421700457-10-1-2025-29-AS-KKOS-DM339E-20251001180301

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 421700457
Report Date: 10/01/2025
Date Signed: 10/01/2025 06:03:17 PM

Document Has Been Signed on 10/01/2025 06:03 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	WOOD GLEN HALL, INC.		FACILITY NUMBER:	421700457
ADMINISTRATOR/ DIRECTOR:	RICK OLDS		FACILITY TYPE:	740
ADDRESS:	3010 FOOTHILL ROAD		TELEPHONE:	(805) 687-7771
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93105
CAPACITY: 72		CENSUS: 49	DATE:	10/01/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	12:05 PM
MET WITH:	Rick Olds, Administrator		TIME VISIT/ INSPECTION COMPLETED:	05:45 PM

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Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced Annual visit to the facility stated above. LPA was greeted by staff and explained the purpose of the visit. Administrator Rick Olds arrived shortly after LPA’s arrival. The facility is a non-profit residential care facility for the elderly. The facility is licensed for a capacity of 72 residents of which 72 can be non-ambulatory. The facility maintains a hospice waiver for 10 residents. There are currently 5 residents on hospice.
The facility is maintained in conformity with State Fire Marshall regulations. The facility has smoke alarms, a sprinkler system, and a pull alarm system that is hard-wired and notifies the local fire department when activated. Fire drills and disaster emergency preparedness drills are conducted quarterly throughout the facility.
The community has two vans and one pick up truck utilized for transporting residents to appointments and outings. The Administrator is present a sufficient number of hours to manage and oversee the facility.
The facility consists of 63 resident rooms, a dining room, lanai, game room, library, meditation room, tea room, garden room, a computer lab, a beauty shop, a laundry room, east side patio, gardening area, and a gazebo. Throughout the facility are private sitting areas, snack stations, hydration stations, and an area for sewing/ironing. Paved walkways surround the facility are utilized by residents for daily strolls. The parking area and resident pick up/drop off area has flush curbing to assist non-ambulatory residents
Meals are prepared in the main kitchen and served to residents in the dining area and in their private rooms. The facility utilizes assigned seating in the dining room for purposes of special diets and special requests. The Garden Room is available to residents for family meals and special occasions.

Due to time restraints, LPA will return at a later date to continue the inspection.

Exit interview conducted. No deficiencies noted. Report issued at the time of the visit.

NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Kristin Kontilis
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 10/01/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2025

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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