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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425801008
Report Date: 10/17/2025
Date Signed: 10/17/2025 02:01:50 PM

Document Has Been Signed on 10/17/2025 02:01 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:ALAMEDA HOUSEFACILITY NUMBER:
425801008
ADMINISTRATOR/
DIRECTOR:		NICHOLAS PAPAGEORGEFACILITY TYPE:
735
ADDRESS:7167 ALAMEDA AVENUETELEPHONE:
(805) 685-1111
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY: 6CENSUS: 5DATE:
10/17/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:Nicolas Papageorge, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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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) and explained the purpose of the visit. Elvira Perez, Operations Manager arrived at approximately 12:15 pm. Co-Administrator Jennifer Goddard also participated in the inspection. At the time of arrival, there were 5 clients in care and 1 staff on duty.

Entrance interview conducted:
The facility is a one-story home licensed as an Adult Residential Facility (ARF) for adults with a mental illness diagnosis and contracted with Santa Barbara County Behavioral Wellness Program. LPA toured facility with Operations Manager.
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 facility for fire safety, personal accommodations, and food service. Fire extinguisher was last serviced on 8/21/2025.
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. The carbon monoxide alarm and smoke alarms are in good working order.
Medications, First aid kit, and additional first aid supplies are kept in a locked office in a locked centrally stored cabinet. Medications are given as per Physician’s directions. First aid kit was observed to be complete.
Clients participate at will in activities with the mental wellness center (meditation groups, journaling, computer skills, life enrichment skills, and off-site trainings), community meetings, and special celebrations. Clients also participate independently in arts and crafts, outdoor recreations including walks, excursions to the local eateries, entertainment places, and places of worship. Each resident has an assigned cooking

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NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Kristin Kontilis
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/17/2025
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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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)
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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: ALAMEDA HOUSE
FACILITY NUMBER: 425801008
VISIT DATE: 10/17/2025
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day which includes preparing main meals for all residents and staff. Independently, residents prepare their breakfast and lunch. Residents are assigned a weekly chore on a rotation basis. Each resident has an assigned laundry day for their individual laundry needs.
The front yard consists of paved walkways and an open porch. The backyard is an open area with patio furniture and a basketball hoop. The backyard area is conducive for visiting with family and friends.
A locked garage is located at the back of the home. The recycling bin, green waste bin, and trash bins are standard bins with flip lids kept in a locked gate next to the garage.
The kitchen, living room, and dining area are neat and clean and maintain a comfortable room temperature.
There are three (3) shared bedrooms for six residents. Each bedroom has two (2) single beds, nightstands, and lights and nightstand lamps to provide sufficient lighting.
There are two bathrooms shared by the residents. Bathroom #1 is located between the dining area and Bedriin #1. Bathroom #2 is located in the hallway near Bedrooms #2 and #3. The bathrooms have secure grab bars.
 Residents’ files were reviewed. LPA noted that on file for each resident was the following: Physician's Reports, Admission Agreements, Medical Assessments, Health Screening, Identification and Emergency information, Appraisals/Needs Service Plan, and Medication Accounting Records (MARs).
Staff files reviewed had criminal background clearances, health screenings, current first aid certificates, and all required training.

Exit interview conducted. No deficiencies noted. Copy of report 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: 10/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025
LIC809 (FAS) - (06/04)
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