197609943-12-28-2022-31-AS-LQLY-CMJT75-20221228132810

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197609943
Report Date: 12/28/2022
Date Signed: 12/28/2022 01:28:20 PM

Document Has Been Signed on 12/28/2022 01:28 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:	JOCELYN'S LOVING CARE		FACILITY NUMBER:	197609943
ADMINISTRATOR:	ESPIRITU, JOCELYN		FACILITY TYPE:	740
ADDRESS:	803 N GENESEE AVE		TELEPHONE:	(323) 592-3100
CITY:	LOS ANGELES	STATE: CA	ZIP CODE:	90046
CAPACITY:	6	CENSUS: 5	DATE:	12/28/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:	Jocelyn Espiritu		TIME COMPLETED:	01:30 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 Analyst (LPA) LaQueena Lacy arrived at the facility at 11:10am to conduct a One (01) year Required Infection Control visit. LPA meet with the administrator Jocelyn Espiritu and explained the purpose of this visit. A tour of the physical plant was conducted at 11:17am and the following was observed: The facility has one main entrance being used, there are required Covid-19 prevention signage (hand washing, coughing etiquette and physical distancing) posted. The PPE screening station is located at the entrance of the facility and is equipped with sufficient PPE readily accessible thermometer, hand sanitizer, gloves, mask and sign in sheet at the time of visit, the facility has six (06) bedrooms. A fire clearance and a hospice waiver for (06). Fire extinguisher located in the facility have a tag dated 11/23/2022. The facility maintains a comfortable temperature of 71 degrees. The facility has an approved mitigation plan on file. Kitchen: At 11:20am LPA observed the kitchen to be clean and an adequate supply of perishables and non-perishable food located in the refrigerator, freezer and second refrigerator located in the hallway near room five (05). Food was properly labeled and stored. Sharps were observed to be locked and stored in a small lock box on the kitchen counter. Toxins and cleaning supplies observed to be locked and stored under the kitchen sink. Food storage and preparation areas are clean and inaccessible to pests. The emergency food is stored in a cabinet located adjacent to the kitchen. Trash cans observed to be with tight fitting lids. Kitchen appliances observed to be operational and in good repair. Medication: At 11:37am the medication cart was observed to be locked and located in the hallway near room (01). At 11:46am LPA observed the First Aid Kit and Manual located in a cabinet cupboard in the hallway near room (01), also storing extra wash and bath towels. Continue on LIC 809C

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena Lacy	TELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

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: JOCELYN'S LOVING CARE	FACILITY NUMBER: 197609943
	VISIT DATE: 12/28/2022

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Laundry Room: At 11:44am LPA observed the laundry room to be locked located near room (01) observed to be clean and clear from obstruction and storing toxins, poisons, and laundry supplies.

Storage Cabinets: LPA observed two (02) storage cabinets near room (06) at 11:48am. Storage (01) has PPE, incontinent supplies and personal care items, storage (02) has extra linens, mattress pads and comforters.
Bedrooms: At 11:57am LPA observed (06) bedrooms, bedroom (06) is designated for staff. All bedrooms observed to be clean, properly furnished with appropriate bedding and linens and sufficient lighting. LPA observed auditory alarm on the door in bedroom (01).
Bathrooms: LPA observed three (03) out of (04) bathrooms at 12:10pm. (02) out of (04) bathrooms are located in room (01) and (04), bedroom (04) is vacant and not being utilized. All bathrooms observed to be clean and in good repair and appropriate grab bars and non-slip skid mats. The hot water temperature measured at 108.4 between 110.7 degree Fahrenheit. LPA observed appropriate hand washing signs posted in each bathroom, with paper towels and hand soap, hand towels and washcloths are not shared.
Living, dining room and common areas: At 12:17pm LPA observed all areas to have sufficient tables and chairs for seating with sufficient lighting. Living room sofa and love seats observed to be in good repair clean and clear from obstruction. Activities observed to be stored on a shelf in the living room.
Surrounding grounds: LPA observed the outside and surrounding ground of the facility at 12:23pm observed to have a shaded area with tables and chairs for seating, observed to be clean and clear of debris. The facility has an attached garage observed to be locked and storing old bed furniture, wheelchairs, medical equipment and incontinent supplies.
At 12:29pm LPA tested and observed the carbon monoxide detector located on a wall in the dining room to be operational and functioning properly. Smoke alarms are interconnected they were tested and observed to be operational and functioning properly.

No bodies of water observed on the property.

No deficiencies cited, Exit interview conducted, copy of report issued.

SUPERVISOR'S NAME: Naira Margaryan	TELEPHONE: (818) 596-4368
LICENSING EVALUATOR NAME: LaQueena Lacy	TELEPHONE: (818) 661-0002
LICENSING EVALUATOR SIGNATURE:	DATE: 12/28/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/28/2022

LIC809 (FAS) - (06/04)

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