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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425801744
Report Date: 03/13/2024
Date Signed: 03/13/2024 02:37:20 PM

Document Has Been Signed on 03/13/2024 02:37 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:DEVEREUX CALIFORNIA - CASA FELIZFACILITY NUMBER:
425801744
ADMINISTRATOR:ANTONELA MILITOFACILITY TYPE:
735
ADDRESS:6990 FALBERG WAYTELEPHONE:
(805) 968-2525
CITY:GOLETASTATE: CAZIP CODE:
93117
CAPACITY: 7CENSUS: 7DATE:
03/13/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:13 AM
MET WITH:James AbrokwahTIME COMPLETED:
03:30 PM
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Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced required Annual Inspection at the above-named facility. LPA met with James Abrokwah, Program Manager and explained the purpose of the visit. At the time of arrival, there was one staff and the Program Manager on duty and three clients present. Antonella Milito, Program Administrator arrived at approximately 12:39 pm.

Entrance interview conducted.


There are currently seven (7) clients residing in the one-story facility that is home to clients with a developmental/intellectual disabilities. Tri-Counties Regional Center provides self-determination services.
A tour of the physical environment and accommodations were assessed, and the following was noted: LPA observed the required posting of the complaint poster, bill of rights and Resident’s Rights. LPA inspected the facility for fire safety, personal accommodations, and food service.
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. Fire inspection was current as of 1/25/2024. The carbon monoxide detector is in good working order.

The kitchen area was sufficiently stocked with two-day perishables and seven days of non-perishables. Frozen foods are properly wrapped and stored appropriately. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean.


Clients participate at will in activities including outings to local eateries, retail business, movie theatres, local beaches and parks, worship places, and amusement parks. Clients also participate in bowling, gardening, adult day programs, libraries, artwork, games, house meetings, social media, and watch television. Clients volunteer within the community at their will. One client is employed outside the facility.
Personnel records were reviewed for trainings, health screenings, and background clearances. All persons associated with the facility have a criminal record clearance and have been properly associated to the facility.

Please continue to 809-C Page 2.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE: DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/13/2024
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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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: DEVEREUX CALIFORNIA - CASA FELIZ
FACILITY NUMBER: 425801744
VISIT DATE: 03/13/2024
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A First Aid kit is located in the locked medication room and the staff office. Clients’ records, medications, personnel documents and records of confidentiality are kept in the locked medication room and the staff office. Medications are administered as prescribed.

Exit interview conducted. No deficiencies noted. Copy of report issued at the time of the visit.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:

DATE: 03/13/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024
LIC809 (FAS) - (06/04)
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