425802109-1-7-2025-29-AS-KKOS-DCQ28Z-20250107161111

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 425802109
Report Date: 01/07/2025
Date Signed: 01/07/2025 04:11:43 PM

Document Has Been Signed on 01/07/2025 04:11 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:	A CASA RHODA 2		FACILITY NUMBER:	425802109
ADMINISTRATOR/ DIRECTOR:	NORMAN DEMONTEVERDE		FACILITY TYPE:	740
ADDRESS:	165 SANTA ANA AVENUE		TELEPHONE:	(805) 964-4236
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93111
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 0	DATE:	01/07/2025
TYPE OF VISIT:	Case Management - Other	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:30 AM
MET WITH:	Licensee, Norma Demonteverde		TIME VISIT/ INSPECTION COMPLETED:	02:15 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 Case Management Closure visit to the facility. LPA met with Licensee Norma Demonteverde and explained the reason for the visit. On 12/10/2024, Licensee notified the Woodland Hills Regional Office (RO) the closure of the facility. During today’s visit, At the time of arrival, LPA observed personal mail with a postmarked date of 12/13/2024 addressed to former Resident 1 (R1) on a patio table outside the front door. Licensee’s family member answered the door and stated they are currently lives in the facility and no residents are currently residing in the facility. At approximately 11:44 am, Licensee Norma Demonteverde arrived at the facility. Administrator, Norman Demonteverde accompanied Licensee in the visit. Administrator Demonteverde stated R1 moved out of the facility on or about November 30, 2024. Administrator stated when medications, mail, and other personal items belonging to R1 are delivered to the facility, Administrator and another family member (FM1) of Licensee have been setting the items on the front porch for pick up by R1’s responsible party. Upon entry into the facility, Licensee verified no care and supervision was being provided to residents in care. During the facility tour of both indoor premises and the outdoor patio, LPA observed residents’ rooms and living space areas to be unoccupied at this time. LPA observed the facility’s staff room is currently being occupied by Licensee's family member. At approximately 12:10 pm, LPA observed binders and a large envelope containing records of confidentiality belonging to R1, Resident 2 (R2) and Resident 3 (R3) located in an unlocked cabinet located in the dining area of the facility. LPA also observed binders containing records of confidentiality belonging to Licensee, Administrator Demonteverde and numerous staff member located in the unlocked cabinet. The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies may result in civil penalties. Closure of the facility is contingent upon corrections of all deficiencies noted. Exit interview conducted. Due to technical issues, copy of report and Appeal Rights issued via email.

Kelly Burley	TELEPHONE: (805) 562-0413
Kristin Kontilis	TELEPHONE: (805) 689-2787
	DATE: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

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 01/07/2025 04:11 PM - 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: A CASA RHODA 2	FACILITY NUMBER: 425802109
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 01/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

80075(l) Health Related Services: Prescription medications which are not taken with the client upon termination of services, or which are not to be retained shall be destroyed by the facility administrator, or a designated substitute, and one other adult who is not a client.
	Deficient Practice Statement
1 2 3 4
	POC Due Date: 01/08/2025
	Plan of Correction
1 2 3 4	Licensee agrees to provide proof of correction in writing per regulation. Written statement will be submitted to LPA via email no later than due date.

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: 01/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025

LIC809 (FAS) - (06/04)

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