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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208993
Report Date: 10/19/2022
Date Signed: 10/19/2022 01:04:09 PM


Document Has Been Signed on 10/19/2022 01:04 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, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:JOYFUL LIVING CARE HOME II LLCFACILITY NUMBER:
157208993
ADMINISTRATOR:JIMENEZ, JOELFACILITY TYPE:
740
ADDRESS:10310 MALAGUENA CTTELEPHONE:
(661) 679-7876
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:6CENSUS: 4DATE:
10/19/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Administrator, Joel JimenezTIME COMPLETED:
01:03 PM
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Licensing Program Analyst (LPA) Darius Wiliams conducted an unannounced Annual Inspection visit. LPA Williams met with Administrator, Joel Jiminez, and discussed the purpose of the visit.

LPA Williams toured the facility with Administrator..

LPA Williams observed a visitor/temperature and disinfection station at the front entrance. Facility has one entry and exit point. Social distancing is maintained in the common areas.

LPA Williams observed a two day supply of perishable food and seven day supply of non-perishable food. Cleaning supplies and medications were observed behind a locked door. LPA Williams observed the following personal protective equipment in storage; masks, gloves, and gowns.

Staff have received training regarding Covid-19 infection control and mitigation. 4 of 4 resident’s files had updated emergency contact information.

LPA Williams requested the following documents be sent to the Department by 10/28/2022; personnel report (LIC 500) ,designation of facility responsibility (LIC 308), and administrator certificate.

No deficiencies were observed.

Exit interview was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Serigy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius WilliamsTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 10/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/19/2022
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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