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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425801995
Report Date: 02/17/2021
Date Signed: 04/19/2021 03:48:46 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:ALEXANDER GARDENSFACILITY NUMBER:
425801995
ADMINISTRATOR:LEICHTER, MITCHELLFACILITY TYPE:
740
ADDRESS:2120 SANTA BARBARA STTELEPHONE:
(805) 682-9644
CITY:SANTA BARBARASTATE: CAZIP CODE:
93105
CAPACITY:36CENSUS: 20DATE:
02/17/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:19 AM
MET WITH:Mitchell LeichterTIME COMPLETED:
11:36 AM
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Licensing Program Analyst (LPA) JoAnn Rosales conducted a case management visit telephonically with Administrator Mitchell Leichter due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures.

The purpose of today's visit is to follow up on a self-reported incident pertaining to Resident #1 (R1) who reported on 2/10/21, their personal rights were violated by Staff #1 (S1) on 3 separate occasions. S1 is currently on a leave of absence pending investigation. During today's visit LPA toured the facility and requested copies of pertinent documents. No immediate health and safety hazards were observed during today's visit. Further investigation will be conducted by Community Care Licensing Division's (CCLD) Investigations Branch (IB) Investigator Douglas Real.

A telephonic exit interview was conducted with Administrator, and a hard copy was provided via email for signature.
SUPERVISOR'S NAME: Kristin HeffernanTELEPHONE: (818) 596-4493
LICENSING EVALUATOR NAME: Joann RosalesTELEPHONE: (626) 419-4072
LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2021
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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