421701844-2-21-2023-29-AS-KKOS-CPA5MG-20230221190444

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 421701844
Report Date: 02/14/2023
Date Signed: 02/21/2023 07:05:15 PM

Document Has Been Signed on 02/21/2023 07:05 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 TERRACE		FACILITY NUMBER:	421701844
ADMINISTRATOR:	MURPHY, EVELINA L.		FACILITY TYPE:	740
ADDRESS:	1020 CLIFF DRIVE		TELEPHONE:	(805) 963-7556
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93109
CAPACITY:	72	CENSUS: 36	DATE:	02/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Evelina Murphy, Administrator		TIME COMPLETED:	04:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced Annual Infection Control Inspection visit at the above-named facility. LPA arrived at 2:00 pm and was greeted by Ruby Rodriguez, Assistant Administrator and explained the purpose of the visit. At the time of arrival, there were four (4) staff on duty and thirty-six (36) residents in care. Administrator Evelina Murphy was present during the inspection. Entrance interview conducted. The facility is a one-story Residential Care Facility for the Elderly (RCFE) with a hospice waiver for 10. Currently, there are 25 residents with a dementia diagnosis, 3 residents on hospice, and no bedridden residents. A tour of the physical environment and accommodations were assessed, and the following was noted: LPA observed the required posting of the complaint poster, bill of rights and Resident’s Rights. LPA inspected the one-story facility for fire safety, personal accommodations, and food service. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, doors, floors and floor coverings were checked. The facility was seen to be in good repair inside and outside. There are nine (9) fire extinguishers and one pull alarm. The fire extinguishers were recently inspected on 8/1/2022. The dual carbon monoxide detector/smoke alarms are in good working order. The kitchen is equipped with an automatic sprinkler system. The kitchen area was sufficiently stocked with two-day perishables and seven days of non-perishables. Snacks and beverages are readily available for Residents. Frozen foods are properly wrapped and stored appropriately. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean. Medications, First Aid kit, and additional first aid supplies are kept in a locked centrally stored cabinet. First aid kit was observed to be complete. Residents participate independently in music entertainment, joyous movement (music and chair exercise), floral arranging, books by Braille, pet therapy with various types of pets, arts and crafts, and outings to parks, restaurants, and other local attractions. Please continue to 809-C, Pg 2.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: CLIFF VIEW TERRACE	FACILITY NUMBER: 421701844
	VISIT DATE: 02/14/2023

NARRATIVE

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Upon entrance into the facility, there are walkways, sitting areas, and a variety of plants. There are no bodies of water. The facility consists of a lobby, Administrator’s office, a cinema, the common area including the dining area, beauty salon, library, and two conference rooms.
The kitchen is equipped with industrial kitchen equipment, is neat and clean. The facility maintains a comfortable temperature.
There are 39 rooms with 7 private bedrooms and 32 shared rooms. There are approximately 20 bedrooms with private baths. Each bedroom has a bed, night-stands, and ceiling lights and night stand lamps to provide sufficient lighting. The bathrooms have secure grab bars and no skid flooring.
All persons associated with the facility have criminal record clearance. Administrator certificate is valid.
If any suspected or confirmed cases of COVID-19 are found in the facility a staff will be assigned to only work with those quarantined/isolated individuals and will not work with other COVID negative individuals until cleared by Health Department. Staff will use full PPE with N95 masks and face shields when dealing with any pending or confirmed cases of COVID-19. Precautionary Droplet signs will be posted on any room with quarantine or isolated individuals.
PPE supplies will be located immediately outside those rooms when required. Facility has a 30-day supply of PPE on hand. Facility has plans for delivering medications and meals to any quarantined/isolation resident room.
The facility has proper cleaning and disinfectant sprays. Facility Administrator has a plan in place for when and whom to notify in an outbreak or other emergencies. Administrator will keep a line list of all vaccinated and tested staff/residents in care with dates/results.
Facility has conducted training on infection prevention, symptoms, transmission and PPE use. Facility has non-punitive sick leave polices for staff. Staff who have a respiratory illness are requested to stay home and not report to work.
Activities have been modified to individuals or small groups with social distancing. Residents' medication is delivered in 30-day supplies to the facility. The facility ensures proper cleaning is done on frequently touched surfaces and between any individuals sharing of space or items.
Sinks were well stocked with soap, paper towels and hand washing signs. Staff and resident records are kept in the locked staff office. Facility observes guidance changes and the most up-to-date guidance from CCL-PINS, CDC, CDPH, and local health departments should be followed to remain in compliance. The most stringent orders should be followed by any of these agencies.

Exit interview conducted. No citations issued. A copy of this report has been issued..

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 02/14/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2023

LIC809 (FAS) - (06/04)

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