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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425802118
Report Date: 04/26/2024
Date Signed: 04/26/2024 03:47:24 PM


Document Has Been Signed on 04/26/2024 03:47 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:OAK COTTAGE OF SANTA BARBARA MEMORY CAREFACILITY NUMBER:
425802118
ADMINISTRATOR:ANDREA KATZFACILITY TYPE:
740
ADDRESS:1820 DE LA VINA STREETTELEPHONE:
(805) 456-7270
CITY:SANTA BARBARASTATE: CAZIP CODE:
93101
CAPACITY:50CENSUS: 36DATE:
04/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Andrea Katz, AdministratorTIME COMPLETED:
04:00 PM
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Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced required Annual Inspection to the above-named facility. LPA met with Jovany Guerra, Senior Generations Program Director. Administrator Andrea Katz was not available at the time of the inspection. Per Generations Program Director, Andrea Katz submitted her resignation and her last day working in the facility was Thursday, April 25, 2024. LPA explained the purpose of the visit.
The facility is a two-story secured perimeter Residential Care Facility for the Elderly (RCFE). There are currently 36 residents in care with a Dementia diagnosis. There are nine (9) residents currently on hospice.
A tour of the physical environment and accommodations were assessed, and the following was noted: LPA observed the required posting of the complaint poster, bill of rights and Resident’s Rights. LPA inspected the facility for fire safety, personal accommodations, and food service. Fire inspection was conducted on 5/10/2021.
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. There are three (3) fire extinguishers. Each resident's room has a dual smoke alarm and carbon monoxide detector. First Aid kits are kept in the Medication area of the Nurse's station on Floor 2, the kitchen and reception area on Floor 1.
LPA observed the kitchen cabinets, refrigerator, and stove are clean. There is a sufficient amount of perishable foods for two (2) days and non-perishable foods for seven (7) days.
Residents participate at will in activities such as exercise classes, pet therapy, nature walks, puzzles, games, Happy Hour, virtual travel tours, excursions to local eateries, and scenic rides. Residents receive assistance with Assisted Daily Living (ADLs) needs such as toileting, bathing, showering, eating, feeding, transferring, laundry tasks, light housekeeping, and medication administration.

Please continue to 809-C, Pg 2.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/21/2024
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: OAK COTTAGE OF SANTA BARBARA MEMORY CARE
FACILITY NUMBER: 425802118
VISIT DATE: 04/26/2024
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 The front of the facility consists of a patio for visitation, concrete steps, concrete ramps, and concrete walkways. The back patio has a barbeque and outdoor furniture conducive for visitation.
The facility has 40 resident rooms. There are 4 shared bedrooms and 7 shared bathrooms. Each bedroom has a bed, nightstand, and lights to provide sufficient lighting.
Residents’ files were reviewed for health screenings, appraisals, and medication administration.
Due to time restraints, LPA will return at a later date to continue to annual inspection.

Exit interview conducted. No deficiencies cited. Copy of report issued at the time of the visit.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC809 (FAS) - (06/04)
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