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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604614
Report Date: 02/28/2025
Date Signed: 02/28/2025 05:51:54 PM

Document Has Been Signed on 02/28/2025 05:51 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ANABELLA HOMECAREFACILITY NUMBER:
374604614
ADMINISTRATOR/
DIRECTOR:
VON RIVERA ALLANEFACILITY TYPE:
740
ADDRESS:14249 HIGH VALLEYTELEPHONE:
(406) 998-8022
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 6CENSUS: 6DATE:
02/28/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Caregiver Janet BalingitTIME VISIT/
INSPECTION COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to the facility to conduct an annual licensing inspection. LPA identified herself to Caregiver Janet Balingit and was granted entry into the facility. Administrator Bajaoisan was contacted and arrived at the facility to join the inspection. The facility is licensed to serve six (6) residents; of which all can be non-ambulatory and/or receiving Hospice Services, and 4 residents may be bedridden. During today's visit all 6 Residents were present.

LPA Correia conducted a resident records review and conducted a partial facility tour. Per today's facility visit resident records were complete and up to date. During the facility tour LPA observed smoke and carbon monoxide detectors were present and operable, as well as a fire extinguisher. The internal ambient temperature was 78 degrees Fahrenheit. The require posting were appropriately displayed, and the facility had a working landline. Sharps, toxins, and medications were locked and inaccessible to Residents in care.



An overall inspection of the facility began today however due to time constraints LPA was unable to complete the visit and will return later to conduct the remaining portion of this inspection.

No deficiencies were cited during today's visit. This report was discussed with Administrator Bajaoisan. A copy of the report and License Rights (01/2016) will be provided at the conclusion of the visit, and signature on this form acknowledges receipt of the rights and a copy of this report.
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2025
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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