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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603768
Report Date: 03/12/2025
Date Signed: 03/12/2025 10:39:31 AM

Document Has Been Signed on 03/12/2025 10:39 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRALIZED APP UNIT, 744 P STREET, MS 9-14-8201
SACRAMENTO, CA 95814
FACILITY NAME:ST. JUDE'S HOME FOR THE ELDERLY IIIFACILITY NUMBER:
198603768
ADMINISTRATOR/
DIRECTOR:		CORSENTINO, ANTOINETTEFACILITY TYPE:
740
ADDRESS:4942 BUFFINGTON ROADTELEPHONE:
(909) 263-3787
CITY:EL MONTESTATE: CAZIP CODE:
91732
CAPACITY: 6CENSUS: 5DATE:
03/12/2025
TYPE OF VISIT:OfficeANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Terry McGee Jr, Applicant
Antoinette Corsentino, Administrator		TIME VISIT/
INSPECTION COMPLETED:
09:53 AM
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Component II completion: Successful

Facility Type: Residential Care Facility for the Elderly (RCFE)
Application Type: Change in Ownership (CHOW)
Capacity: 6
Census (if any clients in care): 5
COMP II Participants: Terry McGee Jr, Applicant
Antoinette Corsentino, Administrator
Interview Method: Virtual interview (Microsoft Teams)

On March 12, 2025 at 9:00 AM, Applicant and Administrator participated in COMP II for the below pending facilities:
  • St. Jude’s Homes For The Elderly I—198603767
  • St. Jude’s Homes For The Elderly II—198603769
  • St. Jude’s Homes For The Elderly III—198603768

Identification of the Applicant and Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicant and Administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22.

During COMP II, CAB analyst confirmed Applicant and Administrator’s understanding of following areas:
1. Facility Operation: License Type, Client/Resident Populations, and Program.
2. Admission Policies
3. Staffing Requirements & Training
4. Restrictive/Prohibited Health Conditions
5. General Provisions
6. Emergency Preparedness
7. Complaints & Reporting
8. Pre-licensing Readiness

Exit interview conducted with Applicant and Administrator Report sent via email to applicant and informed to return sign copy to CAB by end of business day today.
SUPERVISORS NAME: Tracy Thompson
LICENSING EVALUATOR NAME: Celia Phomphachanh
LICENSING EVALUATOR SIGNATURE: DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/12/2025
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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