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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425801016
Report Date: 03/17/2023
Date Signed: 03/17/2023 04:28:16 PM


Document Has Been Signed on 03/17/2023 04:28 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
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:VILLA RIVIERAFACILITY NUMBER:
425801016
ADMINISTRATOR:MEAGAN DE CARLOFACILITY TYPE:
740
ADDRESS:1621 GRAND AVENUETELEPHONE:
(805) 568-5840
CITY:SANTA BARBARASTATE: CAZIP CODE:
93103
CAPACITY:20CENSUS: 0DATE:
03/17/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Meagan De Carlo, Administrator via telephoneTIME COMPLETED:
02:15 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 Analysts (LPAs) Brian Phillips and Jenny Olson conducted a Case Management Closure visit to the facility above on 03/17/2023 at 1:45pm.

LPAs knocked on the doors of the facility and received no response. LPAs then observed the inside of the facility by looking into the windows throughout the outside of the facility. LPAs observed no evidence of residents or staff on site. LPAs observed open empty drawers, boxes, no furniture was present, and the facility looked vacant. LPA Phillips spoke with Administrator by telephone at 3:00pm.
Administrator stated that the last resident moved out and into a different facility on 03/03/2023.

Exit interview conducted via telephone and copy of report emailed to Administrator.

SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian PhillipsTELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:
DATE: 03/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/17/2023
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 1