421701844-3-5-2024-29-AS-KKOS-D33VNF-20240305153503

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 421701844
Report Date: 03/05/2024
Date Signed: 03/05/2024 03:35:50 PM

Document Has Been Signed on 03/05/2024 03:35 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:	DATE:	03/05/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:15 AM
MET WITH:	Eve Murphy, Administrator		TIME COMPLETED:	03:45 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 required Annual Inspection visit at the above-named facility. Upon arrival, LPA was greeted by Eve Murphy, Administrator and Ruby Rodriguez, Assistant Administrator and explained the purpose of the visit. At the time of arrival, there were four (4) staff on duty and forty 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 dementia waiver and a hospice waiver for 10. Currently, there are 9 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 last inspected on 3/1/2024. 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 are kept along with medications in a locked closet. LPA noted medications are administered as prescribed. Additional First Aid kit, and First Aid supplies are kept in a separate locked centrally stored cabinet. First Aid supplies include emergency lanterns with resident room numbers noted on the lanterns, flashlights, emergency disaster bags, and more. 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: 03/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024

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: 03/05/2024

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 and 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, nightstands, and ceiling lights and nightstand lamps to provide sufficient lighting. The bathrooms have secure grab bars and no skid flooring.
Residents’ files were reviewed. LPA noted that on file for each resident was the following: Physician’s Reports, Admission Agreements, Medical Assessments, Identification and Emergency information, Appraisals/Needs Service Plan, and Medication Administration Records (MARs).
All persons associated with the facility have criminal record clearance. Administrator certificate is valid. Staff files reviewed had criminal record statements, health screenings, current first aid certificates, and all required training.

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

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024

LIC809 (FAS) - (06/04)

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