425802106-11-12-2024-29-AS-KKOS-DAXMN6-20241112084457

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 425802106
Report Date: 11/08/2024
Date Signed: 11/12/2024 08:46:15 AM

Document Has Been Signed on 11/12/2024 08:46 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:	WESTMONT OF SANTA BARBARA		FACILITY NUMBER:	425802106
ADMINISTRATOR/ DIRECTOR:	ERNEST "EJ" LEWIS		FACILITY TYPE:	740
ADDRESS:	190 VIAJERO DR		TELEPHONE:	(805) 265-4327
CITY:	GOLETA	STATE: CA	ZIP CODE:	93117
CAPACITY: 99	TOTAL ENROLLED CHILDREN: 0	CENSUS: 68	DATE:	11/08/2024
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:10 AM
MET WITH:	Ernest "EJ" Lewis, Executive Director		TIME VISIT/ INSPECTION COMPLETED:	04:00 PM

NARRATIVE

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Licensing Program Analyst (LPA) Kristin Kontilis conducted a Case Management visit to address deficiencies noted during Complaint Control #29-AS-20241104104759 investigation visit conducted on 11/8/2024.

At approximately 11:21 am during a tour of the facility, LPA observed the carpet in a resident’s room is stained and soiled. Administrator stated on 10/22/2024, he learned from the Residents’ Council meeting that there are five residents’ rooms that need carpet cleaning service.

The following deficiencies were observed (See LIC 809-D) and cited from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Failure to correct the deficiency may result in additional civil penalties.

Kelly Burley	TELEPHONE: (805) 562-0413
Kristin Kontilis	TELEPHONE: (805) 689-2787
	DATE: 11/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024

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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Document Has Been Signed on 11/12/2024 08:46 AM - It Cannot Be Edited

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: WESTMONT OF SANTA BARBARA	FACILITY NUMBER: 425802106
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/08/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

87303(a) Maintenance and Operation: The facility shall be clean, safe, sanitary and in good repair at all times… This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4
	POC Due Date: 11/15/2024
	Plan of Correction
1 2 3 4	Administrator agrees to have carpets cleaned in five (5) resident's rooms no later than POC due date (11/15/2024). Administrator agrees to provide photographs of cleaned carpets via email on or before POC due date (11/15/2024).

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

Kelly Burley	TELEPHONE: (805) 562-0413
Kristin Kontilis	TELEPHONE: (805) 689-2787
	DATE: 11/08/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2024

LIC809 (FAS) - (06/04)

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