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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374600449
Report Date: 10/05/2026
Date Signed: 10/05/2026 02:27:20 PM

Document Has Been Signed on 10/05/2026 02:27 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:ST. ANTHONY'S BOARD AND CAREFACILITY NUMBER:
374600449
ADMINISTRATOR/
DIRECTOR:		BESSIE PASCUALFACILITY TYPE:
740
ADDRESS:6533 PLAZA RIDGE ROADTELEPHONE:
(619) 470-4571
CITY:SAN DIEGOSTATE: CAZIP CODE:
92114
CAPACITY: 6CENSUS: 3DATE:
10/05/2026
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:08 PM
MET WITH:Bessie PascualTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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On 10/5/2026, Licensing Program Analyst (LPA) Grace Donato conducted an unannounced Case Management visit to St. Anthony’s Board and Care on behalf of LPA Maria “Mita” Partoza. LPA Donato met with Administrator Bessie Pascual and stated the purpose of the visit.

The Case Management visit was initiated as a result of additional licensing concerns identified during the Department’s review of complaint control number 08-AS-20240122101106. The complaint was initially assigned to LPA Rebecca Ruiz and was subsequently reassigned to LPA Partoza for completion. LPA Partoza reviewed the complaint history, interviews, resident records, medical records, and supporting documentation and identified the following licensing deficiencies requiring follow-up.

Deficiency #1 – Reappraisal not updated
CCR Title 22 §87463 – Reappraisals
On 01/26/2024, S1 stated that R1’s Care Plan had not been updated since R1’s admission in 2019 despite R1 experiencing increased weakness, injuries, hospitalization, and changes in care needs. S1 was unable to provide an updated Care Plan. On 02/01/2024, records provided to the Department did not include an updated appraisal reflecting R1’s current condition and care needs.
Based on interviews and records reviewed, the licensee did not ensure R1’s appraisal was updated to reflect R1’s current condition and care needs.

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Brenda Chan
Grace Donato
DATE: 10/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/05/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: ST. ANTHONY'S BOARD AND CARE
FACILITY NUMBER: 374600449
VISIT DATE: 10/05/2026
NARRATIVE
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Deficiency #2 – Resident records were not complete and current
CCR Title 22 §87506 – Resident Records
On 01/26/2024, S1 was unable to provide requested documentation regarding R1’s prior fall, injuries, and Care Plan. S1 stated that some of R1’s records had been left on the front porch and were damaged by rain. The Department also observed miscellaneous records pertaining to R1 maintained in a bag. On 01/30/2024, the Department contacted S1 again because requested records had not been received. On 02/01/2024, S1 provided R1’s face sheet and Physician’s Report dated 06/15/2022; however, requested records documenting R1’s prior incidents and an updated Care Plan were not provided.
Based on interviews and records reviewed, the licensee did not ensure R1’s resident record was complete, current, and available for Department review.

Deficiency #3 – Change in physical condition was not reported to the responsible person ---- CCR Title 22 §87466 – Observation of the Resident
On 01/12/2024, S1 and S3 observed a red area on R1’s coccyx. S3 described the area as approximately the size of a dime and red in color. S3 stated that medication was applied to the area. S1 stated that the area was treated with an ointment and covered with gauze. On 02/06/2024, RP stated that S1 did not notify RP when the skin condition was observed on 01/12/2024. RP stated that had notification occurred, R1 would have been medically evaluated sooner. Medical records reviewed by the Department stated that, on 01/16/2024, R1 had a Stage 2 pressure injury to the sacrum.
Based on interviews and records reviewed, the licensee did not ensure the observed change in R1’s physical condition was brought to the attention of R1’s responsible person.

Deficiency #4 – Facility was not maintained in a sanitary condition
CCR Title 22 §87303 – Maintenance and Operation
On 01/26/2024, the Department observed dirty dishes and open food on the kitchen counter. The staff member present began cleaning the area while the Department was at the facility.
Based on observation documented during the Department’s visit, the licensee did not ensure the facility was maintained in a clean and sanitary condition.

Deficiencies are cited in accordance with the California Code of Regulations, Title 22, and are documented on the attached LIC 809-D. An exit interview was conducted with Bessie Pascual. A copy of this report and appeal rights were provided.

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NAME OF LICENSING PROGRAM MANAGER: Brenda Chan
NAME OF LICENSING PROGRAM ANALYST: Grace Donato
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2026
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 10/05/2026 02:27 PM - It Cannot Be Edited


Created By: Grace Donato On 10/05/2026 at 01:14 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ST. ANTHONY'S BOARD AND CARE
FACILITY NUMBER: 374600449

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/05/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/06/2026
Section Cited
CCR
87463(a)

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87463(a) Reappraisals. The pre-admission appraisal shall be updated in writing…as frequently as necessary or once every 12 months…to note significant changes in condition…and to keep the appraisal accurate.
This requirement is not met as evidenced by:
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Licensee to submit updated resident reappraisals to LPA. Licensee to submit by POC deadline.
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Based on interview and records reviewed, the licensee did not ensure R1’s appraisal was current. On 01/26/24, S1 stated R1’s Care Plan had not been updated since 2019 despite changes in condition; on 02/01/24, no updated appraisal was provided. This poses a potential health and safety risk to residents in care.
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Type B
10/06/2026
Section Cited
CCR87506(a)

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87506(a) Resident Records. The licensee shall ensure that a separate, complete, and current record is maintained for each resident…and readily available to licensing agency staff.
This requirement is not met as evidenced by:
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Licensee to submit a plan ensuring the all resident records are updated and available upon request by licensing. Licensee to submit by POC deadline.
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Based on interview and records reviewed, the licensee did not ensure R1’s record was complete and current. On 01/26/24, S1 could not provide requested records and stated some were damaged by rain; on 02/01/24, requested records remained incomplete. This poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Brenda Chan
NAME OF LICENSING PROGRAM MANAGER:
Grace Donato
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/05/2026


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/05/2026 02:27 PM - It Cannot Be Edited


Created By: Grace Donato On 10/05/2026 at 01:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: ST. ANTHONY'S BOARD AND CARE
FACILITY NUMBER: 374600449

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/05/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/06/2026
Section Cited
CCR
87466

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87466 Observation of the Resident. When changes in a physical health condition are observed…the licensee shall ensure such changes are documented and brought to the attention of the resident’s physician and responsible person…
This requirement is not met as evidenced by:
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Licensee to submit a plan regarding in-service
training for staff about Observation of Resident. Licensee to submit by POC deadline.
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Based on interviews and records reviewed, the licensee did not ensure R1’s change in condition was reported to RP. On 01/12/24, staff observed a red area on R1’s coccyx; on 02/06/24, RP stated RP was not notified. This poses a potential health and safety risk to residents in care.
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Type B
10/06/2026
Section Cited
CCR87303(a)

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87303(a) Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times…
This requirement is not met as evidenced by:
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Licensee to submit a plan on how to keep facility clean, safe, sanitary and in good repair at all times.
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Based on observation, the licensee did not ensure the facility was maintained in a sanitary condition. On 01/26/24, dirty dishes and open food were observed on the kitchen counter. This poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Brenda Chan
NAME OF LICENSING PROGRAM MANAGER:
Grace Donato
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/05/2026


LIC809 (FAS) - (06/04)
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