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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 425850288
Report Date: 09/06/2023
Date Signed: 09/06/2023 03:09:02 PM

Document Has Been Signed on 09/06/2023 03:09 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:ALPHA RESOURCE CENTER OF SANTA BARBARA(SLINGSHOTFACILITY NUMBER:
425850288
ADMINISTRATOR:WEITZMAN, JOSHUAFACILITY TYPE:
775
ADDRESS:1911 DE LA VINA ST.TELEPHONE:
(805) 770-3878
CITY:SANTA BARBARASTATE: CAZIP CODE:
93101
CAPACITY: 35CENSUS: 36DATE:
09/06/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Kelly Cottrell, AdministratorTIME COMPLETED:
04:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Kontilis conducted a Case Management - Annual Continuation visit to the facility above. LPA met with Administrator Kelly Cottrell and explained the purpose of the visit.

LPA checked on the prior Deficiencies and Technical Violations to make sure they were completed. Administrator Cottrell stated an earthquake and fire drill was conducted with all direct care staff on 8/22/2023. Administrator stated a disaster drill was conducted on 5/2/2023 with all direct care staff and a disaster drill will be conducted with clients in care on 9/20/2023.

LPA reviewed Personnel records for various trainings including First Aid/CPR training, criminal background clearance, and health screening. Administrator was unable to provide a health screening for Staff 1 (S1). S1 began employment on 10/22/2020.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D).

Exit interview conducted. Deficiency issued. Copy of report and Appeal Rights issued at the time of the visit.

SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Kristin Kontilis
LICENSING EVALUATOR SIGNATURE: DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/06/2023
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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Document Has Been Signed on 09/06/2023 03:09 PM - It Cannot Be Edited


Created By: Kristin Kontilis On 09/06/2023 at 02:04 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: ALPHA RESOURCE CENTER OF SANTA BARBARA(SLINGSHOT
FACILITY NUMBER: 425850288

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82066(a)(10)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator, and each employee. Each personnel record shall contain the following information: (10) A health screening, as specified in Section 82065(g).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and interviews conducted, the licensee did not comply with the section cited above when one staff out of six staff did not have a tuberculosis health screening which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/13/2023
Plan of Correction
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Administrator agrees to have a health screening including a TB clearance conducted for Staff 1 (S1). Administrator agrees to send the health screening results via email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Kelly Burley
LICENSING EVALUATOR NAME:Kristin Kontilis
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2023


LIC809 (FAS) - (06/04)
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