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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700116
Report Date: 08/08/2024
Date Signed: 08/08/2024 11:33:11 AM


Document Has Been Signed on 08/08/2024 11:33 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:ST ANTHONY ADULT TRAINING PROGRAM 2FACILITY NUMBER:
342700116
ADMINISTRATOR:PALABAY, JOSEPHINEFACILITY TYPE:
775
ADDRESS:7171 BOWLING DRIVE SUITE 400TELEPHONE:
(916) 424-6306
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:45CENSUS: 44DATE:
08/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Matthew Enriquez, Assistant Administrator
Krystal Corpuz, Program Manager		TIME COMPLETED:
12:00 PM
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On 8/8/2024, Licensing Program Analyst (LPA) Tung Truong arrived at this facility unannounced to conduct a Required - 1 Year visit. LPA met with Program Manager Krystal Corpuz and explained the purpose of the visit. Assistant Administrator Matthew Enriquez arrived a bit later.

Administrator holds current certification and expires on 2/23/2025. The facility is licensed for 45 non-ambulatory clients. Current census is 44. LPA toured the facility with Krystal Corpuz.

LPA inspected the physical plant including but not limited to the common areas, office, kitchen, bathrooms, activity area and outside area of the facility to ensure compliance with Title 22 regulations. LPA observed the facility is clean and in good repair. Hot water temperatures were taken to make sure that the hot water being dispensed was within the allowed range of 105-120 degrees Fahrenheit. Facility thermostat observed at 71 degrees Fahrenheit. Fire extinguishers and first aid kits were up to date. LPA observed toxins to be locked away and inaccessible to clients. Smoke and carbon detectors were in good repair.

LPA requested resident and staff files for review. LPA reviewed (5) client files and (5) staff files, including criminal record clearances. A review of staff records indicates that all facility staff or other individuals who require caregiver background checks are fingerprint cleared and associated to the facility.

Report continued on 809-C
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:
DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: ST ANTHONY ADULT TRAINING PROGRAM 2
FACILITY NUMBER: 342700116
VISIT DATE: 08/08/2024
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The following forms and documents were requested to be submitted within 15 days:
LIC308 Designation of Administrative Responsibility, LIC 500 Personnel Report, Administrator Certificate, LIC610 Emergency Disaster Plan and Proof of Current Liability Insurance.

Per California Code of Regulations Title 22, no deficiencies were cited during this visit. Exit interview was conducted and a copy of this report was provided upon exit.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 214-5136
LICENSING EVALUATOR NAME: Tung TruongTELEPHONE: (916) 201-7895
LICENSING EVALUATOR SIGNATURE:

DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2024
LIC809 (FAS) - (06/04)
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