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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425850241
Report Date: 03/06/2024
Date Signed: 03/06/2024 11:18:12 AM


Document Has Been Signed on 03/06/2024 11:18 AM - 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:GARDEN COURT AT VILLA SANTA BARBARAFACILITY NUMBER:
425850241
ADMINISTRATOR:ROBERT GLOCKFACILITY TYPE:
740
ADDRESS:227 E. ANAPAMU STREETTELEPHONE:
(805) 963-4428
CITY:SANTA BARBARASTATE: CAZIP CODE:
93101
CAPACITY:126CENSUS: 89DATE:
03/06/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Robert Glock, Administrator & Karolyn Sorenson, Regional Operations SpecialistTIME COMPLETED:
11:15 AM
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On 03/06/2024, Licensing Program Analyst (LPA) Kristin Kontilis conducted an unannounced Case Management site visit with the purpose of following up on an immediate exclusion served to Staff #1 (S1) via certified mail. LPA met with Robert Glock, Executive Director and Karolyn Sorenson, Regional Operations Specialist for a Confirmation of Removal visit.

An immediate exclusion order for S1 was dated February 2, 2024, and provided via certified mail. S1 is excluded from any care facility licensed by the Department and is required to be removed from the facility. Administrator stated that S1 has not worked at the facility since 4/22/2018; however, S1’s fingerprint clearance was not disassociated and S1’s fingerprints carried over to the current facility license.

During this visit, the Administrator provided LPA with a copy of the current personnel roster to verify S1 is not working at the facility. During today’s visit, S1 was not observed in the facility at this time.

No citations issued during today's visit.

Exit interview was conducted with Administrator; a copy of the report was issued at the time of the visit.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2024
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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