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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 496803884
Report Date: 07/27/2021
Date Signed: 07/27/2021 11:47:02 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928
FACILITY NAME:MONTE VERDE REST HOMEFACILITY NUMBER:
496803884
ADMINISTRATOR:LATIMER, CAROLINEFACILITY TYPE:
740
ADDRESS:5570 MONTE VERDE DRTELEPHONE:
(707) 775-9327
CITY:SANTA ROSASTATE: CAZIP CODE:
95409
CAPACITY:6CENSUS: 0DATE:
07/27/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator, Caroline LatimerTIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Erik Gonzalez Campos arrived at Monte Verde Rest Home unannounced for a voluntary facility closure at 10:15 AM. Upon arrival no one appeared to be present at the facility. LPA called administrator Caroline Latimer who arrived shortly. The Licensee notified Community Care Licensing of intent to close this facility on July 1, 2021. Closure plans and copies of letters given to residents were reviewed. CCL received letter on July 16, 2021 indicating that all residents had been relocated.

This closure is licensee initiated.

LPA inspected all rooms and the exterior of the building and found no evidence that would suggest that residents are residing on the premises. All furniture, clothing and personal items belonging to residents have been removed. Residents who were living in the home were relocated to other properties in Sonoma county .

Administrator will mail out license to the Regional Office. Facility will be closed effective July 28, 2021.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Erik Gonzalez CamposTELEPHONE: (707) 588-5026
LICENSING EVALUATOR SIGNATURE:

DATE: 07/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/27/2021
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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