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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425800332
Report Date: 02/04/2025
Date Signed: 02/04/2025 02:06:48 PM

Document Has Been Signed on 02/04/2025 02:06 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:FUTURESFACILITY NUMBER:
425800332
ADMINISTRATOR/
DIRECTOR:		ASHLEY HOLMESFACILITY TYPE:
735
ADDRESS:4505 ARAGON DRIVE #CTELEPHONE:
(805) 566-1575
CITY:CARPINTERIASTATE: CAZIP CODE:
93013
CAPACITY: 4CENSUS: 4DATE:
02/04/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Ashley Holmes, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:30 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 to the above-named facility. Upon arrival, LPA was greeted by Ashley Holmes, Administrator. LPA explained the purpose of the visit.
Entrance interview conducted.
The facility is a one-story home for adults with disabilities located in a residential area. The facility maintains a contract with Tri-Counties Regional Center.
There are currently four residents residing in the facility. At the time of arrival, two residents were out in the community, one resident was working in an adult day program, and one resident is currently placed in a skilled nursing facility and will return to this facility upon discharge.
A tour of the physical environment and accommodations were assessed, and the following was noted: LPA observed the required posting of the complaint poster and Resident’s Rights. LPA inspected the one story facility for fire safety, personal accommodations, and food service.
The facility consists of a kitchen, dining area, living room, staff room, garage area, and an outdoor patio area. The recycling bin, green waste bin, and trash bins are standard bins with flip lids.
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. Fire inspection was last conducted on 7/24/2024. One carbon monoxide detector and four smoke alarms were in good working order.
The kitchen area was sufficiently stocked with at least two days of perishables and seven days of non-perishables. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean.
Residents participate at will in activities such as meal preparations, Special Olympics, church activities, social gatherings, Best Buddies, holiday and birthday celebrations, and frequenting local eateries and retail businesses.

Please continue to 809-C, Pg 2.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE: DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/04/2025
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 2
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: FUTURES
FACILITY NUMBER: 425800332
VISIT DATE: 02/04/2025
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
26
27
28
29
30
31
32
 There are two private bedrooms and one shared bedroom for four residents in care. All bedrooms are sufficiently furnished with lighting, nightstands, beds, and bedding. There is one half bathroom and one full bathroom. All clients have access to each bathroom. Bathroom grab bars are secure.
Residents participate at will in activities such as meal preparations, Special Olympics, church activities, social gatherings, Best Buddies, holiday and birthday celebrations, and frequenting local eateries and retail businesses.
There are two private bedrooms and one shared bedroom for four residents in care. All bedrooms are sufficiently furnished with lighting, nightstands, beds, and bedding. There is one half bathroom and one full bathroom. All clients have access to each bathroom. Bathroom grab bars are secure.
Residents’ files were reviewed. LPA noted that on file for each resident was the following: Admission Agreements, Medical Assessments, Identification and Emergency information, Appraisals/Needs Service Plan, and Medical Accounting Records (MARs). All medications are given per Doctor’s orders.
Staff records were reviewed. LPA noted that on file for each staff member were the following: Health screening, TB clearance, verification of current trainings, fingerprint clearance, administrator certifications, and criminal record clearance. All staff are properly associated to the facility. Administrator’s certificate is current.

Exit interview conducted. No citations issued. A copy of this report issued at the time of the visit.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:

DATE: 02/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/04/2025
LIC809 (FAS) - (06/04)
Page: 2 of 2