019200247-2-17-2023-15-AS-LFII-CP5TDN-20230217133837

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 019200247
Report Date: 02/17/2023
Date Signed: 02/17/2023 01:38:48 PM

Document Has Been Signed on 02/17/2023 01:38 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME:	JOYCE HOME		FACILITY NUMBER:	019200247
ADMINISTRATOR:	VIRGINIA M. MARCELO		FACILITY TYPE:	735
ADDRESS:	24749 JOYCE ST.		TELEPHONE:	(510) 673-2948
CITY:	HAYWARD	STATE: CA	ZIP CODE:	94544
CAPACITY: 6		CENSUS: 6	DATE:	02/17/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:50 AM
MET WITH:	Nicanor, Marcelo- Licensee		TIME COMPLETED:	01:45 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	On 2/17/2023, at 11:50AM Licensing Program Analyst (LPA) L. Fici arrived unannounced to conduct an Annual Infection Control Visit. LPA was met with Nicanor, Marcelo- Licensee and and explained the purpose of todays visit. During the inspection, LPA toured facility including but not limited to front entrance, kitchen, common areas, hand washing stations, bedrooms, bathrooms, and backyard. LPA observed COVID-19 signage throughout the facility. Hand washing signs were posted at hand washing stations. LPA observed paper supplies and PPEs are sufficient. Facility has a sufficient 2-day perishable and 7-days non-perishable food supply. All toxins were locked up and inaccessible to clients in care. Common areas are disinfected 3 to 4 times throughout the day. Water temperature is measured at 107.2 Degrees F in common area bathroom. Fire extinguisher was last serviced on 11/16/2022. First aid kit is complete. Carbon monoxide and smoke detectors are functional. Facility passages inside and out are free of obstruction and does not pose a health and safety risk for persons in care. *The following documents shall be sent to CCL by 2/22/2023.* - Lic9282: Infection Control Plan - Lic610D: Disaster Plan Continue on Lic809-C

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: JOYCE HOME	FACILITY NUMBER: 019200247
	VISIT DATE: 02/17/2023

NARRATIVE

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Continue from Lic809

The following deficiencies were observed (see LIC 809D) and cited from the California Code of Regulations, Title 22. Failure to correct the deficiencies and/or repeat deficiencies within a 12-month period may result in civil penalties.

At 11:55AM, LPA observed unlocked knifes in the kitchen draw which are accessible to clients.

At 12:15PM, LPA observed 16 expired canned good in the kitchen and garage draw.

Exit interview conducted with Licensee, and a copy of this report provided along with appeal rights.

SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Liridon Fici
LICENSING EVALUATOR SIGNATURE:	DATE: 02/17/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

LIC809 (FAS) - (06/04)

Page: 2 of 4

Document Has Been Signed on 02/17/2023 01:38 PM - It Cannot Be Edited

Created By: Liridon Fici On 02/17/2023 at 01:09 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
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: JOYCE HOME	FACILITY NUMBER: 019200247
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80087(g)

80087(g) Buildings and Grounds: (g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above by having unlocked knifes in the kitcken draw that are assessible to clients which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/18/2023
	Plan of Correction
1 2 3 4	Licensee agreed to keep all sharps locked and not assessible to clients in care. Deficiency Cleared

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Yvonne Flores-Larios

LICENSING EVALUATOR NAME:

Liridon Fici

LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

LIC809 (FAS) - (06/04)

Page: 3 of 4

Document Has Been Signed on 02/17/2023 01:38 PM - It Cannot Be Edited

Created By: Liridon Fici On 02/17/2023 at 01:20 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
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: JOYCE HOME	FACILITY NUMBER: 019200247
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/17/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80076(a)(1)

80076(a)(1) Food Services: a) In facilities providing meals to clients, the following shall apply: (1) All food shall be safe and of the quality and in the quantity necessary to meet the needs of the clients. Each meal shall meet at least 1/3 of the servings recommended in the USDA Basic Food Group Plan - Daily Food Guide for the age group served. All food shall be selected, stored, prepared and served in a safe and healthful manner. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above by allowing 16 expired canned good in the facilities kitchen and garage draw that can be harmful to clients if consumed which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 02/22/2023
	Plan of Correction
1 2 3 4	Licensee agreed to check cans and to throw away all expired canned food and to conduct an in-service training with staff on regulation 80076(a)(1)- Food Services and to submit to CCL by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Yvonne Flores-Larios

LICENSING EVALUATOR NAME:

Liridon Fici

LICENSING EVALUATOR SIGNATURE:

DATE: 02/17/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/17/2023

LIC809 (FAS) - (06/04)

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