St. Paul's Home for the Elderly

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Blanca Gonzalez conducted an unannounced required annual visit. LPA was greeted by staff and the purpose of the visit was explained. Administrator Paul Shay and Caregiver Jade Robles arrived shortly after to assist with facility tour. The facility is licensed to serve six (6) non-ambulatory residents ages 60 and above. One (1) resident may be bedridden. The facility may retain six (6) hospice residents. The facility is a single-story home located in a residential area of Glendora. The home consists of the following: five (5) bedrooms, two (2) bathrooms, kitchen, dining area, receiving room, TV room, attached garage with laundry area, and backyard. LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following: Physical Plant and Environmental Safety: The front and backyard are well maintained and there are no pools or large bodies of water. There is a shaded area located in the backyard with sufficient seating for residents in care. Passageways and exits are free of obstructions. The water temperature was tested in bathroom #1 in the hallway and measured 110.1 degrees F, which is within the required 105 degrees F - 120 degrees F. Bathroom #2 water temperature measured 106.8 degrees F. LPA observed grab bars and non-skid mats in both the bathrooms. continued on LIC 809C continued from LIC 809 (page 2) Resident bedrooms all have required furniture which includes, for each resident, a bed, a chair, nightstand, and lights sufficient for reading. Resident beds have the required linen and linens were observed to be in good repair. There is closet storage space for clothing and other belongings.Hallway cabinet contained PPE supplies, surplus hygiene supplies and extra, clean linens. Smoke detectors were observed throughout the facility and are operable. There is a carbon monoxide detector located in the hallway, was tested and is operable. There are three (3) fire extinguishers located near the kitchen, garage and by back door. Emergency drills conducted quarterly, last drill conducted 10/3/25. All kitchen areas observed clean and free of litter, rodents, vermin and insects. Kitchen appliances such as refrigerators, stove and microwave are clean and were operating at the time of the visit. Sharps are locked in a kitchen drawer and are secured, inaccessible to residents. Cleaning supplies and disinfectants are secured under the sink and are inaccessible to the residents and separate from food supply. Sufficient supply of 2 days perishable and 7 days non-perishable foods were observed. Containers storing waste are in good repair and free of leaks.Telephone service on the premises Fireplace located in receiving room and TV room were observed to have covered screens, inaccessible to residents. Dining area and living room are clean and free of obstructions and have sufficient seating for residents in care. Attached garage has laundry area. Washing machine and dryer wear clean and operable at the time of visit. There is a cabinet with laundry supplies, cleaning supplies and excess PPEs. There is also a refrigerator and freezer with overflow of food supply. Staffing: Administrator and two (2) staff CPR training expired October 2025. Staffing sufficient in number and competent to meet resident need. LPA observed training logs for all staff. continued on LIC 809C (page 3) Personnel Records- training: LPA reviewed files for four (4) staff. Personnel record maintained for each employee to contain the following: criminal record clearance, first aid/CPR, fingerprint clearance, personnel record, health screening, TB test Residents Rights: Personal Rights are posted and observed in client files Planned Activities: LPA observed board games and books for resident use. Resident Records/Incident Reports: LPA reviewed five (5) resident files. Each file contained admission agreement, recent medical assessment, TB clearance, ambulatory status, medical consent form, identification/face sheet, appraisal needs and service plan, personal rights. Medications are centrally stored in the secured kitchen pantry. Medications are documented properly and given as prescribed. First Aid kit was fully stocked with current manual. Residents with Special Health Needs: Home health services provided for R4 to assist with G-tube Per California Code of Regulations, Title 22, and California Health and Safety Code, no deficiencies were cited during today’s visit. Exit interview held and a copy of this report was provided to Administrator Paul Shay.the state’s words, verbatim · CDSS document, Nov 21, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) S Vaid made an unannounced visit at the facility for the purpose of conducting the required annual inspection, using the Compliance and Regulatory Enforcement (CARE) Tool, to evaluate the facility. LPA Vaid met with House Manager, Jade Robles and explained the purpose for the visit. Licensee/Administrator, Paul Shay, arrived shortly after to assist with the visit. During today's visit, LPA Vaid conducted a tour of the physical plant with Jade, observed the facility food supplies, reviewed (6) resident medications, (6) resident files, (3) staff files, and conducted interviews with (2) staff and attempted with (6) residents. The facility is a single-story home, operating as a Residential Care Facility for the Elderly. It is licensed to serve (6) older adults, ages 60 and over. There is a fire clearance approved for (6) non-ambulatory residents, of which (1) may be bedridden. It has a hospice waiver approved for (6). Currently, there are (1) resident on hospice. All resident bedrooms were inspected and had the required furniture, storage space, and lighting. Bathrooms were equipped with a toilet, wash basin, and showers. They were observed to have the required grab bars and non-skid mats. The hot water was tested and measured and is in-compliance. The food supplies were observed and had the required 2-day perishables and 7-day non-perishables, as well as emergency food and water supply available. Fire extinguishers were observed throughout the premises, with current inspections and were fully charged. Walkways and ramps were observed to be free of debris and obstructions/hazards. Auditory devices were observed and operable at all entrances/exits of the facility. Sharps, cleaning supplies, and centrally stored medications were observed stored and inaccessible to residents in care. Laundry equipment was observed in good repair and operational during the visit. Sufficient linens, towels, and personal hygiene supplies were available. Continued on 809C...... The facility has an approved mitigation plan on file and a current infection control plan submitted to the department. Sufficient PPE supplies were observed. Smoke/carbon monoxide detectors were observed in each room. Last fire drill was conducted on July 2024. Staff and resident files were reviewed for required documentation and observed to be complete. Resident's medications were reviewed and observed to be documented properly and given as prescribed. During today's visit, no deficiencies were observed or cited. An exit interview conducted with Administrator. A copy of the report was provided.the state’s words, verbatim · CDSS document, Sep 10, 2024

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) V. Maldonado made an unannounced visit at the facility for the purpose of conducting the required annual inspection, using the Compliance and Regulatory Enforcement (CARE) Tool, to evaluate the facility. LPA Maldonado met with House Manager, Jade Robles and explained the purpose for the visit. Licensee/Administrator, Paul Shay, arrived shortly after to assist with the visit. During today's visit, LPA Maldonado conducted a tour of the physical plant with Jade, observed the facility food supplies, reviewed (4) resident medications, (4) resident files, (3) staff files, and conducted interviews with (2) staff and attempted with (4) residents. The facility is a single-story home, operating as an Residential Care Facility for the Elderly. It is licensed to serve (6) older adults, ages 60 and over. There is a fire clearance approved for (6) non-ambulatory residents, of which (1) may be bedridden. It has a hospice waiver approved for (6). Currently, there are (3) residents on hospice. All resident bedrooms were inspected and had the required furniture, storage space, and lighting. Bathrooms were equipped with a toilet, wash basin, and showers. They were observed to have the required grab bars and non-skid mats. The hot water was tested and measured at 114*F, which is in compliance. The food supplies was observed and had the required 2-day perishables and 7-day non-perishables, as well as emergency food and water supplies available. Fire extinguishers were observed throughout the premises, with current inspections and were fully charged. Walkways and ramps were observed to be free of debris and obstructions/hazards. Auditory devices were observed and operable at all entrances/exits of the facility. Sharps, cleaning supplies, and centrally stored medications were observed stored and inaccessible to residents in care. Laundry equipment was observed in good repair and operational during the visit. Sufficient linens, towels, and personal hygiene supplies were available. The facility has an approved mitigation plan on file and a current infection control plan submitted to the department. Sufficient PPE supplies were observed. Smoke/carbon monoxide detectors were observed in each room. Last fire drill was conducted on 10/15/23. Staff and resident files were reviewed for required documentation, and observed to be complete. Resident's medications were reviewed and observed to be documented properly and given as prescribed. During today's visit, no deficiencies were observed or cited. An exit interview conducted with Administrator. A copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 9, 2023