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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425802119
Report Date: 12/18/2025
Date Signed: 12/23/2025 02:50:43 PM

Document Has Been Signed on 12/23/2025 02:50 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:DEVEREUX CALIFORNIA - FOOTHILLFACILITY NUMBER:
425802119
ADMINISTRATOR/
DIRECTOR:		CECILIA LAURELFACILITY TYPE:
737
ADDRESS:4084 FOOTHILL RDTELEPHONE:
(805) 724-6679
CITY:SANTA BARBARASTATE: CAZIP CODE:
93110
CAPACITY: 4CENSUS: 3DATE:
12/18/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:13 AM
MET WITH:Cecilia Laurel, Program ManagerTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced required Annual Inspection at the above-named facility. Stephanie Cole, Quality Assurance Specialist, Tri-Counties Regional Center accompanied LPA during the visit. LPA met with Cecilia Laurel, Program Manager and explained the purpose of the visit.

Entrance interview conducted.

The facility is an Adult Residential Facility (ARF) – Enhanced Behavioral Support Home to clients with a developmental and/or intellectual disabilities diagnosis. There are currently three (3) clients residing in the one-story facility.
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.
LPA inspected the facility for fire safety, personal accommodations, and food service. The carbon monoxide detector and smoke alarms are in good working order. At approximately 11:05 am, LPA observed two (2) fire extinguishers last serviced on 4/16/2025.
A First Aid kit is located in the locked medication room and the staff office.
The kitchen area was sufficiently stocked with two-day perishables and seven days of non-perishables. LPA observed food items were stored correctly. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean.
Clients participate at will in activities including music therapy, speech therapy, animal therapy, holiday celebrations, participation in holiday events, on-line art classes, outings to local retail businesses, museums, movie theaters, local beaches and parks, special events, family outings, bowling, dance parties, and adult day programs.
Please continue to 809-C, Pg 2.

NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Kristin Kontilis
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 12/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/18/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: DEVEREUX CALIFORNIA - FOOTHILL
FACILITY NUMBER: 425802119
VISIT DATE: 12/18/2025
NARRATIVE
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 Personnel records were reviewed for trainings, health screenings, and background clearances. At approximately 2:15 pm, record review revealed Staff 1 (S1) has not been properly associated to the facility. Program Manager stated S1 has been working at the facility since 7/7/2025.
Clients’ records, medications, personnel documents and records of confidentiality are kept in the locked medication room and the staff office. Medications are administered as prescribed.
At approximately 2:45 pm, LPA reviewed incident report stating on 2/3/2025, a self-reported incident was submitted to Community Care Licensing Division (CCLD) stating on 1/31/2025, Staff 2 (S2) “noticed” three medications were missing from Client 1’s (C1’s) medications drawer. The missing medications included 1 tablet of Lamotrigine 100mg to be administered at 8 am on 1/31/2025; 1 tablet of Naltrexone 50mg to be administered at 8 am on 1/31/2025; and, 1 tablet of Resperidone 4mg to be administered at 8 am on 1/30/2025. Interviews conducted revealed C1 was properly administered medications on 1/30/2025 and 1/31/2025, however the unexplainable missed medications were never located.

Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiency was cited (refer to LIC 809-D):

Exit interview conducted. Copy of report and Appeal Rights issued at the time of the visit.

NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Kristin Kontilis
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 12/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2025
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/23/2025 02:50 PM - It Cannot Be Edited


Created By: Kristin Kontilis On 12/18/2025 at 04:00 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: DEVEREUX CALIFORNIA - FOOTHILL
FACILITY NUMBER: 425802119

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80061(e)(3)
80061(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 80019(f)…

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interview conducted, the licensee did not comply with the section cited above when S1 was not properly associated to the facility which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/19/2025
Plan of Correction
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Program Manager agrees to ensure all staff have been properly associated to the facility prior to working, residing, or volunteering in the facility. Program Manager agrees to have S1 properly associated to the facility within the next 24 hours.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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
NAME OF LICENSING PROGRAM MANAGER:
Kristin Kontilis
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/23/2025 02:50 PM - It Cannot Be Edited


Created By: Kristin Kontilis On 12/18/2025 at 04:25 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: DEVEREUX CALIFORNIA - FOOTHILL
FACILITY NUMBER: 425802119

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80072(a)(2)
80072(a)(2) Personal Rights (a) Except for children’s residential facilities, each client shall have personal rights which include, but are not limited to, the following: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment to meet his/her needs.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interviews conducted and records reviewed, the licensee did not comply with the section cited above as three medications were missing from C1’s bubble back which poses an immediate which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/19/2025
Plan of Correction
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Program Manager agrees to submit a written plan as to what action will be taken when medications become missing and/or a medication error occurrs. Program Manager will submit the Plan of Correction directly to LPA via email no later than the due date (12/19/2025).
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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
NAME OF LICENSING PROGRAM MANAGER:
Kristin Kontilis
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 12/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/18/2025


LIC809 (FAS) - (06/04)
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