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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603419
Report Date: 03/12/2024
Date Signed: 03/12/2024 03:47:23 PM


Document Has Been Signed on 03/12/2024 03:47 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754



FACILITY NAME:PT MOUNTAIN VIEW HOME INC.FACILITY NUMBER:
198603419
ADMINISTRATOR:TABACHNIKOV, PAULFACILITY TYPE:
735
ADDRESS:23546 SUNSET CROSSING RD.TELEPHONE:
(310) 221-1383
CITY:DIAMOND BARSTATE: CAZIP CODE:
91765
CAPACITY:4CENSUS: 4DATE:
03/12/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Felicitas Soralbo, Assistant AdministratorTIME COMPLETED:
04:00 PM
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Licensing Program Analysts (LPAs) Cynthia Chan and Christian Gutierrez conducted an annual inspection using the Compliance and Regulatory Enforcement (CARE) tool. LPAs arrived unannounced and met with Felicitas Soralbo. The purpose of the visit was explained.

LPAs toured the facility and inspected the following domains:
Infection Control: The facility staff are performing hand hygiene and wearing gloves while assisting clients. Staff are cleaning and disinfecting at least 3 times a day and more often for high touched surfaces. Facility has sufficient PPE supplies.
Physical Plant & Environment Safety: The facility consists of 4 client bedrooms, 2 bathrooms, living room, dining room, kitchen, and attached garage. Each client bedroom has the required furniture and bedding. Extra hygiene supplies are observed. Facility has an operable smoke detector in each room and 2 carbon monoxide detectors. Knives and cleaning solutions are locked in the garage. There is no swimming pool on the premises.
Operational Requirements: The facility is licensed for (4) ambulatory adults ages 18 - 59. There are currently 4 clients residing at the home and receive services through the San Gabriel/Pomona Regional Center.
Food Service: There are sufficient food supplies of 2-day perishable and a week of non-perishable items. Freezers are maintained at a temperature of 0 degree F and the refrigerators at a maximum of 45 degrees F. Both are kept clean and foods are properly stored.

LPA will return another day to complete the remainder of the domains. There are no deficiencies issued today. An exit interview was held with Felicitas Soralbo and a copy of this report was given.
SUPERVISOR'S NAME: Tony VasalloTELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D ChanTELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:
DATE: 03/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/12/2024
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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