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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198601631
Report Date: 04/28/2023
Date Signed: 04/28/2023 02:29:02 PM

Document Has Been Signed on 04/28/2023 02:29 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. JUDE'S ELDER CARE IIIFACILITY NUMBER:
198601631
ADMINISTRATOR:JUDY RAGANOFACILITY TYPE:
740
ADDRESS:146 SHIRE COURTTELEPHONE:
(909) 263-3787
CITY:SAN DIMASSTATE: CAZIP CODE:
91773
CAPACITY: 6CENSUS: 6DATE:
04/28/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
12:27 PM
MET WITH:Judy Ragano TIME COMPLETED:
02:38 PM
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LPA Lopez made unannounced subsequent visit to facility to complete annual inspection, Initial Inspection was on 4/13/2023. LPA met with Josie Alberto DSP and Administrator Judy Ragano arrived a short time later. LPA explained the purpose of the visit.

LPA utilized the Compliance and Regulatory Enforcement (CARE) tools for the visit today and observed the following:
Operational Requirements The licensee provides care and supervision as required. Has fire clearance.
Staffing: There appears to be sufficient staffing at the facility. The administrator’s JC Castro certificate expires 11/14/23 Staff employed are all over the age of 18.
Personnel Records-Training: Staff files are maintained at the facility. Some staff have current CPR first aid training but not all staff. Facility has documentation on file that verify CPR for all staff.
Residents with Special Health Needs: The facility accepts and retains residents with dementia and/or hospice. The staff received training on appropriately caring for residents with dementia, those on hospice, and receiving oxygen. No Smoking - Oxygen in use signs are posted on the doors of residents using oxygen.
No deficiencies observed during todays visit.

Exit interview conducted and report and appeals rights provided to administrator Judy Ragano
SUPERVISORS NAME: Lisa Hicks
LICENSING EVALUATOR NAME: Alberto Lopez
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2023
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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