<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201440
Report Date: 10/22/2024
Date Signed: 10/22/2024 04:03:25 PM

Document Has Been Signed on 10/22/2024 04:03 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:
079201440
ADMINISTRATOR/
DIRECTOR:
MATHARU, GURPREETFACILITY TYPE:
740
ADDRESS:6400 BRENTWOOD BLVDTELEPHONE:
(510) 543-4695
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 18CENSUS: 16DATE:
10/22/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:13 PM
MET WITH:Alicia Cuntapay, CaregiverTIME VISIT/
INSPECTION COMPLETED:
04:12 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 10/22/2024 at 2:10PM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 10/17/2024. LPA met with Alicia Cuntapay, Caregiver and explained the purpose of the visit. Alicia called Administrator, Gupreet Mathanu and LPA explained purpose of visit via telephone. Administrator gave the authorization for Alicia Cuntapay to provide requested documents and sign the reports.


The regional office received a incident report on 10/17/2024, stating Resident 1 (R1) had fell and was on the floor by his bed. (R1) was transported to the hospital that morning to be examined for the pain her was experiencing.

LPA obtained the following documents: LIC602 and After Care Summary Report.

LPA interviewed Staff 1 who witnessed the fall. Per (S1) I was assisting him to his room after he finished eating breakfast that morning. He uses a wheelchair, so I was pushing him to his room. Once in the room I told him to wait to sit down, he was rushing sit down decided to sit without my help and slid down from the edge of bed.” I couldn’t stop his fall because he is too strong and big and I’m little” It wasn’t a hard fall, but he did slide down to the floor. I called for assistance from my coworkers to get him off the floor. Staff called the paramedics they took him to hospital to be examined. (R1)returned to the community later that afternoon.

No deficiencies observed during visit.

Exit interview conducted and a copy of this report was provided to Alicia Cuntapay.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 10/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/22/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1