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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002860
Report Date: 02/02/2023
Date Signed: 02/02/2023 12:27:27 PM

Document Has Been Signed on 02/02/2023 12:27 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:JOY'S CARE HOME 2FACILITY NUMBER:
315002860
ADMINISTRATOR:SUSBILLA, GLORIA JOYCE BROFACILITY TYPE:
740
ADDRESS:1229 KASEBERG CIRCLETELEPHONE:
(916) 297-5675
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 6CENSUS: 0DATE:
02/02/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:50 AM
MET WITH:Administrator, Gloria J.B. Susbilla TIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Talwinder Bains arrived at the facility on 02/02/2023 to conduct a Required-1 Year Inspection utilizing the infection control domain, LPA arrived at facility around 11.50am and ring the doorbell but nobody answered. LPA Called 916-297-5675 and spoke to Calvin Bron Susbilla and he stated that facility does not have any residents at this time , that is why no-one is there. LPA explained the purpose of the visit and Calvin told LPA administrator Gloria will be there in few minutes and gave permission to complete annual inspection with Gloria . LPA met with Gloria at 11.55am to conduct annual facility inspection. Prior to initiating the annual inspection, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; completed a facility risk assessment. LPA ensured they applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask.

Prior to entering facility, LPA was informed facility currently does not have no residents in care, and has not had residents in care since May 2022. Facility is up to date on licensing fees. LPA asked if licensee plans to open facility for operation, and was informed licensee is unsure of future plans with facility, but will notify Community Care Licensing if plans to open. LPA and Gloria toured the facility together and inspect these areas but not limited to- Kitchen, common rooms, dining area, resident's bedrooms, bathrooms, laundry area and outside area. In the areas toured no immediate health, safety, or personal rights violations were observed.


LPA and Gloria completed the Infection Control Domain Tool together.
No deficiencies are cited as a result of todays inspection.
Exit interview conducted and copy of the report left at facility.
SUPERVISORS NAME: Laura Munoz
LICENSING EVALUATOR NAME: Talwinder Bains
LICENSING EVALUATOR SIGNATURE: DATE: 02/02/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/02/2023
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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