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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610286
Report Date: 09/20/2026
Date Signed: 09/20/2026 03:37:19 PM

Document Has Been Signed on 09/20/2026 03:37 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:PALM VISTA SENIOR LIVINGFACILITY NUMBER:
197610286
ADMINISTRATOR/
DIRECTOR:		MONTALVO, STUARTFACILITY TYPE:
740
ADDRESS:3850 W Rancho Vista BLVDTELEPHONE:
(661) 202-3999
CITY:PalmdaleSTATE: CAZIP CODE:
93551
CAPACITY: 115CENSUS: DATE:
09/20/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:10 AM
MET WITH:Stuart Montavo, Executive Director TIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Gabriela Castro conducted an unannounced required annual inspection utilizing the Compliance and Regulatory Enforcement (CARE) Tool. Upon arrival, LPA was greeted by the receptionist, who was informed of the purpose of the visit. Executive Director Stuart Montavo subsequently met with LPA and provided a tour of the community.

The facility is licensed to serve one hundred fifteen (115) non-ambulatory residents, ages 60 and older, of which ten (10) may be bedridden. The facility is approved to retain no more than twenty (20) residents receiving hospice services. At the time of the inspection, there were no residents receiving hospice services.

LPA utilized the Compliance and Regulatory Enforcement (CARE) Tool during today's inspection and observed the following:

Physical Plant and Environmental Safety:

The facility is centrally located within the City of Palmdale and provides Assisted Living and Memory Care services. The facility is a two-story property consisting of seventy (70) apartments in the Assisted Living section and twenty-five (25) apartments in the Memory Care section.

LPA toured the facility and observed a front sports lounge, bistro, main dining area, and a private dining area available for residents seeking additional privacy. Public restrooms were available throughout the facility. Water temperatures were observed to be within the required range, and handwashing signs promoting proper handwashing practices were posted.

(continued on 809C)

David Sicairos
Gabriela Castro
DATE: 09/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: PALM VISTA SENIOR LIVING
FACILITY NUMBER: 197610286
VISIT DATE: 09/20/2026
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LPA toured the Memory Care unit, where twenty-three (23) residents currently reside. LPA inspected five (5) resident apartments, including Apartments #2, #6, #12, #18, and #19. Apartments inspected contained the required furniture, linens, and adequate lighting. Water temperatures in resident grooming and bathing areas measured between 105°F and 120°F. LPA observed no hazardous items, chemicals, or medications accessible to residents in the Memory Care apartments inspected. LPA also observed a courtyard within the Memory Care unit that provided residents with outdoor space and adequate shaded areas for resident use. LPA also toured the Assisted Living area and inspected six (6) resident apartments, including Apartments #115, #111, #108, #213, #216, and #237. Apartments inspected contained the required furniture, linens, and adequate lighting. Resident bathrooms were equipped with grab bars adjacent to toilets and inside showers. Water temperatures in resident grooming and bathing areas measured between 105°F and 120°F. Carbon monoxide detectors and smoke alarms were observed in resident bedrooms and hallways. LPA also observed evacuation chairs positioned in the stairwells for emergency use. LPA observed an outdoor front lounge area and courtyard available for resident use. The outdoor areas provided adequate shaded seating and sufficient space for resident activities, including barbecues and social gatherings. A miniature golf putting area was also available for resident recreational use.

Food Service:

LPA toured both dining areas and the kitchens that serve the Assisted Living and Memory Care residents. LPA observed proper food storage, food preparation, and food handling practices throughout both kitchen areas. No chemicals, cleaning supplies, or other hazardous substances were observed in food preparation or food storage areas.

LPA discussed with kitchen staff the process for monitoring and providing meals to residents with physician-ordered special diets. LPA observed the community’s daily and weekly menus, which were posted and available for resident review. Food menus were readily available throughout the community, and printed copies are available for residents upon request. The facility maintained at least a one-week supply of nonperishable food and a minimum two-day supply of perishable food. Soaps, detergents, and cleaning compounds were stored separately from food supplies. Freezers and refrigerators were clean and maintained at appropriate temperatures. Freezers measured approximately 0°F (-17.7°C), and refrigerators were maintained at or below 40°F (4.4°C).

Planned Activities:

LPA observed residents attending a church service during the visit. A September 2026 activity calendar was posted and included a variety of recreational activities and scheduled community outings. LPA observed adequate indoor and outdoor recreational space available for resident activities.

(continued on 809C)

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Gabriela Castro
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2026
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: PALM VISTA SENIOR LIVING
FACILITY NUMBER: 197610286
VISIT DATE: 09/20/2026
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Amenities:

LPA observed that the community offers a variety of amenities for resident use, including a movie theater, equipped fitness gym, and an on-site beauty salon. These amenities provide residents with opportunities for recreation, exercise, personal care, and social engagement. LPA observed the amenities to be clean, well-maintained, and available for resident use.

Resident Rights/Information:

LPA observed the required postings displayed throughout the facility's common areas, including the Complaint Poster (PUB 475), Personal Rights, and the Nondiscrimination Notice. Internet access was also available for residents’ use.

Health-Related Services & Records

Ten (10) resident files were reviewed. Files contained current required documentation, including Admission Agreements, signed consents, Needs and Services Plans, Physician's Reports documenting TB results and ambulatory status, and signed Resident Rights acknowledgments. Residents' medications were reviewed. Medications were observed to be centrally stored in the facility's medication room in locked medication cabinets, locked medication carts. All medications observed were maintained in a secure manner and inaccessible to residents.

Disaster Preparedness

LPA received and reviewed documentation of the facility's most recent fire drills conducted on 09/10/2026 for both the AM and PM shifts by Fire Safety Services, Inc. LPA reviewed documentation indicating that a State of California Fire Marshal inspection was completed on 09/15/2026. LPA observed that the facility's LIC 610D, Emergency Disaster Plan, was in the process of being updated. Emergency disaster supplies, including potable water, nonperishable food, flashlights, batteries, and first aid supplies, were observed and appeared sufficient to meet the facility's emergency preparedness needs.

Personnel Records & Training

Six (6) staff files were reviewed and included criminal record clearances, CPR/First Aid, required training and TB screenings. Administrator Certificate for Stuart Montalvo was valid through September 27, 2027.

An exit interview was conducted with Executive Director Stuart Montalvo. Based on observations made and records reviewed during today's inspection, the facility was observed to be in compliance with applicable Title 22, Division 6 regulations. No deficiencies were cited during today's inspection.

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Gabriela Castro
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/20/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2026
LIC809 (FAS) - (06/04)
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