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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361880853
Report Date: 02/27/2023
Date Signed: 03/02/2023 03:13:44 PM


Document Has Been Signed on 03/02/2023 03:13 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:MOUNTAIN VIEW PLEASANT LIVINGFACILITY NUMBER:
361880853
ADMINISTRATOR:KARA RICHARDSONFACILITY TYPE:
740
ADDRESS:2258 MENTONE BLVDTELEPHONE:
(909) 810-1500
CITY:MENTONESTATE: CAZIP CODE:
92359
CAPACITY:20CENSUS: 18DATE:
02/27/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:26 PM
MET WITH:Kara Richardson, AdministratorTIME COMPLETED:
03:15 PM
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Licensing Program Analyst, Amber Coleman (LPA) arrived at the Mountain View Pleasant Living Facility unannounced to conduct and Annual Inspection with a focus on Infection Control. Upon arrival to the front door, LPA was greeted by staff member Ambreen Khalid and invited LPA inside, while she notified Administrator of LPA's arrival. LPA signed in, while waiting LPA observed Infection Control Supplies made available to visitors upon entry. LPA observed staff wearing appropriate PPE throughout facility.

During the inspection, LPA conducted a brief tour of the facility and made observations pertaining to the facility's infection control measures and other health and safety concerns. LPA observed appropriate postings throughout the facility, including hand-washing and cough etiquette, face coverings, and COVID-19 symptoms postings. The facility was also equipped with sufficient hand hygiene supplies, sufficient cleaning/disinfecting provisions, and a supply of Personal Protective Equipment (PPE). LPA observed that the Administrator wearing a mask during the visit. Administrator shared that extra PPE is kept in a storage unit right outside facility. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the facility's infection control measures. The facility has a plan in place which follows Community Care Licensing Division (CCLD) guidelines for COVID-19 testing, isolating/quarantining residents, and properly caring for residents with COVID-19 positive results and/or exposures. The facility also has a plan in place to monitor residents regularly for any changes in condition and to subsequently notify the resident's physician and emergency personnel in the event the resident presents any COVID-19 symptoms. LPA reviewed resident records and interviewed Licensee.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Amber ColemanTELEPHONE: 951-248-0338
LICENSING EVALUATOR SIGNATURE:
DATE: 02/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/27/2023
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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