet the requirement of 2 days perishable and 7 days non-perishable. Food is varied and of good quality.

Smoke/carbon monoxide detectors are installed, fire extinguishers charged.

Rooms are appropriately furnished.

LPA reviewed the CARE Tool with licensee.

The facility appears to be in substantial compliance with the regulations at this time.

No deficiencies were cited at this visit. Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 06/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/08/2023
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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