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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425850025
Report Date: 08/02/2022
Date Signed: 08/02/2022 01:34:57 PM


Document Has Been Signed on 08/02/2022 01:34 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:SANTA MARIA TERRACEFACILITY NUMBER:
425850025
ADMINISTRATOR:ENRIQUEZ, SANJUANAFACILITY TYPE:
740
ADDRESS:1405 E MAIN STTELEPHONE:
(805) 925-8713
CITY:SANTA MARIASTATE: CAZIP CODE:
93454
CAPACITY:140CENSUS: 97DATE:
08/02/2022
TYPE OF VISIT:OfficeANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Joanna Enriquez, Administrator and Amy Bowman, Wellness DirectorTIME COMPLETED:
11:40 AM
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An Informal Conference was conducted today via Teams. The purpose of the Informal Conference was to discuss the multiple complaints received and deficiencies cited for Santa Maria Terrace.
Present at today’s meeting were: Kelly Burley, Licensing Program Manager (LPM); Jeannette Olson, Licensing Program Analyst; Joanna Enriquez, Administrator; and Amy Bowman, Wellness Director.

The Informal Conference process was explained to the Administrator. The Administrator was notified that this Informal Conference is a part of the Administrative Action process and that further citations may result in Probation or a formal Non-Compliance Plan, which could then lead to a referral to the Department's Legal Division for possible Administrative Action.



Today's conference addressed the following issues:
- Staffing
- Meeting the residents’ needs (showering, diapering needs, and call buttons)
- Incontinence supplies
- Physical plant
- Reporting
- COVID-19 Protocols

LPM Burley encouraged the Administrator to check the Provider Information Notices (PINs) on CCLD's website (www.ccld.ca.gov) to stay up to date on guidance.
LPM Burley also discussed the Administrator’s presence in the facility, and that the Administrator was helping at another facility multiple times per week. Administrator stated they are no longer going to the other facility multiple times a week, and have implemented the Wellness Director as a back-up designee if the Administrator is absent from the facility.
Exit interview. Report emailed for signature
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette OlsonTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2022
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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