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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603672
Report Date: 09/11/2023
Date Signed: 09/11/2023 12:27:13 PM

Document Has Been Signed on 09/11/2023 12:27 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ST. CHRISTOPHER AND JUDE HOME FOR THE ELDERLYFACILITY NUMBER:
198603672
ADMINISTRATOR:CORSENTINO, ANTOINETTEFACILITY TYPE:
740
ADDRESS:1506 S. CANDISH AVENUETELEPHONE:
(626) 335-0429
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY: 6CENSUS: 6DATE:
09/11/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:51 AM
MET WITH:Antoinette Corsentino and Barbara BoistonTIME COMPLETED:
12:36 PM
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Licensing Program Analyst (LPA) Alberto Lopez conducted an announced pre-licensed visit and met with Licensee Antoinette Corsentino and Administrator Barbara Boiston for the purpose of conducting a Pre-Licensing Inspection / Component III visit. This Pre-Licensing Inspection is due to change of ownership.

The facility has an approved fire clearance to be licensed to serve five (6) non-ambulatory clients. The facility is a single-story home: 4 bedrooms,1 staff room 3 bathrooms, dining/ living room, backyard with pool that is inaccessible to residents, and attached garage located in Glendora, CA.

The physical plant was toured inside and out alongside Antoinette Corsentino. Pre-Licensed Inspection Tool was used.


The following was observed/inspected:

· There is a locked storage area that is centrally located for medication.

· Cleaning supplies are kept separate from food and located in a locked cabinet..

· Facility walls, ceilings, floors, window screens and areas around the facility are clean and in good repair.

· Fire extinguisher and smoke detectors operate properly.

· Doors and passageways are free of obstruction.

· Pools/bodies of water at the facility are inaccessible to residents. .

· Facility does not have firearms on premises.

· Facility has sketch and sample menus.

(Continued on 809-C)

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 09/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/11/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: ST. CHRISTOPHER AND JUDE HOME FOR THE ELDERLY
FACILITY NUMBER: 198603672
VISIT DATE: 09/11/2023
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·There is an emergency exiting plan with emergency phone numbers posted.

· Facility has a current disaster and mass casualty plan maintained at the facility.

· There is a plan for employee accommodations and staffing arrangements.

· Operating telephone is on the premises and will be available to residents..

· Resident Records were observed and have all the appropriate documents/records in their file.

· First-aid supplies are maintained and readily available.

· Refrigerator and freezer were observed and are maintained at the correct temperatures.

· Food storage and preparation are clean and appropriate for food preparation.

· Hot water temperature was tested and measured between 113.3.-120.0 degrees F is within the required range of 105-120 degrees F.

Component III was completed during Pre-Licensing visit today.

An exit interview was conducted, and a copy of this report has been furnished to Licensee Antoinette Corsentino. Accordingly, LPA will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.

SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE:

DATE: 09/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2023
LIC809 (FAS) - (06/04)
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