St. Anthony's Board and Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPA identified herself and was granted entry by caregiver Benachloe Sabio. LPA discussed the purpose of the visit with caregiver Sabio. According to the facility’s license, there may be a maximum of 6 residents, 4 of whom may be non-ambulatory in approved bedrooms 1 & 5 at any given time at the facility site. The facility is approved for 2 hospice residents. During today’s inspection, the facility’s current census is 5 residents living at the facility. There were no residents present at the facility site during the inspection. LPA inspected the interior and exterior of the facility and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities. There were at least 2 days of perishable food, and at least 7 days of non-perishable food present. Cooking, dining equipment, and utensils were present and all safely stored. There were no toxic chemicals or poisons accessible to residents. Medications were properly labeled, as required, and stored in a locked cabinet, which LPA inspected. The facility-maintained medication logs, which LPA reviewed. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] No pools or bodies of water on the premises. There is was a fireplace which was not in use and inaccessible to clients. Per caregiver Sabio, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and the facility telephone were all working. A fire extinguisher was present (01) but needed to be serviced within the last 12 months. A first aid kit was complete and readily accessible. LPA spoke with a staff and resident, and reviewed staff and resident records. LPA interviews did not raise any licensing concerns. The files that LPA reviewed contained the required documents. Confidential records were stored in a locked area. Required licensing postings were observed in a visible area of the facility. There were deficiencies observed and cited during today's annual inspection, as well as Technical Violations (TV) and Technical Advisories (TA) issued, which may be found within this report. An exit interview was conducted with caregiver Benachloe Sabio, to whom a copy of this report, along with the Licensee/Appeal Rights (LIC9058 03/22), were provided at the conclusion of the visit. The signature below confirms that the documents were received. LPA requested caregiver Sabio to submit a current Designation of Administrative Responsibility (LIC 308), Personnel Report (LIC 500), and Emergency Disaster Plan (LIC610-E) to the licensing office within 10 business days. Forms are available at www.ccld.ca.gov.the state’s words, verbatim · CDSS document, Dec 5, 2025

The state marks this report as 13 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Allegation investigated: - Staff did not ensure resident is spoken to in an appropriate manner - Staff did not ensure medication is dispensed as prescribed - Licensee did not ensure staff is in good health to perform assigned tasks

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to open a complaint investigation. While at the facility, LPA investigated and delivered findings regarding the above-mentioned allegations. LPA identified herself and was granted entry by Benachloe Sabio, caregiver. LPA stated the purpose of the visit and reviewed the findings of the complaint with Licensee Bessie Pascual. The Department’s investigation consisted of interviews with staff and residents, and records review of relevant documents pertinent to this investigation. On October 8, 2025, it was said that staff did not speak with residents in an appropriate manner; staff did not ensure medication is dispensed as prescribed; and licensee did not ensure that staff is in good health to perform assigned tasks. It was specifically alleged that staff scream at residents in care and licensee did not ensure that staff were in good health to perform assigned tasks. Interview with the residents #1, 2, and 4 confirmed that the staff #1 (S1) did scream at them while in their care. (Continuation on LIC9099-C) Substantiated According to R1, they had to tell S1 not to scream at resident #2 (R2) who is unable to defend themselves. R1 said that they informed the Licensee and their daughter. According to R2, they were able to understand the questions and answer them in small words and were able to articulate and scream how S1 would scream at them. While LPA spoke with them, they seemed in an altered state and their eyes started to tear up. LPA was able to inquire how they are currently being treated, and they were able to say they were being treated better. Resident #4 (R4) did confirm that S1 did yell at everyone. According to resident #3 (R3), they were treated fine and S1 did not yell at them. Resident #5 was unable to be interviewed as they were unable to hear well and would change the conversation when LPA asked them questions multiple times. According to staff #2 they confirmed S1 would yell at the residents. Staff and residents did confirm that S1 was hard of hearing which Licensee confirmed. Licensee did inform LPA that S1 was hard of hearing and had vision issues. LPA inquired if they had any PCP notes for the staff that indicated they had any issues with their hearing and they did not. Licensee said that when they had asked S1 about yelling at residents they had denied they yelled at them. S1 had informed Licensee that they were unable to hear. According to staff #3 and 4 (S3 and S4), they had not heard any staff yell at residents. According to S5 they had observed S1 being burnt out the last few weeks when they would speak to them but did not observe S1 yelling at residents. It was specifically said that staff were unable to administer medications as prescribed. The facility was unable to provide a medication profile sheet for R1, but they did have a MAR from R1s pharmacy. The facility had just recently received their MAR but were using their own medication log. LPA was unable to obtain the accurate medications R1 was to take but was able to compare the medications to the pharmacy MAR and the facility MAR. There were discrepancies found during the review. The pharmacy MAR did not have three medications the facility had on their medication log and in R1s medications that are being administered. There was one medication that the bubble pack and the facility MAR had as a PRN, but the pharmacy log had the medication being administered two times daily. The pharmacy MAR had a medication that the facility MAR and the facility did not have. Based on the Department’s investigation of the above-mentioned allegations and the evidence obtained during staff and resident interviews, and records reviewed, there is sufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegations are deemed to be substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC9099D. The report was discussed, plan of correction was jointly developed, and an exit interview was conducted with Licensee Bessie Pascual. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) were provided to Licensee Pascual at the conclusion of the visit. The signature below confirms the receipt of these documents. They believed that R4 had taken them as they had previously taken their food items that are on the facility cub board. According to S2, they were informed that R1 had missing hats for a few days and decided to look for them alongside R1. S2 had found the hats in their assigned closet under their television and the rest behind their television. According to R1, nothing further was taken. R1 said that they keep their food items in their room, which LPA observed and confirmed. According to R1 they had bug bites prior to the facility being tented. LPA inquired if they had any bites after they had returned and they denied having any new bug bites on them. LPA confirmed with staff #2 and Licensee that the facility had been tented within the last month, between 09/18 – 21/2025. Licensee said that they had to remove the pesticides from the facility as the bi-monthly services were inadequate and there were still bugs around. Licensee said that so far they had not see any bugs since their return. It was specifically alleged that the food they only eat is a peanut butter and jelly sandwich with a salad for dinner. According to R1, they are fine with the food they eat at the facility. The Licensee recently took them to the store to purchase some food, snacks and hygiene products they wanted. They said that the food there is okay but better than the last place they lived. According to R2, they do like the food at the facility and had no issues with it. They like eating meatballs and spaghetti. According to R3, they liked the food especially pizza nights which they have weekly and eating pancakes. According to R4, they used to eat a lot of Filipino foods, but no longer eat that and currently eat cereals, hard boiled eggs, tea and coffee which is better than before. According to S2 and S3 they assist with meal preparation. S2 cooks the food and they attempt to make the meals that the residents prefer such as french toast, pancakes, coffee, tea, cereals, oatmeal, eggs, beef stew and other meals they prefer. LPA observed that the facility did have two refrigerators and pantry which held sufficient food items. Based on the Department’s investigation of the above-mentioned allegations and the evidence obtained during staff and outside source interviews, records reviewed, and LPA observations, there is insufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegations are deemed to be unsubstantiated. The report was discussed, and an exit interview was conducted with Licensee Bessie Pascual. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) were provided to Licensee Pascual at the conclusion of the visit. The signature below confirms the receipt of these documents.the state’s words, verbatim · CDSS document, Oct 15, 2025 · control 08-AS-20251008160719

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(1) · Plan of correction due date: Oct 17, 2025

Personal Rights of Resident in All Facilities (1) To be accorded dignity in their personal relationships with staff, residents, and other persons... This requirement was not met as evidenced by: Based on the Departments investigation during interviews there was confirmation that staff #1 (S1) would yell at three of 5 residents in care which posed an potential risk to residents in care.the state’s words, verbatim · CDSS document, Oct 15, 2025

Plan of correction: According to LIcensee, S1 is not currently working at this facility. This is deemed cleared during the visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(f) · Plan of correction due date: Oct 17, 2025

Personnel Requirements - General: (f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks...this requirement was not met as evidenced by: Based on the Department's investigation, during staff and resident interviews, they confirmed that S1, had hearing and vision conditions that needed to be addressed which posed an potential risk to 5 of 5 residents in care.the state’s words, verbatim · CDSS document, Oct 15, 2025

Plan of correction: Per the Licensee, S1 is no longer working at this facility. This is deemed cleared during the visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(e) · Plan of correction due date: Oct 16, 2025

Incidential Medical and Dental: e) For every prescription and nonprescription PRN medication for which the licensee provides assistance there shall be a signed, dated written order from a physician, on a prescription blank, maintained in the residents file, and a label on the medication. Both the physician's order and the label shall contain at least all of the following information... this requirement was not met as evidenced by: Based on the Departments investigation during the records review, the facility did not maintain an accurate MAR for resident #1 (R1) of 5 residents in care which posed an immediate health risk to 1 of 5 residents in care.the state’s words, verbatim · CDSS document, Oct 15, 2025

Plan of correction: Licensee agreed to contact R1s pharmacy and obtain medication sheets for all their residents and schedule staff to obtain medication training by POC due date, 10/16/2025.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPA Lopez identified herself, was granted entry by caregiver Benachloe Sabio. LPA discussed the purpose of the visit with caregiver Sabio and Licensee Bessie Pascual who later arrived and joined the visit. According to the facility’s license, there may be a maximum of six (6) residents in care, four (4) of whom may be non-ambulatory in rooms 1 & 5 in at any given time at the facility site. Facility is approved for 2 hospice residents. During today’s inspection, the facility’s current census is five (5) residents living at the facility. There were 2 residents present at the facility site during the inspection. LPA, accompanied by Licensee Pascual, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary and mostly in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Sink in bathroom #1 was observed to be leaking. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities. The facility’s ambient internal temperature was comfortable and compliant, at 70 degrees Fahrenheit (F). Hot water temperature at taps accessible to clients were also compliant: Kitchen sink measured hot water at 109.9 degrees F; sink in restroom #1 delivered hot water at 109.9 degrees F; and sink in restroom #2 delivered hot water at 111.6 degrees F. LPA observed that there were cockroaches located in bathroom #1. There was at least 2 days of perishable food, and at least 7 days non-perishable food present. Cooking/dining equipment and utensils were present, and all safely stored. There were no toxic chemicals/poisons accessible to residents. Medications were properly labeled, as required, and stored in a locked cabinet which LPA inspected. The facility - maintained medication logs which LPA reviewed. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] No pools or bodies of water on the premises. Per licensee Pascual, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher was present (01) and serviced within the last 12 months. First aid kit were complete and readily accessible. LPA spoke with staff and residents, and reviewed staff and resident records. During today’s visit there were 2 residents on the facility premise and three returned from their program during the visit. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in a locked area. Required licensing postings were observed in a visible area of the facility. There were deficiencies observed and cited during today's annual inspection and may be found on the LIC809-D page of this report. An exit interview was conducted with Licensee Bessie Pascual and Assistant Administrator Blythe Pascual to whom a copy of this report along with the Licensee/Appeal Rights (LIC9058 03/22) were provided to Licensee Pascual at the conclusion of the visit. The signature below confirms the documents were received. LPA requested Assistant Administrator Pascual and Licensee Pascual to submit a current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500, Emergency Disaster Plan LIC 610-E, and Residential Infection Control Plan LIC 9282 (6/23), to the licensing office within 10 business days. Forms are available at www.ccld.ca.gov.the state’s words, verbatim · CDSS document, Dec 4, 2024

The state marks this report as 6 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: - Facility did not meet food supply requirements - Licensee did not provide client access to telephone

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced complaint visit to open a complaint investigation. While at the facility LPA investigated and delivered findings regarding the above-mentioned allegations. LPA identified herself and was granted entry by Melchora Manalo, caregiver. LPA stated the purpose of the visit and reviewed the elements of the visit with caregiver Manalo. Licensee Bessie Pascual later arrived and joined the visit. LPA reviewed the findings of the complaint investigation with Licensee Pascual. The Department’s investigation consisted of interviews with staff and outside source, records review of relevant documents pertinent to this investigation and LPA observations. On March 12, 2024, it was alleged that the facility did not meet food supply requirements and Licensee did not provide client access to telephone. It was specifically said that the facility did not have sufficient food supply in the cabinets or for snacking. LPA spoke with the Licensee who said that they did not have sufficient food such as fruit and vegetables when they had an inspection from their third-party vendor. Substantiated As they did not have enough food supplies, they went grocery shopping to ensure items were enough. Licensee said that they did have more than enough meats in their freezer and their canned foods were in storage as they were cleaning their pantry. On March 18, 2024, during the visit, LPA observed that there were sufficient food items for three residents. There were at least 2 days of perishable food and 7 days of non-perishable food items stored which included fruit, vegetables, canned food items and snacks for the residents. Snacks included popcorn, crackers, muffins, and fruit. Based on the information obtained there is sufficient evidence to support the allegation and is being cleared during today’s visit. It was specifically said that the licensee did not provide residents access to a telephone. Interviews with Licensee said that during their inspection from their third party-vendor they found out that their phone was inoperable. According to the Licensee, they contacted their phone company and had them come out to inspect their lines. According to the Licensee their phone company said that it was their phone that was inoperable. That same day, Licensee was able to purchase a new phone. During the visit on March 18, 2024, while LPA toured the facility, Licensee was able to show LPA the former phones that were inoperable. LPA was able to take photos of the inoperable phones. During the visit, LPA saw a new phone in the kitchen area and able to make a phone call with no issues. Based on the information obtained, there is sufficient evidence to support the allegation and is being cleared during today’s visit. Based on the Department’s investigation of the above-mentioned allegations and the evidence obtained during staff and outside source interviews and LPA observations, there is sufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegations are deemed to be substantiated. California Code of Regulations, Title 22, Division 6, Chapter 8, is being cited on the attached LIC9099-D. The report was discussed, plan of correction was jointly developed, and an exit interview was conducted with Licensee Bessie Pascual. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) was provided to Licensee Pascual at the conclusion of the visit. The signature below confirms the receipt of these documents. It was specifically alleged that the Licensee did not have the residents cash resources on the facility premise and was located off site. Interviews with Licensee said that they do have the funds on site in their room. Licensee demonstrated to LPA where the cash resource funds were located on the facility premise. On March 18, 2024, LPA toured the facility and observed where the Licensee kept the residents cash resources on the facility site. The binder was located where the Licensee resides when on the facility premise. Based on the information obtained there is insufficient evidence to support the allegation. It was specifically alleged that there was no emergency fire drills, but then said that there were drills observed at a later date. Interviews with the Licensee said that they do have the fire drills. A review of records revealed that the fire drills are located in a binder for the last three years and going ongoing to four years. On March 18, 2024, LPA observed that the records were located in a locked area and had the drills up to date. They currently will need to have their next drill this month. Based on the information obtained, there is insufficient evident to support the allegation. It was specifically alleged that the facility did not have the resident records current with Admission Agreements, IPPs and medical assessments. Interview with Licensee said that during their inspection with their third-party vendor they only mentioned that only one clients missing their Admission Agreement for their third party vendor. A review of records revealed that client records were all intact. There were three residents whom had their paperwork up to date. On March 18, 2024, LPA inspected their binders and was able to review the clients records. All records were up to date. Based on the information obtained, there is insufficient evidence to support the allegation. Based on the Department’s investigation of the above-mentioned allegations and the evidence obtained during staff and outside source interviews, records reviewed, and LPA observations, there is insufficient evidence to meet the preponderance of evidence standard. Therefore, the above allegations are deemed to be unsubstantiated. The report was discussed and an exit interview was conducted with Licensee Bessie Pascual. A copy of this report along with Licensee/Appeal Rights (LIC9058 3/22) were provided to Licensee Pascual at the conclusion of the visit. The signature below confirms the receipt of these documents.the state’s words, verbatim · CDSS document, Mar 18, 2024 · control 08-AS-20240312153517

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555 · Plan of correction due date: Mar 18, 2024

87555 General Fod Service Requirememts Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This was not met as evidence by: Based on interviews, staff did not have sufficient food items during an inspection. This posed a potential health risk to 3 of 3 residents in care.the state’s words, verbatim · CDSS document, Mar 18, 2024

Plan of correction: POC has been cleared. LPA observed that there is 1 week of non-perishable food items and 2 days of perishable food items on the premise.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1 · Plan of correction due date: Mar 18, 2024

87468.1 Personal Rights of Residents in All Facilities (14) To have reasonable access to telephones, to both make and receive confidential calls. This was not met as evidence by: Based on interviews, staff did not have a working telephone which posed a potential personal rights risk to 3 of 3 residents in care.the state’s words, verbatim · CDSS document, Mar 18, 2024

Plan of correction: POC has been cleared during the visit. LPA observed that there was an operable telephone working on the facility premise.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Carmen Lopez conducted an unannounced required Annual Inspection. The facility file was reviewed prior to the visit. LPA Lopez identified herself, was granted entry by caregiver Nenita Abat. LPA discussed the purpose of the visit with caregiver Abat. Licensee Bessie Pascual later arrived and joined the visit. According to the facility’s license, there may be a maximum of six (6) residents; four (4) whom may be non-ambulatory approved in rooms 1 & 5, and two (2) approved for hospice, in at any given time at the facility site. During today’s inspection, the facility’s current census is 6 residents living at the facility. There were 5 residents present at the facility site during the inspection. The last resident returned from program during the inspection. LPA, accompanied by Licensee Pascual, toured the interior and exterior parts of the facility, and inspected each room. The facility was clean, sanitary and in good repair. Pathways were free of obstruction and slip hazards. Resident bedrooms contained the required furnishings. Doors, windows, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and activities. The facility’s ambient internal temperature was comfortable and compliant, at 68 degrees Fahrenheit (F). Hot water temperature at taps accessible to residents was not compliant before the visit was concluded: kitchen sink was a high of 135.1 degrees F; sink in restroom #1 delivered hot water at 130.8 degrees F; sink in restroom #2 delivered hot water at 129.6 degrees F. There was at least 2 days of perishable food, and at least 7 days non-perishable food present. Cooking/dining equipment and utensils were present, and all safely stored. There were no toxic chemicals/poisons accessible to residents. Medications were properly labeled, as required, and stored in locked areas. LPA inspected the medication room and found that medications were properly labeled and stored in a locked cabinet. The facility maintained medication logs which LPA reviewed. [CONTINUED ON LIC 809-C] [CONTINUED FROM LIC 809] No pools or bodies of water on the premises. Per licensee, no firearms or ammunition are kept at the facility. Carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher was present (01) and serviced within the last 12 months. First aid kit(s) were complete and readily accessible. LPA interviewed residents, and reviewed staff and resident records. During today’s visit there were 6 residents on the facility premise. LPA interviews did not raise any licensing concerns. The files which LPA reviewed contained required documents. Confidential records were stored in a locked area. Required licensing postings were observed in a visible area of the facility. There was deficiencies observed and cited during today's annual inspection along with a technical violation and a technical advisory. The deficiencies observed during today’s inspection may be reviewed and is included on the LIC809-D page. The report was discussed, a POC was jointly developed, and an exit interview was conducted with Licensee Bessie Pascual to whom a copy of this report along with the Licensee/Appeal Rights (LIC9058 03/22) were provided at the conclusion of the visit. The signature below confirms the documents were received. LPA requested Licensee Pascual to submit a current Designation of Administrative Responsibility LIC 308, Personnel Report LIC 500, Emergency Disaster Plan LIC 610-E, and Residential Infection Control Plan LIC 9282 (6/23), to the licensing office within 10 business days. Forms are available at www.ccld.ca.gov.the state’s words, verbatim · CDSS document, Dec 7, 2023

The state marks this report as 6 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.