St. Jude's Elder Care IV

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced Required- 1 year visit. LPA was met by Jinky Rose Nagai and Alex John Banal, Caregivers and explained the purpose of the visit. At 10:45am, Tiffany Vanderpoorten, designated Administrator arrived to drop off files. The facility is approved to serve residents age range 60 and above, (1) ambulatory & (5) non ambulatory. Hospice granted for (6). LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Infection Control: Infection control practices and Personal Protective Equipment (PPEs) were maintained. Staff are trained in the proper use of all required PPEs prior to being around residents. Bathroom has hygiene items such as paper towel, hand soap and toilet paper. Operational Requirements: Facility has working signal systems in exit points, with the exception of the exit door in one of the resident's bedrooms, which was not functioning when tested. Facility maintains liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) in the total annual aggregate and expires on 11/04/2026. Physical Plant/Environment Safety: The facility is a single story home located in a residential neighborhood which now consists of (7) bedrooms, one of which is a staff bedroom, (3) bathrooms, living room with covered fireplace, activity room with massage chairs, kitchen, dining area, laundry room and backyard with patio area. There are currently (6) residents, 60 years and older residing in the facility, (4) are under hospice care and (0) bedridden. LPA observed that the facility sketch submitted to CCLD did not match the actual lay out of the facility. LPA learned that the facility had finished construction where the garage was converted into (2) additional bedrooms and administrator failed to notify CCLD of the modification. The interior and exterior physical plant was inspected. Resident bedrooms were toured. Each bedroom has a smoke detector, linen, light, chair and sufficient closet space. The fireplace in the living room is adequately screened. Backyard was inspected and there are no swimming pool or bodies of water on the premises. There are (2) fire extinguishers in the facility which were serviced on 12/18/2025. Sufficient food supplies of 2 day perishable and at least a week of non-perishable are observed. Knives, cleaning solutions, and disinfectants are locked. Smoke alarms and carbon monoxide were tested and operable. Hot water temperature reading measured within the required 105 - 120 degrees Fahrenheit *****REPORT CONTINUED ON LIC809-C***** Staffing: A total of (3) caregivers including the Administrator provide care and supervision to the residents. One (1) staff provides night supervision and can assist in caring for residents in the event of an emergency. Staff employed are over the age of 18 and have criminal background clearance, fingerprint cleared, have the required training and associated to the facility. Personnel Records-Training: All three (3) staff files were reviewed for criminal background clearance and training. Personnel records have health/TB screenings. Administrator has completed the required Administrator courses and certificate is valid through 09/12/2027. Resident Rights-Information: Resident personal rights are posted. Facility provides internet services to all residents and have access to the facility phone. Facility provides initial and ongoing training for staff. Planned Activities: Information regarding Dementia is part of training for direct care staff and is included in the Plan of Operation. The facility provides sufficient space to accommodate both indoor and outdoor activities. Food Service: The kitchen was inspected and has sufficient supply of 2 day perishable & 7 day non-perishable food. Pesticides and cleaning supplies are kept away from the food preparation areas. Incidental Medical Services: Residents' medications were reviewed during the visit. The facility uses the centrally stored medication log to document medications given. Medications are stored in a locked cabinet and inaccessible to residents. However, LPA observed the cabinet to be unlocked during the inspection. Resident Records-Incident Reports: Six (6) resident files were reviewed containing admission agreements, Physician's Report, Medical/Functional assessments, Needs and Services Plans, TB clearance, Personal rights, Medical Consent, Medication Records. Disaster Preparedness: The facility has a complete Emergency Disaster and Mass Casualty Plan containing emergency evacuation, storage and preservation of medications, operation of manual assist devices. Fire drill conducted monthly, last fire drill was on 04/01/2026. Residents with SHN: Currently, there are no residents under hospice care. An Immediate Civil Penalty $500 was assessed due to a Fire Clearance Violation and deficiencies cited. Exit interview and a copy of this report along with the appeal rights were provided to Jinky Rose Nagai, Caregiver.the state’s words, verbatim · CDSS document, May 19, 2026

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Bennette Pena conducted an announced Pre-Licensing facility evaluation visit. LPA met with Scott Ragano and Judy Ragano, Applicants who assisted LPA with the visit. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and the following was inspected during the evaluation. The physical plant was toured inside and out, and the following are observed: Physical Plant & Environment Safety: The facility is in a residential neighborhood in the city of West Covina. This single-story home contains (5) bedrooms, (3) bathrooms, living room, family room/activity area, dining area, kitchen, laundry area, backyard and attached garage. Each bedroom has a smoke detector and sufficient closet space. There are no furniture such as bed, dresser, chair, bedside tables in all (5) bedrooms because the applicant will bring their furniture from another facility. The applicant also mentioned that residents can bring their own furniture if they wish. (2) bathrooms have grab bars and non skid mats, except for bathroom #3 which is designated for staff use only. Smoke alarms and carbon monoxide were tested and operable. Cleaning solutions, soaps, pesticides stored in a locked cabinet in the laundry area, stored separately from food supplies. Sufficient supply of linens available to permit weekly changing are available. Sufficient personal hygiene supply available. (1) fire extinguisher was observed mounted on the wall in the dining area and was recently serviced. Kitchen cabinets, refrigerator/freezer, oven, microwave, dishwasher, laundry machines are in working condition, clean and sanitary. The home has an auditory device that will alert staff to monitor exits. Doors, exits, hallways, and passageways were clear and free of obstruction. No pools or bodies of water were observed in or around the property. There are no firearms present at the property. The home does not have a video camera monitor system inside and outside the property. There is a covered outdoor patio area that is furnished for outdoor use. Equipment and supplies for indoor activities was observed and available for use. Hot water temperature readings were within the Title 22 Regulations requirement. Hot water readings were 109/112 deg F in bathroom #1, 111.7 deg F in bathroom #2 and 112.6 deg F in bathroom #3. ***CONTINUED ON LIC 809-C***** Operational Requirements: The Infection Control Plan has been submitted to CCL and the CAB Analyst. The facility has Infection Control Training Plan. The facility has a fire clearance granted by the City of West Covina Fire Department. Fire clearance granted for (1) ambulatory and (5) non ambulatory. Liability insurance is current and expires on 11/04/2025. Applicant stated that she will not handle residents' cash resources. One (1) operating telephone was observed and tested by LPA on the premises. Telephone is easily accessible and available for residents' use. Staffing: Both applicants are qualified Administrators to manage the facility. Personnel Records-Training: Staff files will be maintained at the facility and will be stored in a locked cabinet next to the dining area. Resident Rights-Information: Resident personal rights are posted. Facility provides internet service and phone to the residents. Planned Activities: Facility provides sufficient space to accommodate both indoor and outdoor activities. Food Service: Meals will be stored and prepared in a safe manner, necessary to meet the needs of residents. Food storage and preparation areas, which include pantries, cupboards, drawers and counters were observed to be clean and appropriate for food preparation. Appliances such as a microwave, refrigerator and stove were observed to be clean and operating properly. The refrigerator was observed to be at 40 degrees Fahrenheit and the freezer at 0 degrees Fahrenheit. Incidental Medical and Dental Care: The medications will be centrally stored in their original containers in a locked cabinet next to the dining area. A complete first aid kit is maintained, including current edition of the first aid manual. Resident Records-Incident Reports: Resident files will be maintained at the facility and will be stored in a locked cabinet next to the dining area. Disaster Preparedness: The home has a complete Emergency and Disaster Preparedness Plan that includes, EVAC Procedures, Transportation arrangements, Location of all utility shut-off valves and instructions for use. There is a contact information list of local emergency response personnel, residents authorized representative or local emergency contact name but not posted and visible to staff and residents. Component III was conducted at the Pre-Licensing visit, information provided about how to operate the facility within substantial compliance. Facility met the physical plant requirements/ inspection as required. An exit interview was conducted, and a copy of this report has been furnished to the applicant, Judy Ragano. 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.the state’s words, verbatim · CDSS document, Jun 17, 2025