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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202509
Report Date: 05/13/2024
Date Signed: 05/13/2024 05:41:41 PM


Document Has Been Signed on 05/13/2024 05:41 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131



FACILITY NAME:VILA MONTEFACILITY NUMBER:
435202509
ADMINISTRATOR:NICHOLAS INNEHFACILITY TYPE:
740
ADDRESS:17090 PEAK AVENUETELEPHONE:
(408) 500-2693
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY:28CENSUS: 25DATE:
05/13/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:20 PM
MET WITH:Nicholas InnehTIME COMPLETED:
05:45 PM
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Licensing Program Analysts (LPAs) Christine Dolores and Simi Rai arrived unannounced to conduct a case management - other visit. LPAs met with Administrator (ADM) Nicholas Inneh.

The purpose of the visit is to hand deliver an exclusion letter for staff member (S1). The letter was handed to the Administrator.

Staff (S1) was present during visit. LPA Dolores explained the exclusion letter to S1. S1 refused to take the letter. S1 was immediately released from work. LPAs observed another staff (S2) replace S1.

No deficiencies were cited today per California Code of Regulations, Title 22.

This report was reviewed with Administrator, Nicholas Inneh and a copy of the report was provided.
SUPERVISOR'S NAME: Sarah YipTELEPHONE: (408) 324-2131
LICENSING EVALUATOR NAME: Christine DoloresTELEPHONE: (408) 334-8552
LICENSING EVALUATOR SIGNATURE:
DATE: 05/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/13/2024
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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