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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 335530231
Report Date: 12/27/2024
Date Signed: 12/27/2024 11:44:49 AM

Document Has Been Signed on 12/27/2024 11:44 AM - 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:PARKMOUNT MANORFACILITY NUMBER:
335530231
ADMINISTRATOR/
DIRECTOR:		PINTO, LEAHFACILITY TYPE:
740
ADDRESS:1001 YARDLEY WAYTELEPHONE:
(951) 870-7189
CITY:CORONASTATE: CAZIP CODE:
92881
CAPACITY: 6CENSUS: 0DATE:
12/27/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Staff- Geoffrey BrouilletteTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Mary Rico conducted an unannounced visit to the facility. LPA Rico met with Administrator Geoffrey Brouillette and was granted entry to the facility.

The Administrator informed LPA that the facility is waiting to be approved for an Assisted Living Waiver (Medi-Cal). LPA Rico obtain documents for verification and tour the facility. During inspection, LPA observed no residents.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.



An exit interview was conducted, and this report LIC809 was discussed and provided to Administrator Geoffrey Brouillette.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Mary Rico
LICENSING EVALUATOR SIGNATURE: DATE: 12/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/27/2024
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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