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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421702848
Report Date: 04/25/2022
Date Signed: 04/26/2022 08:00:00 AM

Document Has Been Signed on 04/26/2022 08:00 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
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME:COVENANT LIVING AT THE SAMARKANDFACILITY NUMBER:
421702848
ADMINISTRATOR:LAURIE SMALLFACILITY TYPE:
741
ADDRESS:2550 TREASURE DRIVETELEPHONE:
(805) 687-0701
CITY:SANTA BARBARASTATE: CAZIP CODE:
93105
CAPACITY: 379CENSUS: 348DATE:
04/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Jennifer Leggett, Associate Executive DirectorTIME COMPLETED:
05:30 PM
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Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced on-site one-year infection control inspection visit to the above-named facility. LPA began the inspection at 3:00 pm. A Mitigation plan has been submitted to CCLD. LPA met with Karen Harris, Human Resources Director and Jennifer Leggett, Associate Executive Director. Administrator Michael Easbey was unavailable at the time of the visit. LPA explained the purpose of the visit.
The facility is a Residential Care Facility for the Elderly (RCFE) Continuing Care Retirement Community consisting of independent living, assisted living, and memory care.
Due to time restraints, LPA will return at a later date to continue the investigation.
Exit interview conducted. Additional follow up is needed. No deficiencies cited at this time. A copy of the report has been issued via email.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2022
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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