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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603898
Report Date: 06/17/2025
Date Signed: 06/17/2025 11:18:42 AM

Document Has Been Signed on 06/17/2025 11:18 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:ST. JUDE'S ELDER CARE IVFACILITY NUMBER:
198603898
ADMINISTRATOR/
DIRECTOR:		RAGANO, SCOTTFACILITY TYPE:
740
ADDRESS:1324 SOUTH DONNA BETHTELEPHONE:
(909) 263-3787
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY: 6CENSUS: 0DATE:
06/17/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Scott Ragano and Judy Ragano - ApplicantsTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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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*****
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/17/2025
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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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)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 IV
FACILITY NUMBER: 198603898
VISIT DATE: 06/17/2025
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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.
NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 06/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/17/2025
LIC809 (FAS) - (06/04)
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