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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607020
Report Date: 02/05/2024
Date Signed: 02/08/2024 09:19:35 AM


Document Has Been Signed on 02/08/2024 09:19 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364



FACILITY NAME:JOE-SEPHINE RESIDENTIAL CARE FAC. FOR THE ELDERLYFACILITY NUMBER:
197607020
ADMINISTRATOR:JOSEPHINE C. SANOYFACILITY TYPE:
740
ADDRESS:615 CURVE CIRCLETELEPHONE:
(661) 942-4307
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY:4CENSUS: 3DATE:
02/05/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Josephine SanoyTIME COMPLETED:
09:45 AM
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On 2/5/2024 at 9:00 am Licensing Program Analyst (LPA) Casillas arrived at facility to conduct a Plan Of Correction visit for complaint visit dated 2/2/2024. LPA observed that both bathrooms had anti-slip strips that are compliance.

LPA forgot to get signature for this report on 2/5/2024. LPA Casillas could not return to the facility due to state of emergency related to severe weather watch, however Licensing Program Manager (LPM) Nichelle Gillyard approved for LPA Casillas to return at a later date to get Administrator signature and provide a copy of this report.

On 2/8/2024 LPA Casillas returned to the facility to deliver report and get signature.

A copy was given to Administrator.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4370
LICENSING EVALUATOR NAME: Lorena CasillasTELEPHONE: 818-304-2695
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2024
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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