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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600905
Report Date: 06/30/2020
Date Signed: 06/30/2020 01:30:27 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ST. FRANCIS HOMEFACILITY NUMBER:
300600905
ADMINISTRATOR:SR IRMA PADILLAFACILITY TYPE:
740
ADDRESS:1718 WEST SIXTH STREETTELEPHONE:
(714) 542-0381
CITY:SANTA ANASTATE: CAZIP CODE:
92703
CAPACITY:90CENSUS: 17DATE:
06/30/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:51 AM
MET WITH:Sister Veronica VillalbandoTIME COMPLETED:
01:45 PM
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Licensing Program Manager Alisa Ortiz and Licensing Program Analysts (LPAs) Kimberly Lyman and Albert Marin made an unannounced visit to the facility for purpose of conducting a case management visit. During today’s visit, LPM and LPAs met with Sister Veronica Villalbando and explained the reason for the visit.

The purpose of today's visit is to discuss options for support of the family during the Covid-19 outbreak.
During the visit, LPAs and LPM reviewed documentation and conducted a tour of the facility.















An exit interview was conducted and a copy of this report was provided to Sister Veronica Villalbando
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2020
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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