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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 360909015
Report Date: 09/15/2020
Date Signed: 09/16/2020 04:30:08 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:MONTCLAIR GUEST HOME IFACILITY NUMBER:
360909015
ADMINISTRATOR:DINA MOPERAFACILITY TYPE:
740
ADDRESS:4515 ORCHARD STREETTELEPHONE:
(909) 624-5575
CITY:MONTCLAIRSTATE: CAZIP CODE:
91763
CAPACITY:24CENSUS: DATE:
09/15/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Oran ReznikTIME COMPLETED:
04:30 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 Analysts (LPA's) Pauline Beschorner conducted a telephonic case management visit via Face Time in regards to complaint number 18-AS-20200901113145. LPA met with Oran Reznik, Licensee and Dina Mopera, Administrator at the time of the inspection.

LPA observed there to 1 carbon monoxide detector installed in the hallway and 1 carbon monoxide detector installed in the hallway. Reznik and Mopera both stated that the handyman will be back tomorrow morning to install 2 more carbon monoxide detectors at each end of the hall.

LPA observed there to be 1 smoke detector installed in a resident room. Reznik and Mopera stated that the handyman will be coming in the morning to install the other smoke detectors bought.

An exit interview was conducted a copy of this report was reviewed with and provided to Licensee Oran Reznik.
SUPERVISOR'S NAME: Karen ClemonsTELEPHONE: (951) 248-0349
LICENSING EVALUATOR NAME: Pauline BeschornerTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:

DATE: 09/15/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/15/2020
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