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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200247
Report Date: 04/26/2024
Date Signed: 04/26/2024 03:21:48 PM

Document Has Been Signed on 04/26/2024 03:21 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 HOMEFACILITY NUMBER:
019200247
ADMINISTRATOR/
DIRECTOR:		VIRGINIA M. MARCELOFACILITY TYPE:
735
ADDRESS:24749 JOYCE ST.TELEPHONE:
(510) 673-2948
CITY:HAYWARDSTATE: CAZIP CODE:
94544
CAPACITY: 6CENSUS: 6DATE:
04/26/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:20 PM
MET WITH:Nicole MarceloTIME VISIT/
INSPECTION COMPLETED:
03:45 PM
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On this day at around 12:20 pm, Licensing Program Analyst (LPA) Luisa Fontanilla arrived unannounced to conduct an annual required inspection. LPA was met by caregiver Gerly Ferrer. LPA explained to Ferrer the purpose of the visit. Licensees Nicanor and Nicole Marcelo arrived at the facility at a later time. The facility is a Level 4C home vendorized by the Regional Center of the East Bay (RCEB).

LPA inspected the facility inside and out including but not limited to 3 client rooms, dining, kitchen, garage and backyard. There was sufficient supply of perishable and non perishable foods. There was ample supply of linen, towel and warm blankets available for use of client. Hygiene products were observed available. Knives and sharp objects were observed locked in a cabinet in the kitchen. Medications were locked in a cabinet in the dining room. Fire extinguishers appeared full and were last serviced on 6/20/2023. Smoke detectors were tested and observed functional. Last fire drill was conducted on April 15, 2024.

At 1:10 PM, LPA reviewed 5 client and 4 staff file. All staff are fingerprint cleared and associated to the facility. They have current First aid/CPR training.

At 2:10 pm, LPA interviewed 2 staff and 2 clients. At 2:30 pm, LPA verified P & I money and log and observed records are accurate and money intact. The facility has surety bond sufficient to cover amount of money being handled at one time.

At 2:55 pm, LPA reviewed medications and Medication Administration Record (MAR) with Ferrer.

continuation on Lic 809C
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2024
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: 04/26/2024
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The following deficiencies were observed and cited per Title 22 California Code of Regulations:
  • Hot water temperature measured at 125.7 degrees
  • Both exit side gates were observed locked with a sliding bolt lock.
  • One window screen was observed ripped

Exit interview was conducted with Nicanor Marcelo and Appeal Rights was provided.
SUPERVISORS NAME: Yvonne Flores-Larios
LICENSING EVALUATOR NAME: Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:

DATE: 04/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 04/26/2024 03:21 PM - It Cannot Be Edited


Created By: Luisa Fontanilla On 04/26/2024 at 03:10 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: 04/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(c)
Building and Grounds
(c) All outdoor and indoor passageways, stairways, inclines, ramps, open porches and other areas of potential hazard shall be kept free of obstruction.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in having side gate exits locked which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/26/2024
Plan of Correction
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Exit gates were unlocked during the visit. This deficiency is cleared.
Type A
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation], the licensee did not comply with the section cited above in having hot water at 125.7 degrees Fahrenheit which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 04/26/2024
Plan of Correction
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Hot water was adjusted to 106 degrees Fahrenheit during the visit. This deficiency is cleared
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:Luisa Fontanilla
LICENSING EVALUATOR SIGNATURE:
DATE: 04/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/26/2024


LIC809 (FAS) - (06/04)
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