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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300600905
Report Date: 01/07/2025
Date Signed: 01/07/2025 04:36:57 PM

Document Has Been Signed on 01/07/2025 04:36 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:ST. FRANCIS HOMEFACILITY NUMBER:
300600905
ADMINISTRATOR/
DIRECTOR:		VERONICA VILLALPANDOFACILITY TYPE:
740
ADDRESS:1718 WEST SIXTH STREETTELEPHONE:
(714) 542-0381
CITY:SANTA ANASTATE: CAZIP CODE:
92703
CAPACITY: 74TOTAL ENROLLED CHILDREN: 0CENSUS: 34DATE:
01/07/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:16 PM
MET WITH:Veronica Villalpando- AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:50 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Alvaro Ramirez, Jr. and Nancy Guillen conducted an unannounced visit for the Required 1 Year Inspection. LPAs explained the purpose of today’s visit, and were greeted and granted entry by Emma Vasquez. The Administrator (AD) Veronica Villalpando was notified by telephone and arrived shortly.

For today’s visit, LPAs observed a total of 34 residents in care.

LPAs toured the interior and exterior portions of the facility with AD Villalpando. The facility is a two story structure and is licensed for a capacity of 74 residents. There are a total of 75 bedrooms of which 60 are private bedrooms with private bathrooms. There are an additional five public bathrooms available in the hallways of the facility for resident useace, and. LPAs observed that bedrooms were provided with furniture in good repair, clean linens, adequate storage sp kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. Restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. LPAs observed bathrooms to have hand washing signs posted. Water temperature tested between 124.5.0-149 degrees Fahrenheit; a Deficiency was cited on today's date.

Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care. Fire extinguishers were charged with a service date of May 31, 2024.

During the tour LPAs observed a monthly activities calendar posted by the resident bedrooms hallway. LPAs also observed residents playing Bingo.

LPAs observed the emergency disaster and evacuation plan, located by the front receptionist desk.

Continued on LIC 809-C

Sheila SantosTELEPHONE: (714) 334-2062
Alvaro Ramirez Jr.TELEPHONE: 714-705-6007
DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/07/2025
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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Document Has Been Signed on 01/07/2025 04:36 PM - It Cannot Be Edited


Created By: Alvaro Ramirez Jr. On 01/07/2025 at 03:38 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ST. FRANCIS HOME
FACILITY NUMBER: 300600905

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(a)
Maintenance and Operation
(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited which poses a potential safety rights risk to persons in care. Side gate to exit building is non-operational. Door is closed shut using a brick and wood panel.
POC Due Date: 01/14/2025
Plan of Correction
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Licensee to email LPA proof of door being fixed by POC due date.
Type B
Section Cited
CCR
87303(e)(3)
Maintenance and Operation
(e) Water supplies and plumbing fixtures shall be maintained as follows: (3) Taps delivering water at 125 degree F (52 degrees C) or above shall be prominently identified by warning signs.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on water test, the licensee did not comply with the section cited above which poses a potential safety risk to persons in care. In one public restroom water tested at 149 degrees fahrenheit.
POC Due Date: 01/14/2025
Plan of Correction
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Licensee to email proof of regulated water temperatures to LPA by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sheila Santos
TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME:Alvaro Ramirez Jr.
TELEPHONE: 714-705-6007
LICENSING EVALUATOR SIGNATURE:
DATE: 01/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2025


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 01/07/2025 04:36 PM - It Cannot Be Edited


Created By: Alvaro Ramirez Jr. On 01/07/2025 at 03:38 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: ST. FRANCIS HOME
FACILITY NUMBER: 300600905

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.695(c)
Other Provisions
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill. While a facility may provide an opportunity for residents to participate in a drill, it shall not require any resident participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and the names of staff participating in the drill.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which posess a potential health and safety risk to persons in care. Quarterly drills conducted were not logged.
POC Due Date: 01/14/2025
Plan of Correction
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Licensee to conduct quarterly drills and document the trainings. Licensee to provide LPA proof by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sheila Santos
TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME:Alvaro Ramirez Jr.
TELEPHONE: 714-705-6007
LICENSING EVALUATOR SIGNATURE:
DATE: 01/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/07/2025


LIC809 (FAS) - (06/04)
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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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: ST. FRANCIS HOME
FACILITY NUMBER: 300600905
VISIT DATE: 01/07/2025
NARRATIVE
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Facility had back-up emergency food and water supply. LPAs observed that First Aid Kit had all the required components. LPAs observed that medications and toxins were locked and inaccessible to residents in care.

For the exterior portion, LPAs observed a shaded patio area with furniture, and observed that the grounds were free of any hazards. There are two exit gates in the backyard. One of the exits was in disrepair and being held shut by a brick and wood panel; a Deficiency was cited on today's date.

LPAs reviewed four resident files and four staff files. LPAs interviewed residents and staff present.

LPAs observed the licensee was not conducting quarterly drills; a Deficiency was cited on today's date.

Based on the observations made on today's inspection, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations.

An exit interview was conducted with AD Villalpando.

A copy of this report was provided at the time of exit.

SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-705-6007
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2025
LIC809 (FAS) - (06/04)
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