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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425800464
Report Date: 06/23/2021
Date Signed: 06/23/2021 02:36:23 PM

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:VISTA DEL MONTEFACILITY NUMBER:
425800464
ADMINISTRATOR:DOUGLAS TUCKERFACILITY TYPE:
741
ADDRESS:3775 MODOC ROADTELEPHONE:
(805) 687-0793
CITY:SANTA BARBARASTATE: CAZIP CODE:
93105
CAPACITY:266CENSUS: 172DATE:
06/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Douglas Tucker, AdministratorTIME COMPLETED:
02:00 PM
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Licensing Program Analysts (LPAs) Darlene Chavez and Kristin Kontilis conducted an onsite one-year infection control annual visit to the above-named facility. LPAs met with Douglas Tucker, Administrator and Ali Reynoso, Director of Health Services and explained the purpose of the visit.
LPAs conducted a physical tour of the facility. The facility has submitted a Mitigation Plan to the Department. The facility has an entry station at the side of the building. Upon entry, staff and visitors are required to sign-in, complete a symptom questionnaire, and have a temperature screening. All documentation is kept in a storage unit at the point of entry. The entry station has PPE gear, hand sanitizer, and a thermometer.
The facility is located on a 10-acre community with seven buildings. The level of care includes independent living, assisted living, and memory care. The facility has a fitness and aquatic center with a full-size lap swimming pool. The fitness and aquatic center has staff on-duty from approximately 7 am – 5 pm. The center is locked and not available to residents in care when there is no staff on duty.
The independent living units consist of 138 units and are fully equipped with oven, refrigerator and have microwaves.
The assisted living unit has a library, main lounge, dining area, multi-purpose room, fitness area, wellness area, little theater, and open patio area. There are 34 resident rooms in the assisted living unit.
The memory care facility has 24 resident rooms, a dining room, two common areas, two multi-purpose rooms, two open patios, and a wellness center.
Meals are prepared in the main kitchen and delivered to the assisted living and memory care units. The independent living units have their own kitchens or kitchenettes.
Screening of residents for symptoms and temperature checks are conducted daily in the assisted living and memory care units. Facility staff monitor residents for change of condition. Increased monitoring is conducted if a change of condition is noted of any residents showing COVID-19 symptoms, or signs of a fever.
Residents participate in Zoom activities, drum circles, water coloring, games, sing-a-longs, bean bag throw, exercise classes (inside and outside), educational presentations, a variety activities with University of California, Santa Barbara (UCSB) students, caring companions, peer counselors, scenic rides to local
Please continue to 809-C, Pg 2.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
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: VISTA DEL MONTE
FACILITY NUMBER: 425800464
VISIT DATE: 06/23/2021
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beaches and parks, medication classes, spiritual engagement activities, and family vehicle parades around the perimeter of the community.
Signs are posted on hallway bulletin boards stating COVID-19 symptoms should be reported to staff, Administrators, and LIcensee.
The room temperature in the facility was measured at a comfortable temperature at 12:05 pm.
All persons associated with the facility have criminal background clearance.
The trash, recycling, and green waste bins are kept in a gated area with no access to residents in care.
Exit interview conducted. No citations issued. Copy of the report has been given.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
LIC809 (FAS) - (06/04)
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