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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005688
Report Date: 03/29/2022
Date Signed: 03/29/2022 12:40:17 PM

Document Has Been Signed on 03/29/2022 12:40 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:JOY IN LIFE HOMESFACILITY NUMBER:
306005688
ADMINISTRATOR:HANNA, BAHIRAFACILITY TYPE:
740
ADDRESS:19301 HICKORY LANETELEPHONE:
(714) 378-0347
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92646
CAPACITY: 6CENSUS: 1DATE:
03/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Kiara Gordon, caregiver
Bahira Hanna, administrator (via phone call)		TIME COMPLETED:
01:00 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Kevin Saborit-Guasch made an unannounced visit to the facility in order to conduct a required annual inspection. LPA arrived at facility, was greeted and granted entry by Kiara Gordon, caregiver after explaining the purpose of the visit. Administrator Bahira Hanna was called via phone and was unavailable to assist the visit in person.

At approximately 11:10am, LPA accompanied by caregiver toured the inside and outside of the facility. There is currently one (1) resident in care while a second one is currently at a Skilled Nursing Facility. The resident is observed to be relaxing in the living room and appears well taken care of. Three (3) of the six (6) bedrooms include all necessary components, while the three (3) others are equipped with every necessary items but beds. Bathrooms are equipped with grab bars and slip mats. Facility appears to be clean, sanitary and free of odors in all areas inspected.

Sharp instruments are kept in a cabinet secured by a magnetic lock. Cleaning supplies and toxic substances are stored in the attached garage which has a combination lock on the door. However, cleaning supplies detergent, room deoodorizer, bug spray and other potentially toxic substances are found unsecured in multiple locations around the house, such as bathroom cabinets and the backyard.

LPAs observed the facility has COVID-19 Precautions posters and required department postings. Caregiver indicates that the facility has no stored supply of PPE on the premises. A LIC808 Mitigation Plan has been submitted and approved by LPA Lyman on 05/04/2021.

(CONTINUED IN FORM LIC809C)
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 9
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: JOY IN LIFE HOMES
FACILITY NUMBER: 306005688
VISIT DATE: 03/29/2022
NARRATIVE
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LPAs observed a sufficient supply of food and water. A 30-day supply of medication is centrally stored and locked in a cabinet. LPAs toured the outside of the facility. Outdoor furniture is present for the residents' enjoyment in the backyard. The perimeter gates are self-latching and can easily be opened in an evacuation. However LPA reminds caretaker that these gates marked on evacuation routes are required to be kept unlocked.

Staff present is observed to be correctly associated in Guardian. The Administrator's license is up to date and posted in a central location.

Based on the observations made during today’s visit, two deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations and a Technical Advisory is being issued. This report was reviewed with facility representative and a copy of this report was provided and left at facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2022
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/29/2022 12:40 PM - It Cannot Be Edited


Created By: Kevin Saborit-Guasch On 03/29/2022 at 12:18 PM
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
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: JOY IN LIFE HOMES
FACILITY NUMBER: 306005688

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.618(b)(3)
Other Provisions
(b) At least one administrator, facility manager, or designated substitute who is at least 21 years of age and has qualifications adequate to be responsible and accountable for the management and administration of the facility pursuant to Title 22 of the California Code of Regulations shall be on the premises 24 hours per day. The designated substitute maybe a direct care staff member who shall not be required to meet the educational, certification, or training requirements of an administrator. The designated substitute shall meet qualifications that include, but are not limited to, all of the following:
(3) Training to effectively interact with emergency personnel in the event of an emergency call, including an ability to provide a resident’s medical records to emergency responders.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations made during today's visit, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/05/2022
Plan of Correction
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Licensee will ensure future staffing allows for continued compliance with the regulation listed above.

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Alisa Ortiz
LICENSING EVALUATOR NAME:Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:
DATE: 03/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2022


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/29/2022 12:40 PM - It Cannot Be Edited


Created By: Kevin Saborit-Guasch On 03/29/2022 at 12:24 PM
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
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: JOY IN LIFE HOMES
FACILITY NUMBER: 306005688

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/29/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87303(a)
Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation made during today's visit, the licensee did not comply with the section cited above in multiple instance of potentially toxic substances stored in unsecure locations around the facility, such as insecticide in the garden or cleaning products under the bathroom sinks which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/04/2022
Plan of Correction
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Licensee will ensure all potentially toxic substances are stored in secure and locked locations.
Training regarding best practices of storage will also be provided to staff in order to ensure secure storage in the future.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Alisa Ortiz
LICENSING EVALUATOR NAME:Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:
DATE: 03/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2022


LIC809 (FAS) - (06/04)
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