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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425850279
Report Date: 10/26/2022
Date Signed: 10/27/2022 09:54:11 AM


Document Has Been Signed on 10/27/2022 09:54 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:A CASA RHODA 1FACILITY NUMBER:
425850279
ADMINISTRATOR:DEMONTEVERDE, RHODA B.FACILITY TYPE:
740
ADDRESS:341 SANTA ROSALIA WAYTELEPHONE:
(805) 679-5208
CITY:SANTA BARBARASTATE: CAZIP CODE:
93111
CAPACITY:6CENSUS: 0DATE:
10/26/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Rhoda Demonteverde, AdministratorTIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) K. Kontilis conducted an announced pre-licensing visit to the facility. Today’s visit was conducted with Rhoda Demonteverde and Administrator, Norma Demonteverde, Co-Administrator.
The facility is a one-story home which will be licensed as a Residential Care Facility for the Elderly (RCFE). Currently, there are no residents residing in the facility.
Interview Conducted:
The facility has a fire clearance for one (1) bedridden (Bedroom #5) and four (4) non-ambulatory residents. The facility consists of a: living room, dining area, kitchen, four private bedrooms, one shared bedroom, one private staff room, two full bathrooms with hallway access, and front and backyards. There are no bodies of water.
Upon entrance of the residence, there is a walkway leading to the front door, garden areas, and a small sitting area.
The entrance into the residence leads into the living and dining area. The kitchen consists of a refrigerator, dishwasher, microwave, sink, stove and oven, and a trash can with a flip lid. Sharps and medications will be kept in locked kitchen cabinets and are inaccessible to residents in care. Emergency food will be kept in a locked pantry.
The living room and dining area are furnished with adequate furnishings to sustain a capacity of six residents.
There are two shared bathrooms off the hallway with access to all residents. Bathrooms have grab bars and non-skid flooring and mats.
The facility maintains a comfortable room temperature. Residents’ records, personnel documents and records of confidentiality will be kept in a locked file located in the dining area.
Please continue to 809-C, Pg 2.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:
DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/26/2022
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 2


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: A CASA RHODA 1
FACILITY NUMBER: 425850279
VISIT DATE: 10/26/2022
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 There are two shared bathrooms off the hallway with access to all residents. Bathrooms have grab bars and non-skid flooring and mats.
The facility maintains a comfortable room temperature. Residents’ records, personnel documents and records of confidentiality are kept in a locked file located in the dining area.
Residents may participate at will in various activities based on their individual interests and preferences.
The backyard consists of walkways, garden areas, sitting areas, covered patio, and a locked storage unit. Outdoor visitations may take place on the front and back patios.
Recycling, green waste, and trash bins are standardized bins with flip lids. Each side of the residence has an unlocked entrance/exit gate.
There are two carbon monoxide detectors, ten (10) smoke alarms, and one hard wired pull alarm that alerts the local fire department. A First Aid kit is kept in the locked cabinet in the dining room.
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. LPA inspected the one-story facility for fire safety and personal accommodations. First aid kit was observed to be complete. The facility floor plan was reviewed with no changes noted.
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. Fire inspection was conducted on 2/14/2022.
LPA determined that the facility has met licensing requirements per Title 22 California Code of Regulations.

Exit interview conducted. Report issued via email.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Kristin KontilisTELEPHONE: (805) 689-2787
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2022
LIC809 (FAS) - (06/04)
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