425850001-2-28-2022-29-AS-KKOS-CC425W-20220228160613

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 425850001
Report Date: 02/28/2022
Date Signed: 02/28/2022 04:06:49 PM

COMPREHENSIVE INSPECTION

Document Has Been Signed on 02/28/2022 04:06 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:	VILLA ALAMAR		FACILITY NUMBER:	425850001
ADMINISTRATOR:	LEICHTER, MITCH		FACILITY TYPE:	740
ADDRESS:	45 E ALAMAR AVE		TELEPHONE:	(805) 682-9345
CITY:	SANTA BARBARA	STATE: CA	ZIP CODE:	93105
CAPACITY:	43	CENSUS: 26	DATE:	02/28/2022
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	02:05 PM
MET WITH:	Mitch Leichter, Administrator		TIME COMPLETED:	04:15 PM

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Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced continuance of an Annual Inspection and Infection Control Inspection visit to the facility. Due to time restraints, LPA continued the annual visit due from the inspection conducted on 2/25/2022. During today’s visit, LPA met with Mitch Leichter, Administrator, Corinne Satterthwaite, Wellness, Nurse, and Viviana “Ingrid” Lino, Director of Operations.

Entrance interview conducted.

There are currently twenty-six (26) Residents residing in the facility. The facility is a one-story facility to Residents with a dementia diagnosis and/or requiring assistance with daily living needs.

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.
The main entrance into the facility is through the office/reception area. Throughout the facility, there are sitting areas with coffee tables and bookshelves with books, magazines, newspapers and other reading materials.
The common areas, dining areas, and kitchen are neat and clean. The facility maintains a comfortable temperature. Hallways, bedroom doors, and walls are in good repair.
The facility looks out to a backyard area with covered patios and garden areas with chairs, tables, umbrellas, fountains, piped music, and is fenced in with a painted seascape mural.
There are approximately 25 shared bedrooms with a shared bathroom. There are approximately six residents in shared rooms and approximately 20 residents in private rooms. Bedroom #11 is a private room and shares a bathroom directly across the hallway. Bedroom #107 is a private single bedroom reserved for incontinent resident(s) with a shower room directly next door. All bathrooms throughout the facility have secure grab bars.

Please continue to 809-C, Pg 2.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2022

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: VILLA ALAMAR	FACILITY NUMBER: 425850001
	VISIT DATE: 02/28/2022

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The physical environment was checked for cleanliness and condition. Walls, windows, ceilings, floors and floor coverings, and doors were checked. The facility was seen to be in good repair inside and outside. Carbon monoxide alarms and smoke alarms are hard-wired and are directly connected to the local fire department.
The kitchen area was sufficiently stocked with two-day perishables and seven days of non-perishables. Frozen foods are properly wrapped and stored appropriately. LPA observed the kitchen cabinets, refrigerator, stove, and counters are clean.
Medications, First Aid kits, and additional first aid supplies are kept in the locked medication station. First aid kits were observed to be complete.
Residents participate at will in activities such as but not limited to an exercise program with various exercises, puzzle activities, arts and crafts, and musical entertainment. The facility contracts with the state-based Vitality program through the local community college.
Please continue to 809-C.
LPA observed Staff 1 (S1) and Staff 2 (S2) were not associated to the facility prior to working in the facility.
Pursuant to Title 22 Division 6 Chapter 8 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Civil penalties assessed.

Exit interview conducted, today's report and civil penalties were reviewed and emailed to Administrator. Report issued via email. Appeal rights issued via email.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2022

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/28/2022 04:06 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: VILLA ALAMAR	FACILITY NUMBER: 425850001
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/28/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/01/2022 Section Cited	1 2 3 4 5 6 7	87355(e)(2) Criminal Record Clearance: All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 87355(c) or...
	8 9 10 11 12 13 14	Based on interviews and record review, the licensee did not comply with the section cited above as the licensee did not ensure that two out of two staff (S1 and S2) were associated prior to working in the facility, which poses an immediate safety risk to persons in care.	8 9 10 11 12 13 14
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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.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin Kontilis	TELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:	DATE: 02/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2022

LIC809 (FAS) - (06/04)

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