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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425850001
Report Date: 03/22/2023
Date Signed: 03/22/2023 01:36:33 PM


Document Has Been Signed on 03/22/2023 01:36 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
WOODLAND HILLS NORTH, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:VILLA ALAMARFACILITY NUMBER:
425850001
ADMINISTRATOR:LEICHTER, MITCHFACILITY TYPE:
740
ADDRESS:45 E ALAMAR AVETELEPHONE:
(805) 682-9345
CITY:SANTA BARBARASTATE: CAZIP CODE:
93105
CAPACITY:43CENSUS: 27DATE:
03/22/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Karen Dacome, Associate Executive Director, Luciana Mitzkun Weston, Community Services DirectorTIME COMPLETED:
01:45 PM
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Licensing Program Analysts (LPAs) Brian Phillips and Jenny Olson conducted a Case Management - Incident visit to investigate an incident the facility self reported. LPA’s met with Karen Dacome, Associate Executive Director, Luciana Mitzkun Weston, Community Services Director and explained the purpose of the visit.

CCL received an incident report on 03/16/2023 stating that on 03/12/2023 a visitor witnessed a caregiver slapping a resident on the back of the resident's head while attempting to guide the resident into their room for a change of briefs. The alleged incident occurred on 03/12/2023 during a visit to the facility, but was not reported to facility administrator until 03/15/2023 via email.

LPAs toured the facility and interviewed Staff, residents and witness regarding the incident. LPAs requested relevant documents. At this time, further investigation is needed. LPAs will follow up at a later date to continue the investigation.

Exit interview conducted and a copy of the report was issued.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Brian PhillipsTELEPHONE: (805) 956-1636
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2023
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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