<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 421703635
Report Date: 04/28/2022
Date Signed: 04/28/2022 02:56:25 PM


Document Has Been Signed on 04/28/2022 02:56 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:DANELLE'S GUEST HOME IFACILITY NUMBER:
421703635
ADMINISTRATOR:COMETA, NONAFACILITY TYPE:
740
ADDRESS:4866 FRANCES STTELEPHONE:
(805) 967-5237
CITY:SANTA BARBARASTATE: CAZIP CODE:
93111
CAPACITY:6CENSUS: 4DATE:
04/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:05 PM
MET WITH:Nona Cometa, Licensee/AdministratorTIME COMPLETED:
02:45 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 on-site one-year Infection Control Inspection visit to the above-named facility. LPA began the inspection at 1:20 PM. A Mitigation Plan has been submitted to CCLD. LPA was greeted by Staff Marino "Mark" Jose and explained the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) and is home to non-ambulatory residents with a dementia diagnosis. Currently, there is 1 resident on hospice.
Entrance interview conducted:
At the time of the arrival, Licensee/Administrator Nona Cometa and Staff Jose were on duty and 4 residents in care. 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. First aid kit was observed to be complete.
The physical environment was checked for cleanliness. Walls, windows, ceilings, doors, floors and floor coverings were checked. Fire extinguisher was serviced on 3/27/2022. Seven dual carbon monoxide detectors/smoke alarms were tested to be in good working order at 1:55 pm.
The kitchen area was sufficiently stocked with two-day perishable and seven-day non-perishables. Snacks and beverages are available for Residents in the facility upon request. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean. The kitchen trash is stored in a trash container with a flip lid. Cleaning agents are kept in the laundry area. Medications and First Aid kit are kept in a locked cabinet located in the dining area.
The backyard has a patio with outdoor furniture conducive for visitations. The recycling bin, green waste bin, and trash bins are standard bins with flip lids.

Exit interview conducted. No deficiencies cited. A copy of this report has been emailed to Licensee/Administrator.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1