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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610110
Report Date: 02/17/2026
Date Signed: 02/17/2026 10:37:10 AM

Document Has Been Signed on 02/17/2026 10:37 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:GOLETA HOMEFACILITY NUMBER:
197610110
ADMINISTRATOR/
DIRECTOR:		UKWAMEDUA, MARIANFACILITY TYPE:
735
ADDRESS:13725 GOLETA STTELEPHONE:
(818) 897-6590
CITY:ARLETASTATE: CAZIP CODE:
91331
CAPACITY: 4CENSUS: 1DATE:
02/17/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:45 AM
MET WITH:Andre FoudaTIME VISIT/
INSPECTION COMPLETED:
10:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Tuesday Cabiness conducted an unannounced annual inspection. LPA was greeted by staff Andre Fouda, who was informed the reason of the visit. Administrator, Marian Ukwamedua was contacted via telephone, and was informed the reason of the visit. Assistant Nusifa Bahingire arrived shortly thereafter. During there visit, there was (1) client present, and the remaining (3) were at day program.

LPA and a staff member Andre toured the facility and the following was observed. Common Areas: LPA observed the common area to be properly furnished with clean furniture and in good repair. No obstructions throughout the common area. The facility has (4) bedroom and three (3) bathrooms. Kitchen Area: The main area kitchen where clients’ meals are prepared was observed to be clean. Appliances were clean and functional. LPA observed a sufficient amount of 2-day perishable and 7-day non-perishable supply of food and were properly stored. LPA observed knives kept in a locked cabinet. The dining table by the kitchen area had the appropriate table and chairs to accommodate the clients. Bedrooms: There are four (4) bedrooms designated for client use and (1) room for staff. All bedrooms are furnished with a night stand, a chair, a lamp, a chest of drawers, a closet and a bed with clean bedding and linens. All bedrooms have sufficient closet space and have sufficient lighting. Bathrooms: LPA observed three (3) bathrooms that are clean and in good repair. LPA observed the functional and appropriate fixtures, with soap and paper towels. The hot water temperature measured between 109.4°F. LPA observed non-skid mats in all the shower areas.

The facility maintains a comfortable temperature. LPA observed the required facility postings by the entrance hallway. Smoke/carbon monoxide detectors are hard wired and interconnected; they were tested and operating. Fire and smoke drill was conducted January 01, 2026.

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Tuesday Cabiness
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 02/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/17/2026
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: GOLETA HOME
FACILITY NUMBER: 197610110
VISIT DATE: 02/17/2026
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Laundry Area: LPA also observed the washer and dryer located outside. LPA also observed a locked cabinet that stores laundry detergents and some cleaning solutions, were locked and secured.

Surrounding grounds: LPA observed the backyard free from obstructions. A seating area available for clients to use. LPA observed a locked shed which is inaccessible to clients and it is used as an additional storage for supplies and clients' personal items.

LPA reviewed four (4) out four (4) client records and (3) staff records to ensure compliance. The facility files were kept in locked cabinet. All client and staff records were current and up to date, including staff training records. Client's money was audited, and all money was accounted for and balanced.

Medications: The medications were kept in locked cabinet in the kitchen area.The first-aid kit is complete. Medications and medication records were reviewed for proper documentation.

No deficiencies cited during today's visit. Exit interview conducted and copy of this report signed and delivered.

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Tuesday Cabiness
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 02/17/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2026
LIC809 (FAS) - (06/04)
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