<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603672
Report Date: 09/20/2025
Date Signed: 09/20/2025 12:51:16 PM

Document Has Been Signed on 09/20/2025 12:51 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
MONTEREY PARK ASC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ST. CHRISTOPHER AND JUDE HOME FOR THE ELDERLYFACILITY NUMBER:
198603672
ADMINISTRATOR/
DIRECTOR:		CORSENTINO, ANTOINETTEFACILITY TYPE:
740
ADDRESS:1506 S. CANDISH AVENUETELEPHONE:
(626) 335-0429
CITY:GLENDORASTATE: CAZIP CODE:
91740
CAPACITY: 6CENSUS: 4DATE:
09/20/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:31 AM
MET WITH:Agripina Maleon, CaregiverTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA), Mayra Cota, conducted an unannounced required annual inspection visit and met with Agripina Maleon, Caregiver. LPA Cota explained the reason for the visit and Maleon facilitated today’s inspection. Barbara Mitchell, House Manager, was informed of the visit telephonically and arrived thereafter.

The facility is licensed to care for adults in the age range (60) and over, (6) non-ambulatory with a hospice waiver for (6). The facility is operating within the scope of its license. There are currently (4) residents in care at the facility.

The facility is a single-story home located in a residential neighborhood of Glendora. The home consists of a living room, TV room, (4) resident bedrooms, (1) staff room (2) full bathrooms, kitchen, pantry, dining room, dining area for caregivers, front and backyard, side patio and pool, and detached garage with a laundry area.

During the visit, LPA toured the facility's indoor and outdoor environment, reviewed (4) resident and (3) staff records and conducted medication review. During today’s visit, LPA observed the following:

The facility was observed clean, inside and out. All walkways, passages, and exits are clear and free of debris and obstructions. Livingroom and dining area have sufficient seating, and furniture is in good repair. Kitchen was observed to be clean. Kitchen appliances are also clean and were operating at the time of visit. Cleaning supplies and toxins were observed locked in a cabinet under the kitchen sink and are inaccessible to residents. Knives/sharps were also properly locked in a kitchen drawer. A sufficient supply of (2) day perishable and (7) day non-perishable food was observed. Food in the refrigerator and pantry is labeled and kept within expiration limits. Fresh fruit was observed throughout the kitchen counters and menus are posted.

***Continues on LIC 809-C

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
Page: 2 of 5
Document Has Been Signed on 09/20/2025 12:51 PM - It Cannot Be Edited


Created By: Mayra Cota On 09/20/2025 at 12:05 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ST. CHRISTOPHER AND JUDE HOME FOR THE ELDERLY
FACILITY NUMBER: 198603672

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87458(a)
Medical Assessment
(a) Prior to a person's acceptance as a resident, the licensee shall obtain documentation of a medical assessment, signed by a licensed medical professional acting within the scope of their practice and made within the last year, to be kept in the resident's record.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, the licensee did not comply with the section cited above due to physician’s report for resident #3 being incomplete (report is missing elements and it is not signed by a physician) and resident #4 is missing a current physician’s report which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/03/2025
Plan of Correction
1
2
3
4
Licensee will submit a complete medical assessment (physician's report) for resident #3 and #4 and send proof to LPA via email by POC due date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Wei Siew Ho
NAME OF LICENSING PROGRAM MANAGER:
Mayra Cota
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2025


LIC809 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
MONTEREY PARK ASC, 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: 09/20/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Resident bedrooms have the required furniture such as bed frames, dressers, lamps, and chairs. Bedrooms also have sufficient closet space. Resident beds have the required linen and mattress pads. One (1) resident bedroom has a call button which was tested and observed to be working properly. Doors to the front entrance, backyard and to the pool patio have safety chime which were tested and working properly. Two (2) full bathrooms were inspected and were observed clean. The water temperature was tested in both bathrooms and measured within the required 105 - 120 degrees F. The laundry area in the garage is clean and the appliances were operable and in good repair. Detergents are kept locked in a cabinet. Garage was also observed to be locked and inaccessible to residents. Interconnected smoke detectors were observed throughout the facility and were tested and were working properly. One (1) carbon monoxide detector was observed and was also tested and working properly. There is (1) fire extinguisher located in the kitchen which was observed to be charged and last serviced on 4/16/25. Drills are conducted monthly. Last fire/safety drill was conducted on 9/4/25. First Aid kit was reviewed and observed to be properly stocked and to have all the required tools. The front and backyard are well maintained and the pool is inaccessible to residents in care. Patio is in good repair.

Three (3) staff files were reviewed; however, (1) caregiver was found to be on the premises without proper criminal background clearance. LPA interviews with (2) staff indicate that the uncleared individual is providing care at this facility for residents since 9/15/25. Three resident files were reviewed; however, physician’s report for resident #3 is incomplete. Report is missing elements and it is not signed by a physician. Also, resident #4 is missing a current physician’s report. Resident medication is centrally stored and kept locked in a cabinet. Resident medication was reviewed and was observed to be administered according to physician’s orders and documented appropriately.

Deficiencies are being cited, and a civil penalty is being assessed today under Title 22 Regulations during today's visit. Exit interview was conducted with Barbara Boiston, House Manager, and a copy of the reports, LIC 421BG and Appeal Rights were provided.

NAME OF LICENSING PROGRAM MANAGER: Wei Siew Ho
NAME OF LICENSING PROGRAM ANALYST: Mayra Cota
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 09/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/20/2025
LIC809 (FAS) - (06/04)
Page: 4 of 5
Document Has Been Signed on 09/20/2025 12:51 PM - It Cannot Be Edited


Created By: Mayra Cota On 09/20/2025 at 12:19 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: ST. CHRISTOPHER AND JUDE HOME FOR THE ELDERLY
FACILITY NUMBER: 198603672

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/20/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Request Denied
Type A
Section Cited
CCR
87355(e)(2)
87355(e)(2) Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Obtain a California clearance or a criminal record exemption as required by the Department…

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation and interviews the licensee did not comply with the section cited above due to: (1) caregiver was found to be on the premises without proper criminal background clearance. LPA interviews with (2) staff indicate that the uncleared individual is providing care at this facility for residents since 9/15/25, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/21/2025
Plan of Correction
1
2
3
4
Individual will leave the premises immediately on 9/20/25. Licensee will ensure staff is finrgerprinted and cleared prior to starting work at the facility by POC due date.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Wei Siew Ho
NAME OF LICENSING PROGRAM MANAGER:
Mayra Cota
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2025


LIC809 (FAS) - (06/04)
Page: 5 of 5