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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600905
Report Date: 03/01/2023
Date Signed: 03/01/2023 02:38:02 PM

Document Has Been Signed on 03/01/2023 02:38 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
ORANGE & INLAND A/SC, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ST. FRANCIS HOMEFACILITY NUMBER:
300600905
ADMINISTRATOR:ELIA CAROFACILITY TYPE:
740
ADDRESS:1718 WEST SIXTH STREETTELEPHONE:
(714) 542-0381
CITY:SANTA ANASTATE: CAZIP CODE:
92703
CAPACITY: 74CENSUS: 31DATE:
03/01/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Sister Elia CaroTIME COMPLETED:
03:00 PM
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Licensing Program Analyst (LPA), Ruth Martinez conducted an unannounced case management visit today. LPA arrived at facility was greeted and granted entry by staff and was signed in. LPA met with Sister Elia Caro, Administrator and explained the nature of the visit.

This visit is to follow up an incident report that was self reported on February 21, 2023 regarding R1 AWOL incident on February 19,2023. LPA completed a resident file review and interviewed staff. Per staff at 4:40pm on 02/29/23 R1 signed out of the community and Administrator asked if they would return in time for dinner. Per R1 they indicated they would be having dinner with a friend. Between 7:00pm – 8:00pm it was observed R1 had not returned to the facility and staff they immediately called R1 on her cell phone and called R1’s son. Per local Police Department a report could not be filed until 72 hours after. Upon the 72 hour mark facility Administrator made a police report for the absence of R1. Son of R1 reported that he had spoken to R1 and it was indicated that they did not wish to return to the facility because they did not want to live there any longer. Son indicated to Administrator that if that was his mothers wishes that was how it would be. Regardless of the indications Administrator continues to be proactive on finding R1 and have them return to the community. LPA took a tour of the physical plant of the facility and inspected R1’s bedroom. R1 has a private bedroom and it was observed personal belonging still remained in the bedroom.

LPA found that facility acted appropriately and in a timely manner to address the incident and all other immediate attention to incident in question. LPA did not observe any immediate and/or safety risks in or out of the facility.

This report was reviewed with Administrator and a copy of the report was provided and left at the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 03/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/01/2023
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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