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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366425800
Report Date: 09/24/2024
Date Signed: 09/24/2024 02:02:41 PM

Document Has Been Signed on 09/24/2024 02:02 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
SAN BERNARDINO ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:MONTE VISTA FAMILY HOME IIFACILITY NUMBER:
366425800
ADMINISTRATOR/
DIRECTOR:		GETHERALL, JENNIFERFACILITY TYPE:
735
ADDRESS:8820 MONTE VISTA ST.TELEPHONE:
(909) 483-4254
CITY:ALTA LOMASTATE: CAZIP CODE:
91701
CAPACITY: 6CENSUS: 5DATE:
09/24/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:53 PM
MET WITH:Mireya Corona, ManagerTIME VISIT/
INSPECTION COMPLETED:
02:05 PM
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Liceninsing Program Analysts (LPAs) LaVette Farlow and Magda Malcore conducted an unannounced followed-up facility visit to gather information pertaining to complaint # 56-AS-20240920092830 investigation. LPAs met with Mireya Corona, Manager and discussed the purpose of the visit.

During today's visit LPA's conducted interviews and obtained copies of relevant documents.

An exit interview was conducted where this report was discussed and a copy of this report was provided to Joseph Getherall.
SUPERVISORS NAME: Nedra Brown
LICENSING EVALUATOR NAME: Lavette Farlow
LICENSING EVALUATOR SIGNATURE: DATE: 09/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/24/2024
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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