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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425801580
Report Date: 07/29/2021
Date Signed: 07/29/2021 02:12:22 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:ABUNDANT CARE IIIFACILITY NUMBER:
425801580
ADMINISTRATOR:DANIEL BONDFACILITY TYPE:
740
ADDRESS:4589 AUHAY DRIVETELEPHONE:
(805) 845-8490
CITY:SANTA BARBARASTATE: CAZIP CODE:
93110
CAPACITY:6CENSUS: 6DATE:
07/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Timothy PrykoTIME COMPLETED:
02:30 PM
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Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced Infection Control Inspection of the facility. LPA arrived at 11;00 am and was greeted by Staff 1 (S1). Upon arrival there were 5 residents and 1 caregiver present in the facility. LPA explained the purpose of the visit.

Entrance interview conducted.
There are currently 6 residents residing in the facility. The facility is home to residents with a dementia diagnosis.
A tour of the physical environment and accommodations were assessed. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked. The facility was seen to be in good repair inside and outside. Fire inspection was conducted on 6/15/2021.
The backyard has a covered sitting areas with outdoor furniture. There are no bodies of water. The recycling bin, green waste bin, and trash bins are standard bins with flip lids. A locked private staff room is located at back of the home.
The living room and dining area are neat and clean. The facility maintains a comfortable temperature at 73.8 degrees Fahrenheit (F). Hallways, bedroom doors and walls are in good repair.
The facility has 6 private bedrooms and private bathrooms for 6 residents. There is an ample amount of non-persihable foods for seven days and perishable foods for 2 days.

Exit interview conducted. No deficiencies cited. A copy of report has been issued.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2021
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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