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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374600449
Report Date: 03/18/2024
Date Signed: 03/18/2024 12:28:30 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/12/2024 and conducted by Evaluator Carmen Lopez
PUBLIC
COMPLAINT CONTROL NUMBER: 08-AS-20240312153517
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: 3DATE:
03/18/2024
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:TIME COMPLETED:
12:30 PM
ALLEGATION(S):
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- Facility did not meet food supply requirements
- Licensee did not provide client access to telephone
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to open a complaint investigation. While at the facility LPA investigated and delivered findings regarding the above-mentioned allegations. LPA identified herself and was granted entry by Melchora Manalo, caregiver. LPA stated the purpose of the visit and reviewed the elements of the visit with caregiver Manalo. Licensee Bessie Pascual later arrived and joined the visit. LPA reviewed the findings of the complaint investigation with Licensee Pascual.

The Department’s investigation consisted of interviews with staff and outside source, records review of relevant documents pertinent to this investigation and LPA observations. On March 12, 2024, it was alleged that the facility did not meet food supply requirements and Licensee did not provide client access to telephone.

It was specifically said that the facility did not have sufficient food supply in the cabinets or for snacking. LPA spoke with the Licensee who said that they did not have sufficient food such as fruit and vegetables when they had an inspection from their third-party vendor.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 5
Control Number 08-AS-20240312153517
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 374600449
VISIT DATE: 03/18/2024
NARRATIVE
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As they did not have enough food supplies, they went grocery shopping to ensure items were enough. Licensee said that they did have more than enough meats in their freezer and their canned foods were in storage as they were cleaning their pantry. On March 18, 2024, during the visit, LPA observed that there were sufficient food items for three residents. There were at least 2 days of perishable food and 7 days of non-perishable food items stored which included fruit, vegetables, canned food items and snacks for the residents. Snacks included popcorn, crackers, muffins, and fruit. Based on the information obtained there is sufficient evidence to support the allegation and is being cleared during today’s visit.

It was specifically said that the licensee did not provide residents access to a telephone. Interviews with Licensee said that during their inspection from their third party-vendor they found out that their phone was inoperable. According to the Licensee, they contacted their phone company and had them come out to inspect their lines. According to the Licensee their phone company said that it was their phone that was inoperable. That same day, Licensee was able to purchase a new phone. During the visit on March 18, 2024, while LPA toured the facility, Licensee was able to show LPA the former phones that were inoperable. LPA was able to take photos of the inoperable phones. During the visit, LPA saw a new phone in the kitchen area and able to make a phone call with no issues. Based on the information obtained, there is sufficient evidence to support the allegation and is being cleared during today’s visit.

Based on the Department’s investigation of the above-mentioned allegations and the evidence obtained during staff and outside source interviews and LPA observations, there is sufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegations are deemed to be substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC9099-D.

The report was discussed, plan of correction was jointly developed, and an exit interview was conducted with Licensee Bessie Pascual. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) was provided to Licensee Pascual at the conclusion of the visit. The signature below confirms the receipt of these documents.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/12/2024 and conducted by Evaluator Carmen Lopez
COMPLAINT CONTROL NUMBER: 08-AS-20240312153517

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: 3DATE:
03/18/2024
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:TIME COMPLETED:
12:30 PM
ALLEGATION(S):
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- Licensee did not allow residents access to personal cash resources
- Licensee did not conduct emergency drills
- Licensee did not maintain current client records
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to open a complaint investigation. While at the facility LPA investigated and delivered findings regarding the above-mentioned allegations. LPA identified herself and was granted entry by Melchora Manalo, caregiver. LPA stated the purpose of the visit and reviewed the elements of the visit with caregiver Manalo. Licensee Bessie Pascual later arrived and joined the visit. LPA reviewed the findings of the complaint investigation with Licensee Pascual.

The Department’s investigation consisted of interviews with staff, records review of relevant documents pertinent to this investigation and LPA observations. On March 12, 2024, it was alleged that the Licensee did not allow residents access to personal cash resources; Licensee did not conduct emergency drills; and licensee did not maintain current client records.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 08-AS-20240312153517
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 374600449
VISIT DATE: 03/18/2024
NARRATIVE
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It was specifically alleged that the Licensee did not have the residents cash resources on the facility premise and was located off site. Interviews with Licensee said that they do have the funds on site in their room. Licensee demonstrated to LPA where the cash resource funds were located on the facility premise. On March 18, 2024, LPA toured the facility and observed where the Licensee kept the residents cash resources on the facility site. The binder was located where the Licensee resides when on the facility premise. Based on the information obtained there is insufficient evidence to support the allegation.

It was specifically alleged that there was no emergency fire drills, but then said that there were drills observed at a later date. Interviews with the Licensee said that they do have the fire drills. A review of records revealed that the fire drills are located in a binder for the last three years and going ongoing to four years. On March 18, 2024, LPA observed that the records were located in a locked area and had the drills up to date. They currently will need to have their next drill this month. Based on the information obtained, there is insufficient evident to support the allegation.

It was specifically alleged that the facility did not have the resident records current with Admission Agreements, IPPs and medical assessments. Interview with Licensee said that during their inspection with their third-party vendor they only mentioned that only one clients missing their Admission Agreement for their third party vendor. A review of records revealed that client records were all intact. There were three residents whom had their paperwork up to date. On March 18, 2024, LPA inspected their binders and was able to review the clients records. All records were up to date. Based on the information obtained, there is insufficient evidence to support the allegation.

Based on the Department’s investigation of the above-mentioned allegations and the evidence obtained during staff and outside source interviews, records reviewed, and LPA observations, there is insufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegations are deemed to be unsubstantiated.

The report was discussed and an exit interview was conducted with Licensee Bessie Pascual. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) were provided to Licensee Pascual at the conclusion of the visit. The signature below confirms the receipt of these documents.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 08-AS-20240312153517
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 CARE
FACILITY NUMBER: 374600449
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/18/2024
Section Cited
CCR
87555
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87555 General Fod Service Requirememts
Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This was not met as evidence by:
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POC has been cleared. LPA observed that there is 1 week of non-perishable food items and 2 days of perishable food items on the premise.
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Based on interviews, staff did not have sufficient food items during an inspection. This posed a potential health risk to 3 of 3 residents in care.
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Type B
03/18/2024
Section Cited
CCR
87468.1
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87468.1 Personal Rights of Residents in All Facilities
(14) To have reasonable access to telephones, to both make and receive confidential calls. This was not met as evidence by:
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POC has been cleared during the visit. LPA observed that there was an operable telephone working on the facility premise.
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Based on interviews, staff did not have a working telephone which posed a potential personal rights risk to 3 of 3 residents in care.
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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.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Carmen Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 5