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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 507005360
Report Date: 04/28/2023
Date Signed: 05/02/2023 03:48:41 PM


Document Has Been Signed on 05/02/2023 03:48 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
SACRAMENTO AC/SC, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833



FACILITY NAME:ST. FRANCIS GUEST HOMEFACILITY NUMBER:
507005360
ADMINISTRATOR:ESTHER TOLIAOFACILITY TYPE:
740
ADDRESS:664 PARADISE ROADTELEPHONE:
(209) 622-0295
CITY:MODESTOSTATE: CAZIP CODE:
95351
CAPACITY:12CENSUS: 12DATE:
04/28/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Esther ToliaoTIME COMPLETED:
02:00 PM
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Unannounced Plan of Correction visit made out to this facility on 04/28/2023 by Licensing Program Analyst (LPA) Charlie Yang.
This LPA was met by the facility designated Administrator Esther Toliao who was briefly interviewed at this time.
The purpose of this visit was to review the correction that was required per prior visit conducted on 10/12/2022 for the following deficiencies:

The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

(1) The licensee shall take measures to keep the facility free of flies and other insects.
This facility was found to be deficient as evidenced by the presence of bed bugs in (2) resident rooms. This posed a potential threat to the Health, Safety, and Personal Rights of residents in care.

Evidence of a contracted pest control company was provided to eradicate the presence of bed bugs and other pests from this facility.

Plan of Correction clearance letter was created and a copy was provided to the facility designated Administrator at this time.

There were no deficiencies observed or cited during today's Plan of Correction visit.

Exit Interview
SUPERVISOR'S NAME: Liza KingTELEPHONE: (916) 263-4752
LICENSING EVALUATOR NAME: Charlie YangTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/28/2023
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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