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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202509
Report Date: 12/14/2023
Date Signed: 12/14/2023 10:51:14 AM


Document Has Been Signed on 12/14/2023 10:51 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
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:
12/14/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Nicholas InnehTIME COMPLETED:
10:55 AM
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Licensing Program Analyst (LPA) Christine Dolores arrived unannounced to conduct a case management - other visit. LPA met with Administrator, Nicolas Inneh.

During visit, LPA advised the facility regarding the use of their video surveillance system in the common areas. Based on interview, the Administrator states they are unsure where the video footage are being stored and who has access to the video surveillance system. It was stated that the video surveillance system was already implemented prior to the Administrator start at the facility in 2022. The individual who may have knowledge of the video surveillance system does not work in the facility and the facility does not have contact to the individual. Based on observation, the video surveillance monitors different locations of the facility to include the hallways, kitchen, dining room, and parking lot. The location of the video surveillance monitor is in the Administrator's office. LPA observed the video surveillance does not have audio component. The Administrator states plans to install another video surveillance system only in the facility's common areas by next week. The new video surveillance system will include access to the video files. LPA advised to disconnect the video surveillance unless the facility knows where the video surveillance records and files are being stored.

No deficiencies are being cited per California Code of Regulations, Title 22. Advisory note provided.

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: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/14/2023
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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