<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331800084
Report Date: 03/10/2022
Date Signed: 03/10/2022 04:20:22 PM

Document Has Been Signed on 03/10/2022 04:20 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME:HEART OF JOY HOME CAREFACILITY NUMBER:
331800084
ADMINISTRATOR:MESINA, JOSEPHINE OFACILITY TYPE:
740
ADDRESS:597 HAMILTON DRTELEPHONE:
(951) 432-7528
CITY:CORONASTATE: CAZIP CODE:
92879
CAPACITY: 5CENSUS: 3DATE:
03/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:20 PM
MET WITH:Josephine MesinaTIME COMPLETED:
04:40 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analysts (LPAs) Jennifer Semin and Ryan Gardner arrived at the facility unannounced after completing a COVID-19 Risk Assessment Screening for the facility via telephone. LPAs met with administrator Josephine Mesina and advised her of the purpose of the visit, and that the Annual Inspection will be limited to Infection Control only.
LPAs went over COVID-19 best practices for infection control and prevention with Ms. Mesina who is successfully incorporating the facility's Mitigation Plan. Residents have hand sanitizer available to them and the bathrooms were stocked with hand soap and paper towels. LPAs observed the facility to have multiple postings throughout the facility for cough etiquette, proper hand washing procedure, social distancing, and emergency contact information for local fire department has been updated.
LPAs requested to inspect the facility's Personal Protective Equipment (PPE) supply, which was located at the central entry point for convenience. LPA observed a storage box for storing all PPE items such as gloves, face shields, gowns, surgical masks, N95 masks, disinfectant and hand sanitizer supply and is inaccessible to residents. LPAs discussed the need to procure additional gowns.
LPAs observed an isolation box with all PPE necessary to be dedicated for isolation room, along with a trash cans to put inside and outside of an isolation room.
LPAs inquired as to if staff have been fit tested for N95 masks, and Ms. Mesina stated although she has been fit tested, her staff have not. LPA will be issuing a Technical Assistance Advisory Note during today's inspection for staff not being fit tested for N95 masks. LPA will not be issuing a deficiency for this item due to the facility not currently having any COVID-19 positive residents, and N95 masks only needing to be worn when a resident is COVID-19 positive or under observation while awaiting test results. LPA and Ms. Mesina discussed Provider Information Notice (PIN) PIN-21-10-ASC which contains resources for getting staff fit tested for N95 masks.
An exit interview was conducted, and this report was discussed and provided to Ms. Mesina along with a copy LIC9102 TA Advisory Notes.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Jennifer Semin
LICENSING EVALUATOR SIGNATURE: DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/10/2022
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 1