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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201440
Report Date: 03/06/2025
Date Signed: 03/06/2025 02:58:57 PM

Document Has Been Signed on 03/06/2025 02:58 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:
03/06/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Alice Cuntapay, Care StaffTIME VISIT/
INSPECTION COMPLETED:
03:10 PM
NARRATIVE
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On 03/06/2025 at 9:30AM, Licensing Program Analyst LPA T. Syess-Gibson conducted an unannounced Annual 1-Year required inspection. Caregiver Alice Cuntapay contacted the Administrator by phone. LPA toured the facility with caregiver Sakaraia Kata. The administrator currently holds a certificate (#7012574740) that expires on 08/15/2026. The facility’s fire clearance was approved for twelve (12) Non ambulatory and six (6) Bedridden residents.

LPA toured the facility including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of eleven (11) total bedrooms and three (3) bathrooms. There are no bodies of water observed. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. A comfortable temperature is maintained at 73 degrees Fahrenheit. LPA observed lighting in all rooms are adequate for the comfort and safety of the residents. The hot water temperature in the residents’ shared bathroom was measured at 115.8 degrees Fahrenheit. Night lights are maintained in hallways and passages to non private bathrooms. LPA observed residents’ bathrooms are equipped with grab bars no non slip mats. Smoke detectors and carbon monoxide were in operating condition during visit. Fire extinguisher was last serviced on 10/05/2024. First aid kit was observed to be complete. Fire drill was last conducted on 01/22/2024.

Five (5) residents records were reviewed, two (2) out of five (5) were missing current appraisal needs and service plan. Five (5) staff records were reviewed, LPA observed during file review, S2 isn’t fingerprint cleared and S3 isn’t associated to the facility.

Continue on LIC809C

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/06/2025
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: JOY SENIOR CENTER
FACILITY NUMBER: 079201440
VISIT DATE: 03/06/2025
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Continued from LIC809

The following deficiencies were observed:

  • At 10:50AM LPA observed hand washing faucet in residents’ shared bathroom wasn't in good operating condition.
  • At 10:55AM LPA observed two (2) walkers, three (3) Wheelchairs and one (1) Hoyer Lift located in the hallway blocking passageway.
  • At 12:36PM LPA observed during file review S2 doesn’t have a criminal clearance.
  • At 12:38PM LPA observed during file review S3 isn’t associated to facility.

Updated copies of the following documents were requested for facility file and are to be submitted to CCLD by 03/13/2025:

  • LIC 308 Designation of Administrative Responsibility
  • LIC 309 Administrative Organization
  • LIC 500 Personnel Report
  • LIC 610E Emergency Disaster Plan
  • Residents roster
  • Updated facility sketch
  • Liability Insurance

Deficiencies cited per Title 22 California Code of Regulations and listed on LIC809D. Failure to submit proof of corrections (POC) by plan of correction due date and/or any repeat deficiencies within a 12-month period may result in civil penalties. The total amount of civil penalties assessed on today's date is $750.00 for staff not being criminal background cleared and repeat deficiency.*

Exit interview conducted. A copy of this report, LIC421FC, LIC421BG and appeal rights provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 03/06/2025 02:58 PM - It Cannot Be Edited


Created By: Tonica Syess-Gibson On 03/06/2025 at 01:44 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: JOY SENIOR CENTER
FACILITY NUMBER: 079201440

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87355(e)(1)
Criminal Record Clearance.
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department or ……


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, licensee did not comply with the section cited above by having uncleared staff work at the facility which poses an immediate health and safety risk to the persons in care.
POC Due Date: 03/07/2025
Plan of Correction
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S2 was asked to leave the facility. Facility has agreed to obtain fingerprint clearance for S2 prior to S2 returning to the facility. Facility will submit correspondence with CCLD regarding S2's clearance or S2's life scan form to CCLD by POC date.
Civil penalty of $500 is being assessed.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Harpreet Humpal
LICENSING EVALUATOR NAME:Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/06/2025 02:58 PM - It Cannot Be Edited


Created By: Tonica Syess-Gibson On 03/06/2025 at 02:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: JOY SENIOR CENTER
FACILITY NUMBER: 079201440

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87355(e)(2)
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (2) Request a transfer of a criminal record clearance as specified in Section 87355(c) or…

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, licensee did not comply with the section cited above by not having S3 associated to the facility which poses an immediate health and safety risk to the persons in care..
POC Due Date: 03/13/2025
Plan of Correction
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Administrator agreed to associate S3 to facility prior to S# returning to work and will submit correspondence with CCLD regarding S3 being associated by POC date.
Type B
Section Cited
CCR
87303(e)(6)
(e) Water supplies and plumbing fixtures shall be maintained as follows:
(6) Toilet, handwashing and bathing facilities shall be maintained in operating condition. Additional equipment shall be provided in facilities accommodating physically handicapped and/or nonambulatory residents, based on the residents' needs.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in not having hand washing faucet in operating condition in residents’ shared bathroom which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/13/2025
Plan of Correction
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Administrator agreed to repair hand washing faucet and send photo email to CCLD by POC date
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:Harpreet Humpal
LICENSING EVALUATOR NAME:Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 03/06/2025 02:58 PM - It Cannot Be Edited


Created By: Tonica Syess-Gibson On 03/06/2025 at 02:18 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: JOY SENIOR CENTER
FACILITY NUMBER: 079201440

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87307(d)(6)
Personal Accommodations and Services
(d) The following space and safety provisions shall apply to all facilities:
(6) All outdoor and indoor passageways and stairways shall be kept free of obstruction.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in having two (2) walkers, three (3) Wheelchairs and one (1) Hoyer Lift in indoor passageways free of obstruction which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/13/2025
Plan of Correction
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Administrator agreed to implement a plan to keep items out of hallway obstructing indoor passageway and remove all items and submit photos to CCLD by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Harpreet Humpal
LICENSING EVALUATOR NAME:Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2025


LIC809 (FAS) - (06/04)
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