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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600905
Report Date: 08/04/2020
Date Signed: 08/04/2020 01:20:08 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: 24DATE:
08/04/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Veronica VillalbandoTIME COMPLETED:
01:35 PM
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Licensing Program Manager (LPM) Marina Stanic and Licensing Program Analyst (LPA) Ruth Martinez made an unannounced visit to the facility for the purpose of conducting a case management visit. During today’s visit, LPM and LPA met with Sisters Veronica Villalbando, Maria De La Luz Acosta, Celena Rojas and Irma Padilla and representatives from the OC Health Care Department and explained the reason for the visit.

OC Health Care Department lead by Helene M. Calvet M.D., Deputy Medical Director advised the Administrator to discontinue the use of face mask with ventilation and wear surgical mask or N95 mask for safety purposes. It was observed that facility is low in gowns. The Department will supply facility with gowns, that will be delivered on August 5, 2020 to the facility. Residents that have moved out with family member were advised by Dr Calvet to return to facility at a later date. Meals to continued to be delivered to each resident rooms. Hand sanitizers to be mounted on the wall and spread out through the facility. Testing will be conducted by the end of this week. LPM Stanic and LPA Martinez will meet with the licensee and Administrator to finalize the contingence/emergency plan and improvements to the facility operations. LPM and LPA left a copy of the Department issued PINS and resources on CCLD website.

An exit interview was conducted and a copy of this report was provided to facility representatives.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Ruth MartinezTELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:

DATE: 08/04/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/04/2020
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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