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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 361881195
Report Date: 09/06/2023
Date Signed: 09/06/2023 01:16:25 PM


Document Has Been Signed on 09/06/2023 01:16 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507



FACILITY NAME:PALM VIEW PLEASANT LIVINGFACILITY NUMBER:
361881195
ADMINISTRATOR:KARA RICHARDSONFACILITY TYPE:
740
ADDRESS:710 N CHURCH STREETTELEPHONE:
(909) 328-2118
CITY:REDLANDSSTATE: CAZIP CODE:
92374
CAPACITY:20CENSUS: 18DATE:
09/06/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Elizabeth Mahan - AdministratorTIME COMPLETED:
01:20 PM
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On this day, Licensing Program Analyst (LPA) Anna Bueno conducted an unannounced visit to the facility to investigate and deliver findings for complaint control number: 56-AS-20230828144225.

During the complaint investigation the following concerns were discovered:
  • Certain food item staples may run out before the end of the week
  • Residents may not receive a full second serving, if requested
  • Staff assist with residents who may or may not have cognitive impairment

Technical advisories (LIC 9102TA) were issued during today's visit. An exit interview was conducted with and a copy of this report were provided to Administrator Mahan.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2023
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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