<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601166
Report Date: 10/28/2023
Date Signed: 10/30/2023 07:28:15 AM

Document Has Been Signed on 10/30/2023 07:28 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
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ANTHONY GUEST HOMEFACILITY NUMBER:
374601166
ADMINISTRATOR:ANTONIO C. BALANZAFACILITY TYPE:
735
ADDRESS:14435 HIGH PINE STREETTELEPHONE:
(858) 748-3669
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 6CENSUS: 5DATE:
10/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Caregiver Solena CantoTIME COMPLETED:
04:45 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
Licensing Program Analyst (LPA) Debbie Correia made an unannounced visit to the facility to conduct the required annual licensing inspection. LPA was met by Caregiver Canto, identified herself, was granted entry into the facility, and stated the purpose of today’s visit, to inspect the facility to ensure that the facility is in compliance with the rules and regulations of California Code of Regulations, Title 22, Division 6. There were 5 clients and 2 staff present during today's visit. LPA Correia conducted a general overall inspection. The facility is licensed to serves 6 clients, ages 18 to 59, and all of whom are ambulatory.

The facility temperature was 76 degrees Fahrenheit at the time of the visit. The client bathroom's hot water temperature measured 112 degrees Fahrenheit. Disinfectants, cleaning solutions, and poisons were inaccessible to clients. All client rooms were equipped with the required furnishings. Client bathrooms were observed to be sanitary and equipped with the required supplies. Showers had nonskid flooring. Lighting was maintained in hallways and passages to client bathrooms. Caregiver Canto provided each client with clean linen in good repair, and sufficient hygiene products for personal use. LPA Correia observed smoke alarms, and carbon monoxide detectors throughout the facility that were in operable condition. Per Caregiver Canto there are no weapons and/or ammunition housed in the facility, nor does the facility have any bodies of water on the premises.

SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: ANTHONY GUEST HOME
FACILITY NUMBER: 374601166
VISIT DATE: 10/28/2023
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
26
27
28
29
30
31
32
The facility is stocked with a 2 day supply of perishable and 7 day supply of nonperishable food items. The food was observed properly stored. Medications are stored in a locked cabinet and administered according to the label instructions. The facility's last disaster drill was conducted on 09/07/2023.

Per staff records reviewed, individuals subject to a criminal record review obtained clearance and/or an exemption; staff responsible for direct care and supervision have current First Aid and CPR training. Administrator Balanzo Certificate is current per the Adult and Senior Care (ASC) application website..



Based on today's visit, there were no deficiencies observed at this time in the areas evaluated. An exit interview was conducted with Caregiver Canto and will be provided with a copy of this report and licensee/appeal rights (LIC 9058 01/16), and their signature on this form acknowledges receipt of these documents.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2