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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425802110
Report Date: 02/22/2023
Date Signed: 02/22/2023 01:46:39 PM


Document Has Been Signed on 02/22/2023 01:46 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 3FACILITY NUMBER:
425802110
ADMINISTRATOR:DEMONTEVERDE, NORMAN RHODEFACILITY TYPE:
740
ADDRESS:126 SANTA ANA AVENUETELEPHONE:
(805) 683-0980
CITY:SANTA BARBARASTATE: CAZIP CODE:
93111
CAPACITY:6CENSUS: 5DATE:
02/22/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:35 AM
MET WITH:Licensee Rhoda Demonteverde TIME COMPLETED:
01:35 PM
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 At 11:35am on 02/22/2023, Licensing Program Analyst (LPA) Jeffries arrived unannounced at the facility to conduct the annual, infection control infection. LPA met with Licensee Rhoda Demonteverde and announced who he was and the reason for the visit. Licensee and LPA conducted annual for another facility on this same day prior to this inspection visit. LPA identified all staff present as cleared on the facility roster.

Administrator and LPA conducted a cursory walk through tour of the facility. This facility is a seven bedroom three bathroom, living room, kitchen and dining room. Six bedrooms are single resident occupancy, and one room is for live-in staff. The back yard had seating and shaded area for resident use outside. The facility is conformance of fire marshal regulations; there are fire detectors that are functioning and working throughout the facility. LPA observed a working carbon monoxide detector and currently tagged and functioning fire extinguisher. LPA observed that all resident rooms meet regulation requirements. LPA noted that the facility water temperature is within regulation range of 105*-120* (f). LPA observed two days of perishable and at least seven days of non-perishable foods on hand at the facility, additionally Licensee stated that Wednesdays are typical food shopping days for this and Licensees' other facilities(five total facility's). LPA observed that the facility was clean and in good repair and that all exits were clear of hazards. LPA did not observe any visible violations, or citations during the cursory walk through tour of the facility.

Licensee and LPA conducted the annual infection control module of the annual inspection. LPA noted that there were no other violations, technical, or citations as a result of the annual infection control module. LPA noted that there were no violations or citations issued as a result of this annual, infection control inspection.

Exit interview, report singed, and report provided.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark JeffriesTELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2023
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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