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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425800464
Report Date: 02/15/2024
Date Signed: 02/15/2024 11:53:47 AM


Document Has Been Signed on 02/15/2024 11:53 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
WOODLAND HILLS NORTH, 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: 216DATE:
02/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Douglas Tucker, Administrator and Monica Leon, Director of Human ResourcesTIME COMPLETED:
12:00 PM
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On 02/15/2024, Licensing Program Analyst (LPA) Brian Phillips conducted an unannounced Case Management site visit with the purpose of following up on an immediate exclusion served to Staff #1 (S1) via certified mail. LPA met with Administrator Douglas Tucker and Director of Human Resources Monica Leon for a Confirmation of Removal visit.

An immediate exclusion order for S1 was dated February 2, 2024, and provided via certified mail. S1 is excluded from any care facility licensed by the Department and is required to be removed from the facility. Administrator stated that S1 has not worked at the facility since July 2nd, 2022 (07/02/2022).

During this visit, the Administrator provided LPA with a copy of the current personnel report to verify S1 is no longer working at the facility. During today’s visit, S1 was not observed in the facility at this time.

No citations issued during today's visit.

Exit interview was conducted with Administrator, and a copy of the report was provided.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian PhillipsTELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:
DATE: 02/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/15/2024
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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