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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603419
Report Date: 03/14/2025
Date Signed: 03/14/2025 04:16:06 PM

Document Has Been Signed on 03/14/2025 04:16 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/
DIRECTOR:
TABACHNIKOV, PAULFACILITY TYPE:
735
ADDRESS:23546 SUNSET CROSSING RD.TELEPHONE:
(310) 221-1383
CITY:DIAMOND BARSTATE: CAZIP CODE:
91765
CAPACITY: 4CENSUS: 4DATE:
03/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:45 PM
MET WITH:Felicitas Soralbo, Assistant AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Cynthia Chan conducted the required annual inspection on 3/14/25. LPA arrived unannounced and met with Assistant Administrator, Felicitas Soralbo, to explain the reason for the visit. The facility is licensed for (4) ambulatory only clients ages 18 to 59. There are currently 4 clients residing at the home.

LPA used the Compliance and Regulatory Enforcement (CARE) tools to inspect the facility.
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. The fireplace is covered and not operable. Facility staff are still following their Infection Control Plan. Staff are cleaning and disinfecting during each shift. 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 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 reviewed 3 personnel files and they all have the required documentation. Staff have current CPR/first aid training and receiving on-going training. Administrator (Paul Tabachnikov) has the HIV & TB certificate that was completed on 11/19/23 and his administrator's certificate expires on 6/5/25. LPA reviewed (4) client files and their files contain the required documentation such as the admission agreement, IPP, medical assessment with TB results, and safeguard of cash and inventory form. Facility provides internet to clients.The medications are centrally stored and locked. LPA reviewed medications and there were no discrepancies found. There is currently no client with a restricted or prohibited health condition. Facility has the updated Emergency Disaster Plan and disaster drills are being conducted at least quarterly. All staff have the CPI training and staff mainly use verbal redirection with clients.

No deficiencies were observed today. An exit interview was held and a copy of this report was given to F. Soralbo.
SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Cynthia D Chan
LICENSING EVALUATOR SIGNATURE: DATE: 03/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/14/2025
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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