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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607020
Report Date: 02/02/2024
Date Signed: 02/02/2024 10:39:39 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/31/2024 and conducted by Evaluator Lorena Casillas
COMPLAINT CONTROL NUMBER: 31-AS-20240131150759
FACILITY NAME:JOE-SEPHINE RESIDENTIAL CARE FAC. FOR THE ELDERLYFACILITY NUMBER:
197607020
ADMINISTRATOR:JOSEPHINE C. SANOYFACILITY TYPE:
740
ADDRESS:615 CURVE CIRCLETELEPHONE:
(661) 942-4307
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:4CENSUS: DATE:
02/02/2024
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Josephine SanoyTIME COMPLETED:
10:55 AM
ALLEGATION(S):
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Staff did not ensure non-skid mats were used in all bathtubs and showers.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Lorena Casillas conducted an unannounced initial 10day complaint visit at 9:45 am. LPA met with Administrator Josephine Sanoy and explained the purpose of the visit. LPA conducted a physical plant tour at 10:00 am.
It is alleged that residents do not have non-slip mats in their shower. LPA requested and obtained copies of facility files and documents including but not limited to staff and resident rosters.
LPA interviewed Administrator and staff at approximately 10:30 am. During the investigation the administrator and staff confirmed they do not provide non-slip mats to residents. LPA observed two (2) out of two (2) bathrooms to not have non-slip mats in the shower. Not having non-skid mat or strips is a potential slip and fall hazard.
Based on inspection, observations, and interviews there is enough evidence to prove the alleged violation did occur, therefore the allegation is SUBSTANTIATED at this time.
Deficiency cited. Exit interview conducted. Copy of report given to Administrator and appeal rights discussed.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 31-AS-20240131150759
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: JOE-SEPHINE RESIDENTIAL CARE FAC. FOR THE ELDERLY
FACILITY NUMBER: 197607020
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/02/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/05/2024
Section Cited
CCR
87030(e)(5)
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87303 Maintenance and Operation(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include...(5) Non-skid mats or strips shall be used in all bathtubs and showers. This requirement is not met as evidence by:
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Licensee will purchase non-slip mats for all bathroom showers and provide invoice to LPA by email by POC due date.
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During the time of the investigation LPA observed two (02) out of two (2) bathrooms to not have non-slip mats in the shower. This may pose a potential Health and Safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/02/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2024
LIC9099 (FAS) - (06/04)
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