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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421704099
Report Date: 09/07/2023
Date Signed: 09/07/2023 01:55:29 PM


Document Has Been Signed on 09/07/2023 01:55 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
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:HILLVIEW RESIDENCEFACILITY NUMBER:
421704099
ADMINISTRATOR:SHERI DROMFACILITY TYPE:
740
ADDRESS:3705 HILLVIEW ROADTELEPHONE:
(805) 937-2360
CITY:SANTA MARIASTATE: CAZIP CODE:
93455
CAPACITY:48CENSUS: 0DATE:
09/07/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Sheri Drom, AdministratorTIME COMPLETED:
02:00 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
On 09/07/2023, Licensing Program Analyst (LPA) Brian Phillips arrived unannounced to the facility to conduct a Case Management Facility Closure Visit of the facility above. On 08/09/2023, Administrator Sheri Drom submitted a Closure plan for the facility, due to the inability to secure an applicant willing to file for a license after the licensee passed away. The Closure Plan reflected the closure of the facility is due to the inability to secure a new operator, and thus there will be a change in use of the facility. The facility planned to cease all operations as of 10/15/2023, requiring all residents to be vacated on or before that date. On 08/14/2023, the Closure Plan from the Licensee/Administrator was approved by the Community Care Licensing Division (CCLD).

The following requirements have been met by the facility. Submission of a closure plan, identification of all 12 residents with current service plans, and signed copies of each resident’s relocation evaluation including date and location. Between 08/21/2023-09/01/2023, all 12 current residents of the facility were relocated to appropriate alternative facilities identified in the relocation evaluations submitted by the facility.

The physical plant of the facility consists of 25 bedrooms, 21 bathrooms, 1 kitchen, 2 dining rooms, 2 large common rooms and a courtyard area. There are additional storage areas and a detached Administrators Office in the back of the facility. LPA conducted an observation of the front physical environment upon arrival to the facility. The entry of the facility is contained by an entrance gate, while the side of the facility has a security gate with an electronic lock that requires the entry of a key code to gain entrance for vehicles to enter. LPA was able to observe that the facility appeared to be vacated. The only vehicle on facility grounds was the Administrator's car and employees leaving from a closing party for employees of the facility. Administrator in the process of cleaning the facility at closure visit. LPA observed that all resident bedrooms were vacated, with only furniture remaining and in the process of being moved and/or cleaned. LPA noticed that all outside electrical outlets had no plugs attached. The courtyard appeared vacated. LPA observations of the physical environment appeared clean, in good condition, and appeared vacant. Walls, windows, ceilings, floors and floor coverings, and doors were checked. Copy of report provided to Administrator.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian PhillipsTELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:
DATE: 09/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/07/2023
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