197606660-9-28-2022-31-AS-MCAA-CJPPFW-20220928111724

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197606660
Report Date: 09/28/2022
Date Signed: 09/28/2022 11:17:55 AM

Document Has Been Signed on 09/28/2022 11:17 AM - 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	JOY HOME CENTER		FACILITY NUMBER:	197606660
ADMINISTRATOR:	ZINAIDA AKSELRUD		FACILITY TYPE:	735
ADDRESS:	8042 MCNULTY AVENUE		TELEPHONE:	(818) 571-2247
CITY:	CANOGA PARK	STATE: CA	ZIP CODE:	91306
CAPACITY: 4		CENSUS: 4	DATE:	09/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Diana Kabazarwe		TIME COMPLETED:	11:20 AM

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	Licensing Program Analysts (LPAs) Evelin Rios and Michael Cava conducted an Annual Required visit and inspection of the facility. LPA met with staff, Diana Kabazarwe and explained the reason for the visit. At 9:15am, with the assistance of staff, LPAs took a tour of the physical plant. The smoke alarms are hardwired and interconnected. The carbon monoxide detector is located in the hallway by the kitchen. It functions properly. The fire extinguisher is located in the laundry room. The charge date is 02/01/2021. Kitchen: The kitchen appliances and fixtures were functional. LPAs found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer. Bedrooms: There were four (4) bedrooms designated for residents' use. All four bedrooms are private. All four rooms were properly furnished with appropriate beddings and linens with sufficient lighting. Bathrooms: There are two (2) bathrooms at the facility. One is designated for the residents' use and the other for staff. The bathroom designated for resident use was properly supplied and had functional fixtures. Hot water temperature was measured at 118 degrees Fahrenheit. The cabinets beneath the kitchen sink was checked. No cleaning supplies or hazardous items were stored there. Common Areas: These included the living room and dining area. The common areas was properly furnished. The furniture was maintained and in good repair. Floors were clean. There is a fireplace, that is not functional and was never in use. No tools observed out and accessible. The dining room area was inspected and observed clean and sanitary. Dining room furniture was clean, maintained and in good repair. Passage ways to the front and back yards were clear of obstruction.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: JOY HOME CENTER	FACILITY NUMBER: 197606660
	VISIT DATE: 09/28/2022

NARRATIVE

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Surrounding Grounds: Entry/exits were free of obstruction. There was furniture appropriate for outdoor
use. The outdoor area was free of hazards. LPAs checked both side gates at each side of the home. No locks were observed on either gates. The laundry area is located adjacent to the kitchen. Detergents and cleaning supplies were observed locked and inaccessible to clients in the laundry area. Staff office is located across from the kitchen. Staff office is kept locked and inaccessible to clients. Properly labeled medications, medication records, client and staff files were kept locked in the staff office.

Client Files: LPA conducted a file review of resident records to insure compliance of licensing forms.

Staff Files: LPA also conducted a file review of staff records to insure forms and training are up to date and compliance with licensing forms.

Medications: Medication and Medication Records were reviewed for proper documentation.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, no deficiencies observed during the visit.

Exit Interview Conducted / Appeal Rights Discussed / A Copy of the Report Issued.

SUPERVISORS NAME: Eva Miller
LICENSING EVALUATOR NAME: Michael Cava
LICENSING EVALUATOR SIGNATURE:	DATE: 09/28/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/28/2022

LIC809 (FAS) - (06/04)

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