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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005976
Report Date: 06/23/2021
Date Signed: 06/23/2021 01:39:43 PM

Document Has Been Signed on 06/23/2021 01:39 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 HOMES IIFACILITY NUMBER:
306005976
ADMINISTRATOR:HANNA, BAHIRAFACILITY TYPE:
740
ADDRESS:19041 WOODWARD LANETELEPHONE:
(951) 741-3267
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92646
CAPACITY: 6CENSUS: 4DATE:
06/23/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:17 AM
MET WITH:Administrator, Bahira HannaTIME COMPLETED:
01:42 PM
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On this day Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a Pre-Licensing visit. LPA was greeted and granted entry into the facility by Administrator Bahira Hanna and explained the reason for the visit. LPA toured facility with Administrator Bahira Hanna.

Fire clearance approval was received on 05/24/21. Facility is a single story 7 bedroom (6 rooms for residents and 1 for caregiver) and 3 bathrooms. There are 4 residents in care. Residents observed watching TV in living room. All residents rooms had the required elements as well as restrooms stocked with soap and paper towels. LPA observed one fire extinguisher mounted and charged. There are 10 Smoke detectors which were tested operational. Sharps, toxins and cleaning supplies will be stored in a locked storage unit inaccessible to clients.
Facility has required Department postings. LPA observed copy of Administrators Certificate expiring 8/20/2021. Facility has ample supply of linens and towels. Facility has emergency food and water supply.Stove and refrigerator are operational. Facility water temperature tested and recorded at 105.0 degrees F. Facility provides games and exercises for residents. Facility has a first aid kit with manual present at the facility. LPA observed completed emergency disaster plan. Facility has secured location for medications and facility files. LPA observed the facility perimeter is secured by brick wall with self latching gate. LPA observed ample shading and seating.

Component III Orientation was waived during this pre-licensing visit due to Administrator having multiple facilities.The pre-licensing visit has been completed. This location is ready for licensure.


No deficiencies noted during todays visit.

An exit interview was conducted with Administrator Bahira Hanna and a copy of this report was left at facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/23/2021
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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