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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604441
Report Date: 02/18/2025
Date Signed: 02/19/2025 07:30:00 AM

Document Has Been Signed on 02/19/2025 07:30 AM - 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 DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:MONTE VISTA VILLAGE SENIOR LIVINGFACILITY NUMBER:
374604441
ADMINISTRATOR/
DIRECTOR:		ADRIAN GUILLENFACILITY TYPE:
740
ADDRESS:2211 MASSACHUSETTS AVENUETELEPHONE:
(619) 465-1331
CITY:LEMON GROVESTATE: CAZIP CODE:
91945
CAPACITY: 219CENSUS: 114DATE:
02/18/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:20 PM
MET WITH:Executive Director Adrian GuillenTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Correia made an unannounced visit to the facility to conduct a case management- annual continuation visit to continue the annual inspection commenced on January 25, 2025. LPA identified herself and was granted entry into the facility by Executive Director Guillen to whom she disclosed the purpose of the visit.

During today’s visit, LPA conducted a continuation of resident and facility records reviews.

Based on today's continuation of the inspection, no deficiencies are being cited at this time. An exit interview was conducted, and this report was discussed with ED Guillen who was advise a copy of the report and Licensee Appeal Rights will be provided after the conclusion of the visit, and signature on this form acknowledges receipt of the rights and a copy of the report.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 02/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/18/2025
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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