<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336426330
Report Date: 06/22/2022
Date Signed: 06/22/2022 03:30:24 PM


Document Has Been Signed on 06/22/2022 03:30 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:VISTA MONTANA SENIOR LIVINGFACILITY NUMBER:
336426330
ADMINISTRATOR:RAQUEL MONTESFACILITY TYPE:
740
ADDRESS:155 N. GIRARD ST.TELEPHONE:
(951) 658-2274
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY:120CENSUS: 63DATE:
06/22/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Maria Navares - Resident Care DirectorTIME COMPLETED:
03:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Crystal Colvin, conducted an unannounced visit to the facility to initiate the investigation complaint #18-AS-20220620144622. The LPA Colvin met with Resident Care Director Maria Navares and informed her of the purpose of the visit.

During LPA Colvin's inspection, LPA Colvin observed that the Assisted Living building had less than 7 days of perishable food. LPA Colvin requested to see the emergency food storage for the facility, and Maria took LPA Colvin to Independent Living where the supplies are kept. LPA Colvin reviewed the supplies and estimated an additional days worth of meals to be present, when factoring in three meals a day for the current combined census of Assisted Living and Independent Living, as Maria confirmed that Independent Living is also provided with three meals a day. LPA Colvin will be issuing a Technical Violation Advisory Note (LIC9102 TV) instead of a deficiency LPA Colvin estimates that the facility has close to the 7 day minimum on non-perishable food (though not quite 7 days), and the facility is scheduled to have another food delivery tomorrow. LPA Colvin recommended to the Resident Care Director to obtain additional emergency food supplies as well as consider increasing the amount of food in the facility's scheduled deliveries of food.

No immediate health and safety concerns were observed at this time.

An exit interview was conducted with Resident Care Director Maria Navares and a copy of this report and LIC9102-TV was provided.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:
DATE: 06/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1