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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019200734
Report Date: 08/01/2023
Date Signed: 08/01/2023 01:30:45 PM


Document Has Been Signed on 08/01/2023 01:30 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: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:
08/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:56 PM
MET WITH:Rose Constastino, CaregiverTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) J. Clancy-Czuleger arrived today to deliver Order for Immediate Exclusion Letters for S1. LPA meet with caregiver Rose Constastino and explained the purpose of the visit. Licensee, Gurpreet Matharu was called and designated Rose Constastino to sign off on the report.

An Audit Report dated 04/03/2023, shows that S1 misappropriated R1's cash resources.

Licensee, and other care staff confirmed that S1 was not present at facility today. Licensee stated that S1 last worked at facility on 12/17/2022. LPA delivered an Order for Immediate Exclusion Letter today to Rose Constastino for S1. An Order for Immediate Exclusion Letter will be sent to S1 via certified mail.


Exit interview conducted and a copy of this report provided.
SUPERVISOR'S NAME: Harpreet HumpalTELEPHONE: (510) 285-3928
LICENSING EVALUATOR NAME: Jill Clancy-CzulegerTELEPHONE: 510-286-4201
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023
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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