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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600449
Report Date: 09/14/2023
Date Signed: 09/14/2023 10:49:51 AM

Document Has Been Signed on 09/14/2023 10:49 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ST. ANTHONY'S BOARD AND CAREFACILITY NUMBER:
374600449
ADMINISTRATOR:BESSIE PASCUALFACILITY TYPE:
740
ADDRESS:6533 PLAZA RIDGE ROADTELEPHONE:
(619) 470-4571
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY: 6CENSUS: 5DATE:
09/14/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Bessie Pascual, AdministratorTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA), Carmen Lopez conducted an unannounced visit to deliver complaint findings and concurrently conducted a case management visit. LPA identified herself and was granted entry by Benachloe Sabio, caregiver. LPA stated the purpose of the visit and reviewed the basic elements of the visit with administrator Bessie Pascual.

LPA provided the facility with additional guidance for resident records. During the course of investigation, LPA reviewed residents’ documentation and observed that resident documents needed signatures and obtain a copy of resident #1 (R1) Individual Development Plan (IPP). The facility is being issued technical advisory and can be found on the LIC 9102TA.

An exit interview was conducted with administrator Bessie Pascual. A copy of this report along with Licensee/Appeal Rights (LIC9058 03/22) were provided to administrator Pascual at the conclusion of the visit. The signature below confirms the documents were received.
SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2023
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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