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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610687
Report Date: 03/06/2025
Date Signed: 03/06/2025 11:31:31 AM

Document Has Been Signed on 03/06/2025 11:31 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:JLCFACILITY NUMBER:
197610687
ADMINISTRATOR/
DIRECTOR:		ESPIRITU, JOCELYNFACILITY TYPE:
740
ADDRESS:3452 PERLITA AVETELEPHONE:
(213) 273-6808
CITY:LOS ANGELESSTATE: CAZIP CODE:
90039
CAPACITY: 4CENSUS: DATE:
03/06/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:25 AM
MET WITH:Jocelyn EspirituTIME VISIT/
INSPECTION COMPLETED:
11:35 AM
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On 3/06/25, 9:25 AM, Licensing Program Analyst, (LPA) Raymond Comer, conducted an announced Pre-Licensing Inspection with Administrator, Jocelyn Espiritu. An application to operate an Residential Care Facility for the Elderly (RCFE) was received by Community Care Licensing (CCL) in August, 2024.

A fire clearance was approved on 9/20/2024, for four (4) non-ambulatory residents; total capacity of four (4). The purpose of today’s visit is to inspect the facility to ensure that it maintains compliance under California Code of Regulations, Title 22, Division 6.

At 9:40 AM, LPA conducted a tour of the 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.

Fire Detection/Protection system is present in the facility. Dual Smoke and Carbon monoxide detectors are hard wired, inter-connected; alarms were tested and function properly. LPA observed a fire extinguisher located in the hallway near bedroom #2. Extinguisher displays service date: 11/01/2024.

Medications will be stored in a secured, locking medications cart located in the kitchen area. First aid kit and manual are stored in a locked tool kit box, located in the hallway closet, and is equipped with necessary supplies.

[LIC809C-Continued]

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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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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: JLC
FACILITY NUMBER: 197610687
VISIT DATE: 03/06/2025
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Kitchen: At 10:20 AM, LPA observed kitchen as clean, equipped with a functional stove, refrigerator, multiple appliances, microwave, oven, and sink. There will be an adequate supply of two (2) days perishable foods once residents are admitted to the facility. LPA observed a seven (7) day supply of nonperishable foods to accommodate a maximum capacity of four (4). Knives and sharps were observed as secured and locked in lower level kitchen cabinet.

Laundry room area is located adjacent to the kitchen. Laundry soaps and other cleaning agents are stored in locked lower cabinet under the kitchen sink. Hallway area storage cabinets contain incontinent supplies, linens, towels, and linens.

Commons: LPA observed living room and dining areas equipped with sofa, television, table and chairs; common areas observed as clean and organized. Furniture is in good condition and provides adequate seating for residents. Living room area dresser contains arts and crafts, board games, puzzles, and other activities for resident use.

Bedrooms: LPA observed two (2) shared bedrooms designated for residents. Bedrooms are clean, well lit, and properly furnished with televisions, closed lid trash cans, sufficient closet space, bedding, linens, chairs, and night stand.

Bathrooms: Facility has one (1) bathroom, which was observed to be clean and sanitary, with necessary supplies and required safety fixtures (grab bars, anti-slip floor stripping). Hot water temperature measured at 116.5°F. Within the required range.

Outdoor At 10:45 AM, LPA observed (backyard) area as having a shaded patio, table, with sufficient seating for residents. Outdoor furniture observed to be in good condition. A locked shed in the backyard stores tools, maintenance supplies, and PPE. All trash cans were observed to be covered. There are no bodies of water in the facility.

Resident records: Resident records will be stored in a secured, locking medications cart, located in the kitchen area.



Staff records: Staff records will be stored in a secured, locking medications cart, located in the kitchen area.
There were no immediate health and safety hazards observed at the time of this inspection. Exit interview conducted and a copy of this report was provide to the Administrator.
SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Raymond Comer
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
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