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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197609853
Report Date: 09/24/2021
Date Signed: 09/24/2021 10:42:25 AM

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:REESEJOY CARE HOME IIFACILITY NUMBER:
197609853
ADMINISTRATOR:RAMIREZ, ROBERTOFACILITY TYPE:
740
ADDRESS:17544 SAN JOSE STTELEPHONE:
(805) 832-8792
CITY:GRANADA HILLSSTATE: CAZIP CODE:
91344
CAPACITY:6CENSUS: 3DATE:
09/24/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:37 AM
MET WITH:Roberto Ramirez/ AdministratorTIME COMPLETED:
11:00 AM
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LPA Shanahan conducted an annual inspection. LPA arrived at the facility and observed the required COVID signs on the front door. LPA was greeted by Caregiver and LPA observed caregiver wearing a mask. LPA confirmed the reason for the visit is to conduct an annual inspection. Caregiver confirmed there are three residents at the facility. Caregiver took LPA's temperature and asked LPA the COVID questions. LPA was asked to sign in at the sign in station. LPA observed thermometer, sign in sheet, masks, and hand sanitizer located at the front door. Administrator arrived a short while later.

LPA observed all three residents in their rooms. LPA was seated at the dining room table. LPA observed the knives and cleaning supplies were locked in drawers and cabinets. LPA observed the medications were locked in a kitchen cabinet. LPA observed an adequate supply of fresh fruits and vegetables in the refrigerator. The freezer contained frozen meats. Water temperature was measured at 123.3 degrees F.

LPA was then escorted through the home and observed the residents rooms were neat and clean. LPA observed the bathroom which contained wash your hands sign, paper towels, hand sanitizer, and trash can. LPA observed the locked garage which contained the washer and dryer, laundry and additional chemicals.

There are no deficiencies to report at this time. Exit interview was conducted, appeal rights discussed, and LPA confirmed the report will be emailed to the Administrator.
SUPERVISOR'S NAME: Nichelle GillyardTELEPHONE: (818) 596-4341
LICENSING EVALUATOR NAME: Patrick ShanahanTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2021
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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