425801782-5-15-2024-29-AS-KKOS-D59U3R-20240514151357

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 425801782
Report Date: 05/14/2024
Date Signed: 05/15/2024 08:35:56 AM

Document Has Been Signed on 05/15/2024 08:35 AM - 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:	CASA NAOMI - BRADFORD HOME		FACILITY NUMBER:	425801782
ADMINISTRATOR:	NOEMI E. BUYCO		FACILITY TYPE:	740
ADDRESS:	7779 BRADFORD DRIVE		TELEPHONE:	(805) 685-2625
CITY:	GOLETA	STATE: CA	ZIP CODE:	93117
CAPACITY:	6	CENSUS: 0	DATE:	05/14/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:05 PM
MET WITH:	Noemi Buyco, Administrator		TIME COMPLETED:	03:45 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 Annual Required visit and inspection of the facility. At the time of arrival, Licensee and Licensee was not present. Licensee Buyco arrived at approximately 1:40 pm. LPA was greeted by Licensee Noemi Buyco and explained the purpose of the visit. Currently there are no residents residing in the facility. Entrance interview conducted. The facility is home to six (6) non-ambulatory residents. The facility is a two-story home consisting of a living room, dining room, kitchen, and four (4) bedrooms. The second floor of the facility is the private residence of the Licensee. The laundry room is located in the garage with no access to residents. A tour of the physical environment and accommodations were assessed. The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, doors, floors and floor coverings were checked. The kitchen was observed to be clean and sanitary. The living room and dining areas are neat and clean. The dining area is located next to the kitchen area. Access into the garage area is available through the dining area. The facility maintains a comfortable temperature at 72 degrees Fahrenheit (F). Hallways, bedroom doors and walls are in good repair. Bedroom #1 is a shared bedroom with a private bathroom. Bedrooms 2, 3, and 4 share a bathroom with access from the hallway. A fire extinguisher is located in the entry way near the front entrance into the facility. The fire extinguisher was serviced on August 7, 2023. There are five (5) dual smoke alarms/carbon monoxide detectors throughout the facility. Please continue to 809-C, Pg 2.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

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: CASA NAOMI - BRADFORD HOME	FACILITY NUMBER: 425801782
	VISIT DATE: 05/14/2024

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The backyard has a covered patio and wheelchair ramp to access the patio area. There is a double storage area located in the backyard adjacent from the patio area.

Technical Violations: Licensee stated Administrator Rhonna Buyco is currently out of the country. LPA issued technical violations and advised Licensee that CCLD must be notified prior to accepting residents in care. Upon notification, CCLD will ensure all technical violations are cleared at the time of accepting residents in care. Licensee stated most likely the facility will start accepting residents no sooner than 2025.

Exit interview conducted. Violations issued. Due to technical difficulties, report was issued via email..

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 05/14/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/14/2024

LIC809 (FAS) - (06/04)

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