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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609943
Report Date: 01/31/2026
Date Signed: 01/31/2026 11:38:59 AM

Document Has Been Signed on 01/31/2026 11:38 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:JOCELYN'S LOVING CAREFACILITY NUMBER:
197609943
ADMINISTRATOR/
DIRECTOR:		ESPIRITU, JOCELYNFACILITY TYPE:
740
ADDRESS:803 N GENESEE AVETELEPHONE:
(323) 592-3100
CITY:LOS ANGELESSTATE: CAZIP CODE:
90046
CAPACITY: 6CENSUS: 5DATE:
01/31/2026
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Jocelyn Espiritu-AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:00 PM
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On 1/31/26, 8:00 am, Licensing Program Analyst, (LPA) Raymond Comer, conducted an unannounced annual visit to this facility. LPA met with Facility Administrator, and reason for the visit was discussed.

Facility is licensed as a single-story residence. Fire clearance approved for six (6) Non-ambulatory residents, and one (1) bedridden. Hospice waiver for six (6). Facility has six (6) total bedrooms, (four private bedrooms, one shared bedroom, and one staff bedroom) with four (4) total bathrooms.

At 8:20 am, LPA conducted a tour of physical plant with the Administrator and observed the following:

Physical plant was inspected for cleanliness and condition. Facility’s main door is the primary entry/exit access. Screening area is located immediately upon entrance. Visitor sign-in sheet, hand sanitizer, gloves and masks are available. Room temperature is comfortable; wall thermostat displays a setting of 72.0°F., within the required range. An approved Mitigation and Infection Control plan is on file. Hand washing, coughing etiquette, and other necessary signage are prominently displayed throughout the facility. Required postings observed to be current. Disaster drills were last conducted on 1/02/26.

Fire Detection/Protection system is present in the facility. Dual Smoke and Carbon Monoxide detectors were tested and function properly. LPA observed two (2) fire extinguishers located in the dining room, and in the hallway. Extinguishers display service date: 12/25/25.

[LIC 809-C Continued]

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Raymond Comer
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 01/31/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2026
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: JOCELYN'S LOVING CARE
FACILITY NUMBER: 197609943
VISIT DATE: 01/31/2026
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Kitchen: At 09:00 am, LPA observed kitchen as clean, equipped with a functional stove, refrigerator, a second refrigerator, (located in hallway near bedroom #05), multiple appliances, with adequate supply of perishables and non-perishable food. Emergency food is stored in a cabinet located adjacent to the kitchen. Food is observed as properly labeled and stored. Kitchen cabinets store dishes, plastic, paper goods and utensils. Knives and sharps are secured in a locked kitchen drawer and inaccessible to residents.

Medications At 9:20 am, LPA observed a secured medication cart, located in hallway area near bedroom#1. Medications are listed on a centrally stored medication and destruction record log. A stocked first aid kit and manual was observed in hallway area cabinets.



Laundry area is located near bedroom#01. Laundry soaps and other cleaning agents are stored and inaccessible to residents. LPA observed two storage cabinets located near bedroom#6. Each storage room contains PPE, incontinent supplies, personal care items, linens, mattress pads, comforters, towels, clean linen and blankets sufficient for residents.

Commons: LPA observed living room and resident dining area. Common areas observed as clean and organized. Furniture provides adequate seating for residents and is in good condition. Activities are observed in living room area dresser which stores arts and crafts, board games, puzzles etc.

Bedrooms are observed as clean, with sufficient lighting, properly furnished with sufficient closet space, bedding, linens, at least one chair, and night stand.

Bathrooms were observed to be clean and sanitary, with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hand towels and washcloths are not shared. Hot water temperature measured at 116°F., Within the required range.

Garage is attached and observed to be locked and inaccessible to residents. Garage stores bedroom furniture, wheelchairs, and medical equipment.

Outdoor At 10:10 am, LPA observed outdoor area to have a shaded patio, with table with sufficient seating for the residents. Outdoor furniture observed to be in good condition. All trash cans were observed to be covered. There are no bodies of water in the facility.

[LIC 809-C Continued]

NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Raymond Comer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/31/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2026
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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: JOCELYN'S LOVING CARE
FACILITY NUMBER: 197609943
VISIT DATE: 01/31/2026
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Resident records: Cabinets in the living room area are locked and inaccessible to residents. A total of five (5) Resident files were reviewed for current IPP and/or Needs and Services plans, physician report, and admission agreements. LPA observed that file for Resident #3 (R3) did not contain record of tuberculosis tests or chest exams. This deficiency is cited on the corresponding LIC 809-D page.

Staff records: Cabinets in the living room area are locked and inaccessible to residents. A total of four (4) Staff files were reviewed. Criminal record clearances were present, and Staff are associated to this facility. LPA observed that file for staff #2 and staff#3 are incomplete; records are missing Health Screening Report (LIC503) This deficiency is cited on the corresponding LIC 809-D page.

An exit interview was conducted, deficiencies were issued, appeals rights and a copy of this report was provided to the administrator.
NAME OF LICENSING PROGRAM MANAGER: Nichelle Gillyard
NAME OF LICENSING PROGRAM ANALYST: Raymond Comer
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 01/31/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2026
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 01/31/2026 11:39 AM - It Cannot Be Edited


Created By: Raymond Comer On 01/31/2026 at 11:14 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: JOCELYN'S LOVING CARE
FACILITY NUMBER: 197609943

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87412(a)(11)
Personnel Records
(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411, Personnel Requirements - General.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA record review, the licensee did not comply with the section cited above in two (2) out of a total of four (4) staff files reviewed, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/14/2026
Plan of Correction
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The Administrator shall submit completed LIC503 Health Screening Report for staff #2 and Staff#3 to CCL.
Type B
Section Cited
CCR
87458(c)(1)(A)
Medical Assessment
(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA record review, the licensee did not comply with the section cited above in one (1) out of a total five (5) resident files reviewed, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/14/2026
Plan of Correction
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Licensee will ensure that tuberculosis medical records test and results for Resident#3 (R3) are current and will submit proof to LPA by POC date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Nichelle Gillyard
NAME OF LICENSING PROGRAM MANAGER:
Raymond Comer
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 01/31/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2026


LIC809 (FAS) - (06/04)
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