Senior Care Records.

Facility Evaluation Report

Antonio's Board and Care, Chula Vista08/31/2023Licence 374603148

Capacity4
Census4
Date signed08/31/2023 01:46:26 PM
The inspector’s account

Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Licensee Dulce Antonio.

Today's visit was in response to licensee’s self-reported death of Client #1 (C1), received at the CCLD San Diego Regional Office on 08/29/2023. [See LIC 811 Confidential Names List for a description of C1]. Per the report, C1 passed away on 08/29/2023.

LPA performed a facility tour / welfare check on remaining clients, collected pertinent records, and interviewed relevant staff. No deficiencies were observed or cited during today's visit.

An exit interview was conducted with Antonio, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction