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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336409595
Report Date: 08/31/2021
Date Signed: 08/31/2021 12:49:55 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:SCENIC VIEW HOME CAREFACILITY NUMBER:
336409595
ADMINISTRATOR:MARILYN HOLMESFACILITY TYPE:
740
ADDRESS:7349 LIPPIZAN DRTELEPHONE:
(951) 727-0175
CITY:RIVERSIDESTATE: CAZIP CODE:
92509
CAPACITY:6CENSUS: 0DATE:
08/31/2021
TYPE OF VISIT:Case Management - Licensee InitiatedANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Earl HolmesTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Melody Brown conducted an announced visit to confirm that all of the residents have been relocated in anticipation for the facility's closure. LPA Brown was granted entrance by Administrator Earl Holmes.

On 8/30/2020, LPA Brown was informed that there are no more clients living in the facility. The licensee is initiating this closure. LPA inspected the entire facility which included the bedrooms, bathrooms, dining area, kitchen, and the backyard. There were no clients present, and there were no belongings of clients in the facility. Administrator Holmes stated that the reason of the closure is due to licensee’s medical condition.



The administrator submitted the following during the closure plan.

1. Letters to clients indicating the closure, and letter to Community Care Licensing (CCL).
2. Names of the five clients (client roster).

The licensee surrendered the original license to LPA Brown.

The effective date of closure will be 08/31/2021.

An exit interview was conducted where this report was discussed with and provided to Administrator Holmes.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Melody BrownTELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:

DATE: 08/31/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2021
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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