421703043-2-26-2026-29-AS-MJES-DRNTUP-20260226140239

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 421703043
Report Date: 02/26/2026
Date Signed: 02/26/2026 02:03:12 PM

Document Has Been Signed on 02/26/2026 02:03 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:	AVE'S BOARD AND CARE		FACILITY NUMBER:	421703043
ADMINISTRATOR/ DIRECTOR:	THELMA TABLADA		FACILITY TYPE:	740
ADDRESS:	111 CRESCENT AVE		TELEPHONE:	(805) 332-3139
CITY:	SANTA MARIA	STATE: CA	ZIP CODE:	93455
CAPACITY: 6		CENSUS: 6	DATE:	02/26/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:00 AM
MET WITH:	Administrator, Christine Ave's		TIME VISIT/ INSPECTION COMPLETED:	01:15 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	At 8:00am on 02/26/2026, Licensing Program Analyst (LPA) Jeffries and arrived unannounced to the facility to conduct the annual facility inspection, additionally, LPA deliver final findings on a separate complaint during this visit. . LPA's met with Administrator, Christine Ave announced who they are and the reason for there visit. Administrator has a designation of Administrator on file, however needs to submit Administrator packet to transition to full time Administrator at this facility. Administrator and LPA conducted a physical tour of the facility. This is a 6 bedroom 5 bathroom home with a side and back yard with ample space for residents and visitors. Four of the bedrooms are single resident occupancy and one bedroom is double resident occupancy and one bedroom is a staff bedroom. There is a living room, dining room and kitchen with and adjacent office and nook. LPA noted that the medications are stored and locked in the cabinet in the office adjacent to the kitchen and the complete first aide kit is also located in this office area. Emergency water is located in the garage and there is a staff room with day bed and chairs for staff. LPA noted that the facility has at least 2 days of perishable food supply and at least 7 days of non-perishable foods on hand for 6 residents and staff. LPA noted several fire extinguisher in the facility and garage that were all primed in the green reading. LPA's tested smoke detectors and carbon monoxide detectors to all be functional and working. LPA's noted that all passage ways are free and clear of obstacles. LPA's reviewed staff and resident files. LPA reviewed the facility infection control plan, emergency disaster plan, quarterly evacuation drills, and liability insurance. LPA also reviewed centrally stored medication records. LPA noted that no violations or citations were issued as a result of the facility physical inspection. LPA's conducted a full review of the annual facility care tools. LPA noted that no violations or citations were issued as a result of the full review of the annual care tools modules. At this time there are no violations or citations issued on this annual facility inspection. Exit interview, report read, and report provided.

NAME OF LICENSING PROGRAM MANAGER: Kelly Burley
NAME OF LICENSING PROGRAM ANALYST: Mark Jeffries
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 02/26/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2026

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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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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