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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157204088
Report Date: 04/12/2023
Date Signed: 04/12/2023 11:03:44 AM


Document Has Been Signed on 04/12/2023 11:03 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:ST. ANTHONY HOMEFACILITY NUMBER:
157204088
ADMINISTRATOR:ASIGNACION, JEANFACILITY TYPE:
740
ADDRESS:11004 SILVER FALLS AVENUETELEPHONE:
(661) 587-6735
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:6CENSUS: 5DATE:
04/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
07:47 AM
MET WITH:Jean AsignacionTIME COMPLETED:
11:00 AM
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On 04/12/23, Licensing Program Analyst (LPA) M. Medina made a unannounced Annual Random inspection. LPA Medina introduced self and was allowed entrance by Administrator Jean Asignacion, Certificate #6005541740, expires 11/12/2023..

Currently, five (5) residents in care and present during inspection visit.

Facility tour began in resident bedrooms. Rooms observed to be sufficiently furnished with adequate lighting. Residents bathroom\s observed to be clean and in good repair. Bath/tub are have non-skid mats and grab bars. Hot water tested in both bathrooms with a water temperature of 105 degrees F. Dining room and living room have adequate seating and lighting for all residents in care. Tour of kitchen conducted. LPA observed a two (2) day supply of perishable food and a seven (7) day supply of nonperishable food on the premises.

Smoke Alarms tested & observed to be operational at time of visit. Carbon monoxide detector present and visible in hallway near kitchen. Fire extinguisher has a service date of 4/07/23. All cleaning supplies observed to be locked in secured cabinet in laundry room. Medications observed to be locked in small cabinets in laundry room.

Outside areas toured. All exits open freely and observed to be free of obstruction. No hazards observed.

Due to computer issues, this inspection will need to be continued at a later date.

No deficiencies cited during visit.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/12/2023
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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