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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201430
Report Date: 02/26/2025
Date Signed: 02/26/2025 02:11:03 PM

Document Has Been Signed on 02/26/2025 02:11 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:VISTA HOUSEFACILITY NUMBER:
079201430
ADMINISTRATOR/
DIRECTOR:		SURNEY, WHITNEYFACILITY TYPE:
735
ADDRESS:1470 AUTUMN WIND CTTELEPHONE:
(925) 214-7081
CITY:PITTSBURGSTATE: CAZIP CODE:
94565
CAPACITY: 6CENSUS: 5DATE:
02/26/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:50 AM
MET WITH:TALIB ARLINE, SUPERVISORTIME VISIT/
INSPECTION COMPLETED:
11:50 AM
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On 2/26/2025 at 9:50am, Licensing Program Analyst (LPA) Carol Fowler conducted an unannounced pre licensing inspection. LPA met with Talib Arline, Supervisor. The facility has an approved fire safety clearance for six (6) ambulatory clients.

LPA inspected the facility inside and out including but not limited to the bedrooms, bathrooms, common living areas, kitchen, garage, back yard. The facility has six (6) bedrooms two (2) bedrooms are occupied by staff and four (4) bathrooms. There is sufficient lighting around the facility. Clients rooms are equipped with the proper furniture, bedding, and lighting. Passageways and hallways are free of obstruction. Medications are located in a cabinet in a storage room. Toxins are locked in the laundry room. Hot water temperature is measured at 116.8 degrees Fahrenheit in shared clients' bathroom. Fire extinguisher was last serviced on 11/26/2024. There is a minimum of 7-day non-perishables and 2-day perishables foods. First Aid kit was complete. Carbon monoxide and smoke detectors present and operable.

There were Issues noted during inspection. LPA observed that facility is not ready to be licensed. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted with Administrator and a copy of this report provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Carol Fowler
LICENSING EVALUATOR SIGNATURE: DATE: 02/26/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/26/2025
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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