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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002965
Report Date: 02/05/2025
Date Signed: 02/19/2025 03:25:56 PM

Document Has Been Signed on 02/19/2025 03:25 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:JOY'S CARE HOME - HICKORYFACILITY NUMBER:
315002965
ADMINISTRATOR/
DIRECTOR:
SUSBILLA, GLORIA JOYCE BROFACILITY TYPE:
740
ADDRESS:1411 HICKORY STREETTELEPHONE:
(916) 297-2675
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY: 6CENSUS: 2DATE:
02/05/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:00 PM
MET WITH:Joy Bron- SusbillaTIME VISIT/
INSPECTION COMPLETED:
03:55 PM
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On 2/5/25 , Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced to conduct a Annual Inspection utilizing the CARE inspection tool. Administrator was present and Licensee arrived to assist.

LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed. LPA advised the type of lock to be used for the pool.

The smoke and carbon monoxide alarms are operational, fire extinguishers are current and all exits are clear.

The home is clean and is in good repair.

Resident and staff records reviewed. Admin is updating resident files and staff training for new dementia regs requirements.

Licensee will submit a copy of liability insurance certificate when it arrives..

No deficiencies are being cited as a result of todays inspection.


Exit interview conducted and copy of report left at the facility.
SUPERVISORS NAME: Maribeth Senty
LICENSING EVALUATOR NAME: Kevin Mknelly
LICENSING EVALUATOR SIGNATURE: DATE: 02/05/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/05/2025
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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