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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425850070
Report Date: 10/24/2023
Date Signed: 11/07/2023 07:51:41 AM


Document Has Been Signed on 11/07/2023 07:51 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:CASA MOUNTAIN VIEWFACILITY NUMBER:
425850070
ADMINISTRATOR:ANDREICHENKO, VIKTORIIAFACILITY TYPE:
740
ADDRESS:1260 MOUNTAIN VIEW RDTELEPHONE:
(805) 403-7455
CITY:SANTA BARBARASTATE: CAZIP CODE:
93109
CAPACITY:6CENSUS: 0DATE:
10/24/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Viktoria AndreichenkoTIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA), Kristin Kontilis conducted an unannounced Case Management Closure visit to the facility. LPA met with Administrator Viktoria Andreichenko and explained the reason for the visit.

On August 25, 2023, Licensee notified the Woodland Hills Regional Office (RO) the closure of the facility. During today’s visit, LPA observed facility to be vacant and verified that no care and supervision was being provided. During the facility tour of both indoor premises and the outdoor patio, LPA observed all rooms and living space areas to be unoccupied at this time. Licensee will surrender license directly to the LPA’s attention at the Goleta Regional Office via U.S.P.S.
Closure of the facility is confirmed as of this visit. Exit interview conducted. Due to technical issues, a copy of the report was emailed to Administrator.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2023
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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