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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700116
Report Date: 06/23/2021
Date Signed: 10/01/2021 02:46:12 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
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:30CENSUS: 0DATE:
06/23/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:50 AM
MET WITH:Krystal CorpzTIME COMPLETED:
12:00 PM
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On 06/23/21 at 10:50 AM, Licensing Program Analyst (LPA) Suong Teh and LPA Christina Valerio arrived unannounced to conduct an annual inspection. LPA met with staff Krystal Corpz. informed LPAs that program is partially opened. Monday and Tuesday is opened for consumers but the rest of the week is zoom virtual activities. Matthew Enriquez arrived the Day Program @11:34 PM. Matthew called the Day Program Manager Jo Palabay but only received her voicemail.

This day program LIC 808 COVID-19 Mitigation was reviewed on 3/6/21 and sent back for correction. Currently licensing still has received the correction from Jo. Program operates with Alta Regional Center with a required ratio of 1 to 2. During today's visit, there were 0 clients present. LPA inspected main assembly room, facility bathrooms, and exterior area. Fire extinguishers were last serviced on 1/29/2021. Carbon monoxide and smoke detectors are operational.

LPA Valerio and LPA Teh toured the facility. All staff are Fingerprint cleared. LPA Valerio and LPA Teh measured the hot water temperature at 105 degrees Fahrenheit which is the required range of 105 to 120 degrees.

Exits were observed to be accessible to clients and free from obstructions.

There were no deficiencies. Appeal rights given, exit interview conducted
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Tuyet-Suong TehTELEPHONE: (916) 709-6830
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
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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