<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610468
Report Date: 03/13/2025
Date Signed: 03/13/2025 04:56:33 PM

Document Has Been Signed on 03/13/2025 04:56 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., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:PT PREFERRED LIVING INC.FACILITY NUMBER:
197610468
ADMINISTRATOR/
DIRECTOR:		TABACHNIKOV, PAULFACILITY TYPE:
735
ADDRESS:7806 DE SOTO AVE.TELEPHONE:
(310) 221-1383
CITY:CANOGA PARKSTATE: CAZIP CODE:
91304
CAPACITY: 4CENSUS: 0DATE:
03/13/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Paul Tabachnikov, Administrator TIME VISIT/
INSPECTION COMPLETED:
04:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
At 2:00pm, Licensing Program Analyst (LPA) Angela Panushkina conducted an unannounced annual visit to this facility. Upon arrival, LPA rang the bell, but no one answered. LPA contacted the Administrator, Paul Tabachnikov, and explained the reason for the visit. At 2:20pm, Designee Erik Padilla arrived and LPA gained access to the facility.

The Fire Clearance approved for four (4) Ambulatory, where two (2) can be Non-Ambulatory in rooms #1 & #2.

The physical plant was toured inside and out with the Designee. The facility is a one level home and has six (6) bedrooms, four (4) of which are designated for clients use only. One (1) room will be designated for live-in staff and one (1) room will be converted to the office. During inspection, all rooms were properly furnished with bedding, linens and furniture. The facility has and three (3) bathrooms. All bathrooms were observed to be clean and included appropriate functional fixtures. Each client has their own personal hygiene storage unit available. Water temperature measured at 120.0 degrees Fahrenheit. Walls, ceilings, floors, window screens, and all areas of the facility, was clean and in good repair. There is sufficient perishable and nonperishable, and food storage, cabinets, pantries, cupboards and counters were clean and appropriate for food preparation. Knives and medication will be stored in cabinets located in the kitchen area. Appliances were clean and functional, and utensils, plates, and cups were in good repair. Cleaning supplies and chemicals were stored under kitchen sink, locked and secured.

Facility has television available for clients. Facility telephone was operating and available for use. The back yard is completely fenced with a gate easily accessible and unlocked. There are no swimming pools or other bodies of water, no visible hazards around the surrounding grounds. Smoke detectors and carbon monoxide were hard-wired and operational. Fire extinguisher is fully charged. All required Licensing documents were visibly posted on the wall. Facility telephone was operating and available for use.
Continue on LIC809-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: PT PREFERRED LIVING INC.
FACILITY NUMBER: 197610468
VISIT DATE: 03/13/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
First aid kit, fully equipped with requirements. Washer and dryer is available and observed to be in a good, working condition. Staff and client files will be stored in a locked cabinet.

There are currently "No" clients at this time. Administrator is awaiting an approval from the North Los Angeles County Regional Center to vendorize the facility, and admit clients.

No deficiency issued

Exit interview conducted and copy of this report signed and delivered.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Angela Panushkina
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2025
LIC809 (FAS) - (06/04)
Page: 2 of 2