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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202509
Report Date: 10/23/2024
Date Signed: 10/23/2024 12:35:43 PM

Document Has Been Signed on 10/23/2024 12:35 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/
DIRECTOR:		NICHOLAS INNEHFACILITY TYPE:
740
ADDRESS:17090 PEAK AVENUETELEPHONE:
(408) 500-2693
CITY:MORGAN HILLSTATE: CAZIP CODE:
95037
CAPACITY: 28CENSUS: DATE:
10/23/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Cyril and Nicholas InnehTIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 10/23/2024 San Bruno Regional Office - San Jose Unit conducted a non-compliance conference meeting with Licensee Cyril Inneh and Administrator Nicholas Inneh.

Present in the meeting were Regional Manager Vivien Helbling, Licensing Program Manager Jackie Jin, and Licensing Program Analyst Christine Dolores.

During the non-compliance meeting, the following serious violations were discussed: 87411(a) Personnel Requirements – General, 87466 Observation of the resident, 87303(a) Maintenance and Operations, 87211(a)(1)(A) Reporting Requirements, 87355(e)(2) Criminal Record Clearance, 87458(b)(1) Medical Assessment, and 87405(d)(2) Administrator - Qualifications and Duties.

During this meeting, the compliance plan was developed and discussed with the licensee which includes more frequent monitoring inspection visits to ensure compliance with this compliance plan and Title 22 Regulations for 2 years. Licensee was provided the link below for resources and guidance to improve facility operations:
https://www.cdss.ca.gov/inforesources/community-care/resource-guide-for-providers.

During this meeting, the LIC809 and LIC809D from 10/22/2024 was amended and report was provided to the Licensee and Administrator.

This report was reviewed with Licensee Cyril Inneh and Administrator Nicholas Inneh and a copy of the report was provided.
SUPERVISORS NAME: Sarah Yip
LICENSING EVALUATOR NAME: Christine Dolores
LICENSING EVALUATOR SIGNATURE: DATE: 10/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/23/2024
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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