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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198204376
Report Date: 02/14/2024
Date Signed: 02/14/2024 12:26:00 PM


Document Has Been Signed on 02/14/2024 12:26 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, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:MOUNTAIN VIEW COTTAGES - IVFACILITY NUMBER:
198204376
ADMINISTRATOR:TRUPTI MODYFACILITY TYPE:
740
ADDRESS:21027 WEST COVINA BLVD.TELEPHONE:
(626) 966-4842
CITY:COVINASTATE: CAZIP CODE:
91724
CAPACITY:6CENSUS: 4DATE:
02/14/2024
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Smita Sanghvit, Licensee
Laura Hernandez, administrator
Trupti Mody, administrator
Jasbindar Singh, administrator		TIME COMPLETED:
12:30 PM
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An Informal Conference meeting was held at the Monterey Park Adult and Senior Care Regional Office. Present during this meeting were Licensing Program Manager (LPM) Fernando Fierros, Licensing Program Analyst (LPA) Bonnie Tao, Licensing Program Analyst (LPA) Tyler Reyes and from MOUNTAIN VIEW COTTAGES were Licensee Smita Sanghvit, administrator Trupti Mody, administrator Laura Hernandez, and administrator Jasbindar Singh.

The following items listed below were discussed during today's meeting:
· Complaint investigation findings for complaint # 28-AS-20210128160641.
· Adequate staffing and appropriate care and supervision for residents in care.
· Obtaining timely medical care or treatment for residents in care.
· Criminal Record Clearance and Associating staff.
· Maintenance and Operation: Facility shall be kept clean and in good repair. The facility free from pest.
· Immediate Civil Penalties

The following Title 22 topics were discussed and a copy of the Section given during office meeting:
· Personnel Requirements – General Section 87411
· Maintenance and Operation Section 87303
· Storage Space Section 87309
· Care of Persons with Dementia Section 87705
· Criminal Record Clearance Section 87355

(-continued in LIC 809C-)
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie TaoTELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: MOUNTAIN VIEW COTTAGES - IV
FACILITY NUMBER: 198204376
VISIT DATE: 02/14/2024
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Licensee was requested to provide procedure plan regarding staff obtaining timely medical care/ treatment for residents by due date 2/21/24.

An exit interview was conducted with Licensee and Administrators, and a copy of this licensing report was provided.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie TaoTELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024
LIC809 (FAS) - (06/04)
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