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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604083
Report Date: 01/24/2020
Date Signed: 01/27/2020 09:31:11 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:MONTERA, THEFACILITY NUMBER:
374604083
ADMINISTRATOR:JUDITH PIERFAXFACILITY TYPE:
740
ADDRESS:5740 LAKE MURRAY BLVDTELEPHONE:
(949) 242-1400
CITY:LA MESASTATE: CAZIP CODE:
91942
CAPACITY:225CENSUS: 147DATE:
01/24/2020
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Executive Director, Judith PierfaxTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to the facility to conduct an annual licensing inspection. LPA identified herself and was granted entry into the facility and met with Executive Director(ED), Judith Pierfax who was explained the purpose of today’s visit. The facility is licensed to serve 225 elderly, ages 60 and above, all of whom may be non-ambulatory. The facility has an approved hospice waiver for twenty (20) residents and may serve twenty (20) bedridden residents.

An overall inspection of the facility was conducted inside and out. Due to time constraints LPA Correia was unable to complete the visit and will return at a later date to conduct the remaining portion of this inspection.

No deficiencies were cited at today's visit. This report was discussed with ED Pierfax. A copy of the report and License Rights (01/2016) were provided to ED Pierfax at the conclusion of the visit, and signature on this form acknowledges receipt of the rights and a copy of this report.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:

DATE: 01/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/24/2020
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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