425801991-10-30-2024-29-AS-KKOS-DAJLM3-20241030085204

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 425801991
Report Date: 10/29/2024
Date Signed: 10/30/2024 08:52:37 AM

Document Has Been Signed on 10/30/2024 08:52 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:	CAREMERIDIAN		FACILITY NUMBER:	425801991
ADMINISTRATOR/ DIRECTOR:	NICOLE DOMINGUEZ		FACILITY TYPE:	775
ADDRESS:	1135 N PATTERSON AVE		TELEPHONE:	(805) 683-1995
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93111
CAPACITY: 8		CENSUS: 1	DATE:	10/29/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	10:53 AM
MET WITH:	Nicole Dominguez, Administrator		TIME VISIT/ INSPECTION COMPLETED:	03:30 PM

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Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced required Annual Inspection to the facility. LPA met with Nicole Dominguez, Administrator and explained the purpose of the visit.

Entrance interview conducted.

There is currently one (1) client attending the day program. The facility is a 1-story facility for clients with neurological injuries.
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.
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 10/7/2024.
Lunch is served to the clients attending the day program. The kitchen area was sufficiently stocked with two-day perishables and seven days of non-perishables. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean.
Medications, First Aid kit, and additional First Aid supplies are kept in the business office in a locked centrally stored cabinet. Four First Aid kits were observed to be complete.The facility stores an emergency crash cart in the medication room. Day program clients transport their medications to and from the facility through a check-in system monitored by Administrator and are stored in a locked cabinet while attending the day program.

Please continue to 809-C, Pg 2.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:	DATE: 10/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024

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: CAREMERIDIAN	FACILITY NUMBER: 425801991
	VISIT DATE: 10/29/2024

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Additionally, clients participate in planning day program activities including outdoor excursions to movies, meal planning, museums, bowling, parks, walks on the beach, and other local attractions. A medical director is on site once a week to oversee clients' medical needs. Clients receive initial evaluations to establish care, ongoing medical treatment as necessary, discharge planning, and medication management. Clients participate at will in the activities. Day program participants get one hour/week individually with the facility Psychologist and one hour/week of group therapy with the facility Psychologist.

LPA toured the outside area which included various shaded and non-shaded garden areas, sitting areas, and potted plants. There are two locked sheds with supplies, equipment, a generator, and other miscellaneous items. Both sheds are inaccessible to clients in care. Emergency food supplies and supplemental supplies are kept in the medication room under the locked medication cabinet.

The recycling bin, green waste bin, and trash bins are standard bins with flip lids. There are no bodies of water.
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: 10/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2024

LIC809 (FAS) - (06/04)

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