197609853-10-5-2023-31-AS-MCAA-CWBSBV-20231005134434

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609853
Report Date: 10/05/2023
Date Signed: 10/05/2023 01:44:39 PM

Document Has Been Signed on 10/05/2023 01:44 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, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME:	REESEJOY CARE HOME II		FACILITY NUMBER:	197609853
ADMINISTRATOR:	RAMIREZ, ROBERTO		FACILITY TYPE:	740
ADDRESS:	17544 SAN JOSE ST		TELEPHONE:	(805) 832-8792
CITY:	GRANADA HILLS	STATE: CA	ZIP CODE:	91344
CAPACITY:	6	CENSUS: 3	DATE:	10/05/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Roberto Ramirez, Mellie Aliga		TIME COMPLETED:	02:00 PM

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) Christopher Alemoh and Michael Cava conducted an Annual Required visit and inspection of the facility. LPAs met with the administrator, Roberto Ramirez and staff, Mellie Aliga and explained the reason for the visit. At approximately 9:00am, with the assistance of staff, LPAs took a tour of the physical plant. Required postings were observed in the entry area. The smoke alarms are battery operated. There is a carbon monoxide detector installed by the kitchen that functions properly. The fire extinguisher is located in the kitchen. It was purchased 09/28/22. Kitchen: The kitchen appliances and fixtures were functional. LPA found a sufficient amount of perishable and non-perishable food at the facility; properly stored. Knives were stored in a locked drawer in the kitchen. Properly labeled medications were locked in one of the kitchen cabinets. Bedrooms: There were six (6) bedrooms of which five (5) designated for residents' use, and one (1) room for staff. Three of the bedrooms (rooms #3, #4, #5) are private. Rooms #1 and #2 are shared. Rooms occupied by residents were properly furnished with appropriate beddings and linens with sufficient lighting. Rooms #2 and #3 are vacant. Bathrooms: There are four (4) bathrooms. Three (3) are designated for residents' use. Bathrooms were properly supplied and had functional fixtures. Hot water temperature was between at 115 to 116 degrees Fahrenheit. Cleaning supplies are being stored in the hallway bathroom. Common Areas: These included the living room and dining area. The common areas were properly furnished. The auditory alarms on all exit doors were on and functional at the time of the visit.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

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: REESEJOY CARE HOME II	FACILITY NUMBER: 197609853
	VISIT DATE: 10/05/2023

NARRATIVE

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Surrounding Grounds: Entry/exits were free of obstruction. The outdoor area was free of hazards. The laundry area and detergents are located in the garage which is kept locked and inaccessible. The garage is also used as storage area, and staff break room. .

Resident 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 review for proper documentation.

Pursuant to Title 22 Division 6 of the CA Code of Regulations, there no deficiencies observed during the visit. Exit Interview Conducted and a copy of the Report Issued.

SUPERVISOR'S NAME: Eva Miller	TELEPHONE: (818) 596-4373
LICENSING EVALUATOR NAME: Michael Cava	TELEPHONE: (818) 389-7921
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2023

LIC809 (FAS) - (06/04)

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