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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601166
Report Date: 05/17/2024
Date Signed: 05/17/2024 02:02:08 PM

Document Has Been Signed on 05/17/2024 02:02 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:ANTHONY GUEST HOMEFACILITY NUMBER:
374601166
ADMINISTRATOR/
DIRECTOR:		ANTONIO C. BALANZAFACILITY TYPE:
735
ADDRESS:14435 HIGH PINE STREETTELEPHONE:
(858) 748-3669
CITY:POWAYSTATE: CAZIP CODE:
92064
CAPACITY: 6CENSUS: 5DATE:
05/17/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Licensee BalanzaTIME VISIT/
INSPECTION COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA), Debbie Correia, made an unannounced visit to conduct the required One-Year Inspection. LPA Correia was greeted by Licensee Balanza, introduced herself and explained the purpose of the visit. The facility is licensed to serve six (6) clients aged 18 to 59, all six (6) of whom must be ambulatory.

LPA Correia conducted client records reviews for current Physician's Report, client Pre-appraisal, Needs & Services Plan/IPP, identification and emergency contact information, and Admission Agreement. LPA Correia also conducted personnel records reviews for First Aid/CPR certification, Criminal Record Clearance, TB clearance, and Health Screening Report, and required training. The facility carbon monoxide and smoke alarms were last inspected on May 23, 2023. The facilities last disaster drill was conducted on April 17, 2024.

[Continued on LIC 809C]
SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/17/2024
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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: ANTHONY GUEST HOME
FACILITY NUMBER: 374601166
VISIT DATE: 05/17/2024
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LPA Correia, accompanied by Licensee Balanza, conducted a facility tour, and inspected resident rooms. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Required postings were observed. Client bedrooms contained the required furnishings and client bathrooms, client showers were equipped with non-skid flooring and grab bars. Doors, windows and screens, toilets, and showers were in working order. Extra linens, hygiene supplies, and Personal Protective Equipment (PPE) were present..

The facility was equipped with emergency lighting, and first-aid kit and manual. Medications were housed in a locked cabinet. Cleaning supplies and other toxins were inaccessible to clients in care. There were no bodies of water on the facility property. Per Licensee Balanza there are no firearms or other weapons on the facility premises. The facility had a 7-day supply of non-perishable and a 2-day supply of perishable food. The facility’s ambient internal temperature was compliant, at 70 F. The facility's hot water temperature for faucets used by residents measured at 113.9 degrees Fahrenheit.

Based on today’s inspection, there are no deficiencies being cited. An exit interview was conducted and a copy of this report, and Licensee Rights - LIC 9058 (rev. 01/16) will be provided to Licensee Balanza, whose signature on this form acknowledges receipt of these documents.

SUPERVISORS NAME: Jennifer Lott
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE:

DATE: 05/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/17/2024
LIC809 (FAS) - (06/04)
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