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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198603419
Report Date: 01/09/2024
Date Signed: 01/09/2024 06:44:50 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/04/2024 and conducted by Evaluator Cynthia D Chan
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20240104091341
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:
01/09/2024
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Norma Lopez, StaffTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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1. Staff hits clients.
2. Staff handle clients inappropriately.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation regarding the allegations listed above. LPA arrived unannounced and met with Staff Norma Lopez. The purpose of the visit was explained to Administrator, Paul Tabachnikov via telephone.

The investigation consisted of the following:
LPA toured the facility and reviewed Client #1’s file. Interviews were held with the Administrator, 8 Staff (Staff #1 - #8), and 4 Clients (Client #1 - #4).

The investigation revealed the following:
Allegation – Staff hits clients. LPA interviewed the administrator and 8 Staff regarding this allegation. Administrator Tabachnikov stated that the San Gabriel/Pomona Regional Center had investigated and determined unsubstantiated findings.
Unsubstantiated
Estimated Days of Completion:
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 28-AS-20240104091341
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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
VISIT DATE: 01/09/2024
NARRATIVE
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He also stated the Walnut Police Department had conducted an interview with Client #1 last week and did not find any concerns at their end. Staff members interviewed during the visit today had not witnessed any staff hitting a client. They had not observed any bruises on clients. They stated they are mandated reporters and required to report any abuse. LPA also interviewed 4 Clients. All 4 of the clients stated that staff did not hit them.

Allegation – Staff handles clients inappropriately. It is alleged that staff pushes and pulls the clients’ hair. LPA interviewed the administrator, staff, and clients for this allegation. Administrator and Staff stated that Client #1 has a history of false accusations and is one of the behaviors that they are working on to reduce the number of occurrences. Client #1’s Individual Support Plan addresses the false allegations and preventive strategies in reducing the frequency of behavior. Staff interview denied ever pushing clients or pulling their hair. They stated they will redirect clients when necessary and do not inappropriately touch or utilize any manual restraints. They have been documenting the number of times Client #1 exhibits the behaviors. LPA interviewed 4 clients. One of the clients reported that a staff had pushed and pulled client's hair multiple times when no one is around. The other 3 clients stated the staff are good to them and do not push them nor pull their hair.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

An exit interview was conducted with Staff Lopez. A copy of this report along with the appeal rights were provided.
NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Cynthia D Chan
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/09/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2