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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201440
Report Date: 11/06/2024
Date Signed: 11/06/2024 03:24:59 PM

Document Has Been Signed on 11/06/2024 03:24 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: 14DATE:
11/06/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:30 AM
MET WITH:Alicia Cuntapay, CaregiverTIME VISIT/
INSPECTION COMPLETED:
01:05 PM
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On 11/06/2024 at 11:30AM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted an unannounced Case Management visit regarding an incident that was reported to CCLD on 11/05/2024. LPA met with Alicia Cuntapay, Caregiver, and explained the purpose of the visit.

The incident occurred on 10/28/2024 which involved a resident (R1) having trouble swallowing food and couldn’t talk. LPA interviewed staff (S1) who was present during the time of incident. S1 stated on 10/28/2024 S1 entered residents' room and noticed he had tears rolling down his face, S1 asked R1 what's going on, why are you crying, are you in pain? R1 didn’t respond as if he couldn’t talk, which alarmed S1 that something was wrong because he would vocalize if something was wrong.

S1 contacted R1's daughter to advise R1 needs to be sent to hospital. S1 interrupted the meeting Administrator was in to advise of what was happening with R1. Administrator and S1 agreed that it was best to call 911 to examine R1. Once paramedics arrived, they immediately put R1 on oxygen machine and transported R1 to Kaiser Permanente in Antioch CA. S1 received a call from R1’s daughter stating R1 was in ICU for Congested Heart Failure and low blood pressure. As 11/04/2024 R1 is in hospital on oxygen and feeding tube.

LPA obtained following document R1’s Physician’s Report LIC602 during visit.

No deficiencies issued during the visit.

Exit interview conducted and a copy of this report was provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 11/06/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/06/2024
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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