157204088-8-12-2026-24-AS-MMEA-DWVSRC-20260812140606

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157204088
Report Date: 08/12/2026
Date Signed: 08/12/2026 02:07:07 PM

Document Has Been Signed on 08/12/2026 02:07 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME:	ST. ANTHONY HOME		FACILITY NUMBER:	157204088
ADMINISTRATOR/ DIRECTOR:	ASIGNACION, JEAN		FACILITY TYPE:	740
ADDRESS:	11004 SILVER FALLS AVENUE		TELEPHONE:	(661) 587-6735
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93312
CAPACITY: 6		CENSUS: 4	DATE:	08/12/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Jean Asignacion		TIME VISIT/ INSPECTION COMPLETED:	02:20 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 8/12/2026, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required inspection. LPA arrived, introduced self, and allowed entrance by direct care staff. Administrator Jean Asignacion was at a medical appointment with a resident and arrived a short time later to conduct facility inspection with LPA LPA conducted facility tour with Staff 1 (S1) while awaiting Administrator to arrive. LPA observed all doors to have auditory alarms in place and operational at time of inspection. Currently, there are 4 residents residing in facility, there is 1 shared room, and 2 private room. LPA conducted facility tour with Administrator. Facility toured resident bedrooms and observed bedrooms to have required furnishings. Resident bathroom toured, LPA observed fixtures operational, there are grab bars, and skid resistant mats in the shower for residents. LPA observed lotions, mouthwash and miscellaneous items on bathroom counters in both shared bedroom and in hallway bathroom. Water temperature measured at 107.2 degrees F. All common areas have adequate seating available for residents. Kitchen toured, LPA observed some food items in both the refrigerator and freezer without dates and not be properly stored. LPA observed molded cheese slices in the refrigerator at time on inspection tour. LPA observed pantry with canned goods in need of cleaning and organization, there were items observed without expiration dates. LPA observed knives to be stored under kitchen sink however, lock to not be working properly. Fire extinguisher present with a purchase date of 4/10/26. Smoke detectors and carbon monoxide detectors observed operational during inspection.

See Moua
Melinda Medina
	DATE: 08/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: ST. ANTHONY HOME	FACILITY NUMBER: 157204088
	VISIT DATE: 08/12/2026

NARRATIVE

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LPA reviewed resident and staff files during visit.

Medications observed to be locked and secured in kitchen cabinet. LPA observed medications for R1 and R2 to be in medication bin but not logged on Medication Administration Record but said to be administered. LPA received current doctor's orders for medications during visit.

Outside of facility toured. LPA observed several gardening tools in the backyard unsecured and several items on the patio in need of storage or removal if not in use. LPA observed electrical outlet on back patio without a cover.

Designated fire exit free of obstruction, gate observed to be self-latching.

Deficiencies observed will be cited during office meeting to be held at Fresno Regional Office at future date. All immediate health & safety observations were secured at time of inspection visit.

Exit interview conducted with Administrator and a copy of this report provided for facility records.

NAME OF LICENSING PROGRAM MANAGER: See Moua
NAME OF LICENSING PROGRAM ANALYST: Melinda Medina
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 08/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2026

LIC809 (FAS) - (06/04)

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