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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421704099
Report Date: 03/27/2023
Date Signed: 03/27/2023 10:05:45 AM


Document Has Been Signed on 03/27/2023 10:05 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
CCLD Regional Office, 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: 18DATE:
03/27/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:36 AM
MET WITH:Sheri Drom, Administrator, and Rachel Varela, Care ManagerTIME COMPLETED:
10:15 AM
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Licensing Program Analyst (LPA) Darlene Chavez conducted a Case Management - Other inspection at the facility today. LPA met with Sheri Drom, Administrator, and Rachel Varela, Care Manager, and explained the purpose of the visit.

On March 23, 2023, Administrator Sheri Drom informed the Department that the licensee, her mother, passed away on May 21, 2023. Administrator is in the process of deciding who will potentially submit an application for license, and in the meantime has decided to continue to operate the facility. Administrator has been informed of the documents needed to continue to operate.

During today's visit, LPA toured the physical plant to ensure there are a sufficient amount of perishable and nonperishable food supplies, sufficient medication supply for all clients, and chemicals and sharps were inaccessible to clients. A conversation was held regarding utility bills and control of property for this facility. Administrator explained that they have been managing and operating the facility for 20 years and have access to money to keep operating the facility.

LPA requested a copy of the LIC 500 Personnel Report and verified current and correct contact information.

Exit interview conducted, report given.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Darlene ChavezTELEPHONE: (805) 450-0283
LICENSING EVALUATOR SIGNATURE:
DATE: 03/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/27/2023
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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