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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200734
Report Date: 07/21/2023
Date Signed: 07/21/2023 04:21:35 PM


Document Has Been Signed on 07/21/2023 04:21 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612



FACILITY NAME:JOY SENIOR CENTERFACILITY NUMBER:
019200734
ADMINISTRATOR:MATHARU, GURPREETFACILITY TYPE:
740
ADDRESS:6400 BRENTWOOD BLVDTELEPHONE:
(510) 543-4695
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY:18CENSUS: 13DATE:
07/21/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Gupreet "Bobby" MatharuTIME COMPLETED:
04:30 PM
NARRATIVE
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On 07/21/2023, Licensing Program Analyst (LPA) J. Sampair arrived unannounced to conduct a health and safety check as a result of a Priority 2 complaint. Upon entering, LPA explained purpose of the visit to staff member Meledel "Mel" Sumaylo, who called the Licensee and Administrator Gupreet "Bobby" Matharu, with whom LPA spoke briefly to explain purpose of the visit. At approximately 2:00 PM, the ADM arrived

LPA toured facility, including but not limited to, the bedrooms, bathrooms, common areas, kitchen, patio, trash disposal, parking, and outdoor areas. Facility temperature was maintained at 77.6 degrees F. Hot water temperature was measured at 118 degrees F in kitchen sink. 7-days of non-perishable and 2-days of perishable food supplies were sufficient. Resident medications were kept locked in the cabinet. Smoke and Carbon monoxide detectors tested and were functional. Fire extinguisher was observed to be full and last serviced on 12/02/2022. There are no accessible bodies of water observed..

1 Type-B citation issued for incomplete first aid kit (refer to LIC 809-D for details).

Exit interview conducted. A copy of this report was provided via email.
SUPERVISOR'S NAME: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2023
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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Document Has Been Signed on 07/21/2023 04:21 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612


FACILITY NAME: JOY SENIOR CENTER
FACILITY NUMBER: 019200734

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/31/2023
Section Cited
CCR
87465(a)(9)

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... a complete first aid kit shall be maintained and be readily available in a specific location in the facility.

This requirement is not met as evidenced by:
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The licensee shall: (1) label the cabinet as "First Aid", (2) ensure that within it is a kit that contains at least the following:
(A) A current edition of a first aid manual approved by the American Red Cross, the
American Medical Association or a state or federal health agency.
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Based on observation, the licensee did not comply with the section cited above, which poses a potential health, safety, or personal rights risk to persons in care.
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(B) Sterile first aid dressings.
(C) Bandages or roller bandages.
(D) Scissors.
(E) Tweezers.
(F) Thermometers.

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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: Bennett FongTELEPHONE: (510) -62-2621
LICENSING EVALUATOR NAME: James SampairTELEPHONE: (510) 286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2023
LIC809 (FAS) - (06/04)
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