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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 565800169
Report Date: 09/19/2023
Date Signed: 09/19/2023 12:52:11 PM


Document Has Been Signed on 09/19/2023 12:52 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:MOUNTAIN VIEW RESIDENTIAL CAREFACILITY NUMBER:
565800169
ADMINISTRATOR:EMMA SABIOFACILITY TYPE:
740
ADDRESS:290 DENA DRIVETELEPHONE:
(805) 498-2743
CITY:NEWBURY PARKSTATE: CAZIP CODE:
91320
CAPACITY:6CENSUS: 0DATE:
09/19/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Emma and Edwin SabioTIME COMPLETED:
01:00 PM
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Licensing Program Analyst (LPA) Martha Arroyo conducted an unannounced Case Management-Other visit to the above facility at 12:30 p.m. Upon arrival, the LPA met with Licensee Emma and Edwin Sabio as the purpose of the visit is to conduct a final walk-through of the facility prior to closure. Entrance interview conducted.

On 09/13/2023, the department received a letter from the licensee which included a Certification of Non-Operation as of 08/24/2023. The Licensee stated they had retired and no longer provide care and supervision. In the correspondence, the Licensee also attached the facility’s License surrendering it to the Department.

During today’s visit, the LPA observed facility to be vacant and verified that no care and supervision was being provided. The facility will be closed effective September 19, 2023, in the Licensing Information System (LIS).

Exit interview conducted. The report was reviewed, and a copy was issued to Emma and Edwin Sabio.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Martha ArroyoTELEPHONE: (818) 421-6459
LICENSING EVALUATOR SIGNATURE:
DATE: 09/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/19/2023
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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