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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421701844
Report Date: 04/04/2022
Date Signed: 04/04/2022 12:43:49 PM


Document Has Been Signed on 04/04/2022 12:43 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:CLIFF VIEW TERRACEFACILITY NUMBER:
421701844
ADMINISTRATOR:MURPHY, EVELINA L.FACILITY TYPE:
740
ADDRESS:1020 CLIFF DRIVETELEPHONE:
(805) 963-7556
CITY:SANTA BARBARASTATE: CAZIP CODE:
93109
CAPACITY:72CENSUS: 27DATE:
04/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Ruby RodriguezTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Toan Luong conducted an unannounced Annual One Year Infection Control visit. LPA met with Assistant Administrator (AA) Ruby Rodriguez and explained the purpose of the visit. LPA toured the facility.

At 11:00 a.m., LPA discussed items in the Infection Control Module with AA and noted that all items were answered yes or n/a in the infection control module. It should be noted that the facility relays information from the California Department of Social Services Provider Information Notices (CDSS PINs) to staff, residents, and residents' responsible party verbally or a paper copy is provided upon request. LPA observed Covid hygiene signs posted throughout the facility. Personal bathrooms and shared bathroom between 2 residents did not have hand washing signs, but bathrooms leading from the facility hallways had signs posted inside the bathroom. Signs were posted prior to LPA's departure.

LPA conducted exit interview and emailed report and appeal rights to the facility.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Toan LuongTELEPHONE: (626) 419-1827
LICENSING EVALUATOR SIGNATURE:
DATE: 04/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/04/2022
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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