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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079200972
Report Date: 04/29/2024
Date Signed: 04/29/2024 01:45:12 PM

Document Has Been Signed on 04/29/2024 01:45 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:HOUSE OF JOYFACILITY NUMBER:
079200972
ADMINISTRATOR/
DIRECTOR:		GAMEZ, JINO FRANKLIN Y.FACILITY TYPE:
735
ADDRESS:1374 SANDSTONE DR.TELEPHONE:
(925) 997-8701
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 6CENSUS: 5DATE:
04/29/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:28 AM
MET WITH:Fely Orejudos CaregiverTIME VISIT/
INSPECTION COMPLETED:
01:50 PM
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On 04/29/2024 at 10:28AM, Licensing Program Analyst (LPA) T.Syess-Gibson conducted an unannounced annual 1-Year required inspection. LPA met with Fely Orejudos, Caregiver, and explained the purpose of the visit. Fely called the Administrator on the phone, Jinofranklin Gamez who gave the okay for staff to assist me with what I need during visit. The administrator currently holds a certificate (#6053711735) that expires on 09/18/2025. The facility’s fire clearance was approved for five(5) ambulatory clients and one (1) non ambulatory.

LPA toured the facility with Caregiver, Fely Orejudos including but not limited to bedrooms, bathrooms, kitchen, common area, garage, and back yard. The facility consists of four (4) total bedrooms and three (3) bathrooms. All indoor passageways are kept free of obstruction. There are no bodies of water. A comfortable temperature for clients is maintained at 70 degrees Fahrenheit.

LPA observed lighting in all rooms are adequate for the comfort and safety of the clients. Hot water temperature in the shared clients’ bathroom was measured at 117.0 degrees Fahrenheit. All toilets, hand washing, and bathing are safe, sanitary and in operating condition. Paper towel, and soap observed at all hand washing stations. The supply of extra hygiene was available for residents. There is a minimum of 7-day non-perishables and 2-day perishables foods.

Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 04/09/2024. Emergency Disaster Plan was last posted on 02/06/2023. Fire drill conducted on 04/26/2024. First aid kit was observed to be complete.

Continued on LIC809C
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/29/2024
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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: HOUSE OF JOY
FACILITY NUMBER: 079200972
VISIT DATE: 04/29/2024
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Continued from LIC809.

LPA reviewed three (3) resident records and three (3) staff records, and they were current and complete. LPA also reviewed P & I and a sample of medication

LPA requested the following documents to be submitted to CCLD by 05/08/2024.



· LIC 308 Designation of Administrative Responsibility
· LIC 309 Administrative Organization
· LIC 500 Personnel Report
· LIC 610E Emergency Disaster Plan (9 pages)
· Liability Insurance

No deficiencies observed during visit

Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 04/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024
LIC809 (FAS) - (06/04)
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