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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425850043
Report Date: 07/14/2026
Date Signed: 07/14/2026 03:49:49 PM

Document Has Been Signed on 07/14/2026 03:49 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:PALS SANTA BARBARA AUTISM CENTERFACILITY NUMBER:
425850043
ADMINISTRATOR/
DIRECTOR:		HERNANDEZ, ARNOLDFACILITY TYPE:
775
ADDRESS:5385 HOLLISTER AVE BLD9 STE215TELEPHONE:
(805) 681-1676
CITY:GOLETASTATE: CAZIP CODE:
93111
CAPACITY: 30CENSUS: 14DATE:
07/14/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:55 AM
MET WITH:Arnold Hernandez, AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:25 PM
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Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced Annual Required Inspection. At the time of arrival, Administrator Arnold Hernandez was present, along with twelve (12) staff on duty, and twelve (12) participants present.
LPA conducted a physical tour of the facility. The facility operates in a leased building through ANKH Life Skills and contracts with Tri-Counties Regional Center. The facility staff are trained in CPI (non-crisis prevention intervention) and is a “hands off” facility.
The program provides community activities, recreational activities, and educational opportunities to participants with an Autism diagnosis. Participants participate in community service activities, music activities, individualized life skills, recreational activities such as basketball and volleyball, gardening, maintaining the nearby coy and duck ponds, and outings/excursions to local eateries, movie theaters, beaches and parks.
The facility has an administration office, a conference room, three (3) bathrooms, a locked supply room, computer lab, three (3) activity rooms, an infirmary, two relaxation rooms; a common area with a television set, board games, and musical instruments; lockers and hangers for personal belongings and a kitchen. The kitchen area consists of a refrigerator, microwave, sink and counter area. Sharps and centrally stored medications are kept in locked cabinets in the kitchen. All cleaning agents, disinfectants, and chemicals are stored in a locked supply room. LPA observed 12 carbon monoxide/smoke alarms were properly working.
A tour of the facility revealed that the program site is clean, safe, sanitary, and in good repair. The main entrance into the facility is through a gate leading into a courtyard. Participants can sit outside with two tables and two umbrellas and a garden area. There is a ramp with wheelchair access that enters the building. There are no bodies of water. The facility has seven (7) vehicles available for participant transportation.

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NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Kristin Kontilis
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
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: PALS SANTA BARBARA AUTISM CENTER
FACILITY NUMBER: 425850043
VISIT DATE: 07/14/2026
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There is a First Aid kit in the kitchen, and one in each of the seven facility vehicles. The two (2) fire extinguishers are located in the entrance and the exit of the building as well as one in each van. The fire extinguishers were last serviced on 10/24/2025.
LPA observed appropriate Community Care Licensing posters including Complaint poster, Mandated Reporter poster, Personal Rights, Emergency Disaster Plan, and COVID-19 guidelines.
Participants bring their own food and snacks; water is provided by the facility staff.
All staff have received a criminal background clearance and are properly associated to the facility. Records reviewed indicate all personnel and residents' records are current and up-to-date.

Exit interview conducted. No deficiencies noted. Copy of the report 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: 07/14/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/14/2026
LIC809 (FAS) - (06/04)
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