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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197610334
Report Date: 08/14/2024
Date Signed: 08/14/2024 01:58:53 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 08/14/2024 01:58 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
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME:JONES LOVE CARE ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
197610334
ADMINISTRATOR/
DIRECTOR:		COUNTS, KENEFACILITY TYPE:
735
ADDRESS:1711 EAST MESA DRIVETELEPHONE:
(714) 200-6139
CITY:LANCASTERSTATE: CAZIP CODE:
93535
CAPACITY: 4CENSUS: 0DATE:
08/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:40 AM
MET WITH:Krisyi JonesTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Lorena Casillas arrived at the facility at 10:40 am and was greeted by Licensee Kristy Jones. LPA explained the reason for the visit and entrance interview conducted.

LPA and Licensee conducted a tour of the facility at 11:05 am. The following was observed:

There are no clients in the home as of today’s date. The tool kit will not be used during this visit.

Kitchen: LPA conducted a food inspection tour at 11:10 am. LPA observed there to be sufficient stock of two-day perishable and seven-days non-perishable foods. Snacks and beverages will be available for clients in the facility when they want. Frozen foods are properly wrapped and stored. Food storage and preparation areas are clean and inaccessible to pests.

Common Areas: LPA toured all common areas of the facility. LPA observed common areas to be clean and furniture to be in good repair. The facility maintains a comfortable temperature at 71 degrees F. LPA observed fire extinguishers to be last purchased on 02/15/23, Licensee will be purchasing new extinguishers and will send LPA proof of purchase via email. Knives are stored in a locked kitchen drawer. Medication will be stored in a locked hallway closet inaccessible to clients. Smoke detectors were not functional, and some were missing. LPA explained the importance of maintaining functioning smoke detectors and carbon monoxide detectors. Licensee will purchase immediately and will provide proof of purchase via email to LPA.

Continued on LIC809-C
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE: DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/14/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364
FACILITY NAME: JONES LOVE CARE ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 197610334
VISIT DATE: 08/14/2024
NARRATIVE
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Laundry: Washer and dryer are located in the laundry room and detergents are locked and inaccessible to clients.

Client rooms: LPA toured the client rooms at 11:30 am. LPA observed rooms to have appropriate bedding sheets, pillowcase, mattress pad, and blankets, which are in good condition. There is at least one chair, nightstand and sufficient lighting for each client. LPA observed extra linens and bedding in a hallway closet.

Bathrooms: LPA observed bathrooms to have appropriate wash your hand signs, paper towels and the showers were equipped with nonskid material embedded on the shower floors. The hot water was measured at 11:45 am and delivered water at 119.4 degrees F.

Outside areas: LPA toured the outside area of the facility. LPA observed appropriate outdoor furniture, with a covered shaded area for clients. No pools or bodies were observed on the premises.

Garage: LPA observed there to be an attached garage that is used for general storage and an extra fridge.

Staff Records/Client Records: There are no staff or clients records as there are no clients at the moment.

Administrative: Annual fees are current. Administrator Certificate is pending and was confirmed pending on Department of Social Services website.

Citation issued, please see LIC809-D. Appeals Rights discussed and provided. Exit interview conducted. Copy of report delivered to Administrator.
SUPERVISORS NAME: Nichelle Gillyard
LICENSING EVALUATOR NAME: Lorena Casillas
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2024
LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/14/2024 01:58 PM - It Cannot Be Edited


Created By: Lorena Casillas On 08/14/2024 at 01:44 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: JONES LOVE CARE ADULT RESIDENTIAL FACILITY
FACILITY NUMBER: 197610334

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/14/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/15/2024
Section Cited
CCR
80087(a)

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80087 Building and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times for the
safety and wellbeing of clients, employees and visitors. This was not met as evidence by:
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POC Licensee will purchase four (4) new smoke detectors to replace the nonfunctioning ones. Licensee will email a copy of the receipt to LPA by POC due date.
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Based on observation the licensee did not comply with the section cited above by not having operational smoke
detectors throughout the facility which poses an immediate health, safety or personal rights risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Nichelle Gillyard
LICENSING EVALUATOR NAME:Lorena Casillas
LICENSING EVALUATOR SIGNATURE:
DATE: 08/14/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/14/2024


LIC809 (FAS) - (06/04)
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