306004786-2-20-2024-22-AS-JTIE-D2MSUJ-20240220131114

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306004786
Report Date: 02/20/2024
Date Signed: 02/20/2024 01:12:00 PM

Document Has Been Signed on 02/20/2024 01:12 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	J.O.Y. HOMECARE		FACILITY NUMBER:	306004786
ADMINISTRATOR:	MARIFEL ANTONETTE V. IVERS		FACILITY TYPE:	740
ADDRESS:	20181 CROWN REEF LANE		TELEPHONE:	(714) 369-2780
CITY:	HUNTINGTON BEACH	STATE: CA	ZIP CODE:	92646
CAPACITY: 6		CENSUS: 4	DATE:	02/20/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:08 AM
MET WITH:	Administrator Marifel Ivers		TIME COMPLETED:	01:25 PM

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On 2/20/2024, Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by Administrator Marifel Ivers and granted entry after stating the purpose of the visit.

The facility is licensed for six (6) non-ambulatory residents with approved hospice waiver for four (4) residents. Currently, there are two (2) Hospice residents present during today’s visit.

This is a single story with a two-car garage facility. The facility has four bedrooms, (three resident rooms & one staff room) and two full bathrooms.

At around 9:23 AM, LPA conducted a tour of the physical plant accompanied by Administrator Marifel Ivers, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were observed during the visit. Bathrooms had operational water Basin. A comfortable temperature of 66 degrees F. was maintained in the facility.

LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene and sharps objects were stored and not accessible to residents. The kitchen was inspected, and sufficient perishable and non-perishable food was maintained adequately. Facility has two fire extinguishers which are fully charged. A review of the Medication Records Administration (MAR) was conducted, and LPA observed the records are in compliance.
During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, and sanitizing stations in common areas and restrooms. LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE).
CONTINUED ON 809C

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024

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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: J.O.Y. HOMECARE	FACILITY NUMBER: 306004786
	VISIT DATE: 02/20/2024

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All mandated inspection control posters were posted.

LPA observed First Aid Kit was maintained. A working landline phone was operational with landline number 657-342-9563. The last fire drill was conducted on 12/1/2023. The facility had operational smoke and carbon monoxide detectors in bedrooms and common areas. The facility has current liability insurance on file effective 6/12/23 - 6/12/24. The facility is current on Community Care Licensing annual dues.

A review of four residents (R1-R4) service files and three staff (S1-S3) personnel files revealed to be complete. The facility has the current administrator's certification on file for Marifel Ivers # 6031958740 Expiration 1/01/2025.

No deficiencies during this inspection visit.

An exit interview was conducted with Administrator Marifel Ivers, and a copy of the report was provided.

SUPERVISORS NAME: Luz Adams
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE:	DATE: 02/20/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2024

LIC809 (FAS) - (06/04)

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