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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003478
Report Date: 07/01/2021
Date Signed: 07/01/2021 03:33:13 PM

Document Has Been Signed on 07/01/2021 03:33 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:JOYFUL HOME IIFACILITY NUMBER:
306003478
ADMINISTRATOR:EMMANUEL DIZONFACILITY TYPE:
740
ADDRESS:24932 CAMBERWELLTELEPHONE:
(949) 215-7627
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY: 6CENSUS: 4DATE:
07/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:53 PM
MET WITH:Sherry Dizon, AdministratorTIME COMPLETED:
03:52 PM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required inspection visit. LPA was greeted at the door by caregiver and granted entry. LPA explained the nature of the visit to caregiver. Administrator arrived shortly after.

LPA began the tour of the facility, the facility currently has 4 residents in care. LPA observed a resident in living room watching tv, remaining residents were in their bedrooms. All residents appeared happy and well taken care of. Facility appears clean and sanitary. Facility staff screens all visitors to the facility and LPA observed the screening station in the main entrance of the facility. Facility keeps documentation in regard to covid for all the staff and residents. At 2:11pm LPA tested the hot water temperature in bathrooms which are used by the residents. The hot water temperature was measured at 114.8 Fahrenheit degrees. LPA observed medication storage supply, medication requiring refrigeration is stored in garage refrigerator inaccessible to residents in care. LPA observed facility has covid precautionary postings through out the facility as well as all required Department postings. Facility has an active covid-19 prevention plan in place for the safety of residents in care. Facility has submitted their mitigation plan to the Department as required. LPA observed ample supply of emergency food and water as well as first aid kits in the facility. Facility has PPE, incontinence, and cleaning supplies. Facility has sanitation precaution in place through out the facility and all common spaces. LPA toured the outside and observed a shaded outside space for resident’s enjoyment. Area is also for outdoor visitations as well. Facility has a plan for covid testing residents and staff as needed as well as a plan for isolation as needed. Facility bedrooms are currently single occupancy.

Based on the observation made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with Administrator and a copy of this LIC809 report was provided.
SUPERVISORS NAME: Marina Stanic
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 07/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2021
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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