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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607020
Report Date: 07/31/2024
Date Signed: 07/31/2024 12:08:38 PM

Document Has Been Signed on 07/31/2024 12:08 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:JOE-SEPHINE RESIDENTIAL CARE FAC. FOR THE ELDERLYFACILITY NUMBER:
197607020
ADMINISTRATOR/
DIRECTOR:		JOSEPHINE C. SANOYFACILITY TYPE:
740
ADDRESS:615 CURVE CIRCLETELEPHONE:
(661) 942-4307
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 3DATE:
07/31/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Josephine SanoyTIME VISIT/
INSPECTION COMPLETED:
12:22 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) Lorena Casillas conducted an unannounced one (1) year Required visit at this facility. LPA was greeted by Administrator Josephine Sanoy and informed of the purpose of the visit.

LPA observed one (1) resident watching TV the living room, one (1) was eating breakfast at the dining table and one (1) was asleep in their room.

A tour of the physical plant was conducted with the Administrator at 9:45 AM. The facility has four (4) bedrooms and two (2) bathrooms currently occupying three (3) residents. One (1) bedroom is designated for staff use only. The facility is Fire Cleared for three (3) non-ambulatory, one (1) bedridden, and a hospice waiver for one (1) resident.

Infection control: The facility has an Infection Control Plan approved on 06/09/2022. Hand washing, coughing etiquette, physical distancing and other necessary signs were posted in the bathroom and all over the facility.

Kitchen Area: At 10:00 am LPA conducted a tour of the kitchen and observed that there is sufficient stock of both two (2) day perishable and seven (7) day non-perishable food items. Frozen foods are properly wrapped and stored. Food storage and preparation areas are clean and inaccessible to pests. LPA observed all knives and sharp objects locked and inaccessible to residents in care. The medication cabinet was also observed to be locked. Cleaning supplies and chemicals were observed to be locked in the storage room.

Continued on LIC809-C

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/31/2024
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 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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
VISIT DATE: 07/31/2024
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
Living and dining: At 10:10 am LPA observed the living room to be neat and clean along with the dining room. The facility maintains a comfortable temperature at 74°F. The smoke detectors and carbon monoxide detectors were tested and observed to be operational. There is a fire extinguisher located in the living room. The Fire extinguisher was observed to be full and last serviced 6/18/24.

Garage/Laundry: At 10:15 am LPA observed the garage to be attached to the facility and is currently being used for storage. LPA observed a refrigerator and deep freezer in the garage. The Laundry room is located in the garage. All chemicals/hazardous items were observed to be locked in a cabinet.

Resident Rooms: At 10:20 am LPA observed rooms to have the appropriate bedding. There is a nightstand and sufficient lighting for each resident. All alarms on the exit doors are functional.

Bathrooms: At 10:22 am LPA observed all bathrooms to have the appropriate wash your hands signs posted, non-skid strips and handles. Hot water was tested and measured at 106.4 °F.

Outside Area: At 10:25 am LPA observed a covered shaded area for residents. No bodies of water on the premises. LPA observed all tools in a locked gated shed.

Staff Files: LPA conducted a file review of staff records at 10:30 am.

Resident Files: LPA conducted a file review of resident records at 11:00 am.

Interviews: At 11:45 am LPA interviewed residents and staff.

Administrative: LPA collected Certificate of Liability Insurance, resident roster, and LIC.500. Annual fee is current.

No citations issued. Exit interview conducted. Copy of this report was emailed to the Administrator.

SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/31/2024
LIC809 (FAS) - (06/04)
Page: 2 of 2