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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609943
Report Date: 11/18/2021
Date Signed: 11/18/2021 01:59:46 PM

Document Has Been Signed on 11/18/2021 01:59 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
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:JOCELYN'S LOVING CAREFACILITY NUMBER:
197609943
ADMINISTRATOR:ESPIRITU, JOCELYNFACILITY TYPE:
740
ADDRESS:803 N GENESEE AVETELEPHONE:
(323) 592-3100
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY: 6CENSUS: 4DATE:
11/18/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Jocelyn EspirituTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA) LaQueena Lacy arrived at the facility at 10:30am to conduct a One (1) year Required Infection Control visit. LPA meet with the administrator Jocelyn Espiritu and explained the purpose of this visit. A tour of the physical plant was conducted at 10:38am and the following was observed:

The facility has one main entrance being used, there are required Covid-19 prevention signage (hand washing, coughing etiquette and physical distancing) posted. The PPE screening station is located at the entrance of the facility and is equipped with sufficient PPE readily accessible thermometer, hand sanitizer, gloves, mask and sign in sheet at the time of visit, visitors are allowed in the facility in common areas or outside patio shaded area with tables and chairs for seating. The facility has six (6) bedrooms, one (1) is designated for staff and four (4) bathrooms. Fire Extinguisher located in the hallway near room 1 has a purchased receipt from Tashman Home Center dated 11/18/21. The facility maintains a comfortable temperature of 73 degrees.
The facility has an approved mitigation plan on file.

Kitchen: At 10:45am LPA observed the kitchen to be clean and an adequate supply of perishables and non-perishable food located in the refrigerator, freezer and second refrigerator located in the hallway near room five (5). Food was properly labeled and stored. Sharps were observed to be locked in a small box on the kitchen counter. Toxins and cleaning supplies observed to be locked and stored under the kitchen sink.
Continue on LIC 809C
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: LaQueena Lacy
LICENSING EVALUATOR SIGNATURE: DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/18/2021
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: JOCELYN'S LOVING CARE
FACILITY NUMBER: 197609943
VISIT DATE: 11/18/2021
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Food storage and preparation areas are clean and inaccessible to pests. The emergency food is stored in a cabinet located adjacent to the kitchen. Garbage cans observed to be with tight fitting lids.
Laundry Room: At 11:03am LPA observed the laundry room to be locked located near room (1)observed to be clean and clear from obstruction and storing toxins, poisons, and laundry supplies.
Medication: At 11:09am the medication cart was observed to be locked and located in the hallway near room (1). At 11:12am LPA observed the First Aid Kit and Manual located in a cabinet cupboard in the hallway near room (1), also storing extra wash and bath towels.
Storage Cabinets: LPA observed two (2) storage cabinets near room (6) at 11:27am. Storage (1) has PPE, incontinent supplies and personal care items, storage (2) has extra linens, mattress pads and comforters.
Client Rooms: At 11:39am LPA observed (6) bedrooms (1) is designated for staff. All bedrooms observed to be clean, properly furnished with appropriate bedding and linens and sufficient lighting.
Bathrooms: LPA observed three (3) out of (4) bathrooms at 11:52am. (2) out of (4) bathrooms are located in rooms (4) which is not being utilized, and room (1), The remaining (2) are for resident use, observed to be clean and in good repair and appropriate grab bars and non-slip skid mats. The hot water temperature measured at 107.6 between 111.9 degree fahrenheit. LPA observed appropriate hand washing signs posted in each bathroom, with paper towels and hand soap, hand towels and washcloths are not shared.
Living, dining room and common areas: At 12:05pm LPA observed all areas to have sufficient tablesand chairs for seating with sufficient lighting. Living room sofa and love seats observed to be in good repair clean and clear from obstruction.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: LaQueena Lacy
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
LIC809 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: JOCELYN'S LOVING CARE
FACILITY NUMBER: 197609943
VISIT DATE: 11/18/2021
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Surrounding grounds: LPA observed the outside and surrounding ground of the facility at 12:08pm observed to have a shaded area with tables and chairs for seating, observed to be clean and clear of debris. The facility has an attached garage observed to be locked and storing old bed furniture, wheelchairs, medical equipment and incontinent supplies.
No bodies of water observed on the property. At 12:15pm LPA tested and observed the carbon monoxide detector all smoke alarms in the living room, bedrooms, and hallways are operational and functioning properly.
No deficiencies issued, Exit Interview conducted, and copy of report issued.
SUPERVISORS NAME: Naira Margaryan
LICENSING EVALUATOR NAME: LaQueena Lacy
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2021
LIC809 (FAS) - (06/04)
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