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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425800669
Report Date: 08/10/2026
Date Signed: 08/10/2026 04:03:07 PM

Document Has Been Signed on 08/10/2026 04:03 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:HOMECARE CASA LINDA, INC.FACILITY NUMBER:
425800669
ADMINISTRATOR/
DIRECTOR:		JOHN ORQUIOLAFACILITY TYPE:
740
ADDRESS:4744 AVALON AVENUETELEPHONE:
(805) 964-6339
CITY:SANTA BARBARASTATE: CAZIP CODE:
93110
CAPACITY: 6CENSUS: 4DATE:
08/10/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Administrator John OrquiolaTIME VISIT/
INSPECTION COMPLETED:
03:40 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 Staff 1 (S1). At the time of arrival, there were 4 residents in care and 1 staff on duty. Administrator John Orguiola arrived shortly thereafter.
LPA 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. There are no residents currently on hospice.
Entrance interview conducted:
A tour of the physical environment and accommodations were assessed, and the following was noted: LPA observed the required posting of the complaint poster, Resident’s Personal Rights, and Long Term Care Ombudsman poster. 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 and condition. Walls, windows, ceilings, doors, floors and floor coverings were checked. There are four private bedrooms and one shared bedroom available for six residents. There is a live-in staff room off the hallway that remains locked throughout the day and night. The facility was seen to be in good repair inside and outside.
The kitchen area was sufficiently stocked with seven (7) days of non-perishables. LPA observed an insufficient amount of perishables for two days including but not limited to fresh vegetables, fresh poultry and/or meat. Snacks and beverages are readily available for residents. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean.

Please continue to 809-C, Pg 2.

Kelly Burley
Kristin Kontilis
DATE: 08/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/10/2026
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 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 5
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: HOMECARE CASA LINDA, INC.
FACILITY NUMBER: 425800669
VISIT DATE: 08/10/2026
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
 Fire inspection was most recently conducted on 7/15/2026. There are fourteen (14) dual carbon monoxide and smoke alarms. All are in good working order.
Medications are stored in a locked cabinet located in the dining area. Medications are administered as prescribed.
Residents participate independently in games, movies, neighborhood walks, and one-on-one socialization among the residents and staff. Residents are taken to medical and dental appointments, on outings to local parks, beaches, and retail businesses.
The front yard is well maintained and consists of walkways and garden areas. The backyard is well maintained and has a paved covered patio, sitting areas, and garden areas with a paved walkway surrounding the parameter of the yard. The backyard is conducive for outdoor visitation.
The recycling bin, green waste bin, and trash bins are standard bins with flip lids. Chemicals and cleaning supplies are kept in a locked closet in the hallway.
The kitchen, living room, and dining area are neat and clean. The facility maintains a comfortable temperature. Hallways, bedroom doors, and walls are in good repair.
There are two bathrooms located in the hallway each with a shower room located with access available to all residents. The bathrooms have secure grab bars and no skid flooring.
Disaster Preparedness Plan was reviewed. Record review revealed a fire drill was conducted on 3/2/2026 and a power outage drill was conducted on 6/1/2026. There was no record of quarterly drills conducted prior to 3/2/2026.
Residents records are current. Admission agreements, Pre-appraisals, Appraisals, Health Screenings, and Needs/Services plans are in good order.
Personnel records and training records are current. All staff have current First Aid/CPR certificates.
All persons associated with the facility have a criminal record clearance and have been properly associated to the facility.

The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22.

Exit interview conducted. Technical advisory issued. A copy of the report and appeal rights issued at the time of the visit.

NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Kristin Kontilis
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/10/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 08/10/2026 04:03 PM - It Cannot Be Edited


Created By: Kristin Kontilis On 08/10/2026 at 02:56 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: HOMECARE CASA LINDA, INC.
FACILITY NUMBER: 425800669

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/10/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1569.695(c)
Other Provisions
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and record review, the licensee did not comply with the section cited above as a disaster drill was not conducted prior to 3/2/2026 which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/11/2026
Plan of Correction
1
2
3
4
Administrator agrees to provide written plan in place of scheduled drills to be conducted within the next two quarters of 2026. Written plan will include type and description of disaster, staff who will attend, and date drills will be conducted. Administrator agrees to send plan directly to LPA via email no later than POC due date (8/11/2026).
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Kelly Burley
NAME OF LICENSING PROGRAM MANAGER:
Kristin Kontilis
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 08/10/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/10/2026


LIC809 (FAS) - (06/04)
Page: 4 of 5