<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603449
Report Date: 08/01/2023
Date Signed: 08/01/2023 04:02:56 PM

Document Has Been Signed on 08/01/2023 04:02 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
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME:JOY HOME AND CAREFACILITY NUMBER:
198603449
ADMINISTRATOR:ARGENTE-GRANADA,MARY ASTERFACILITY TYPE:
735
ADDRESS:16527 E CYPRESS ST.TELEPHONE:
(626) 332-4532
CITY:COVINASTATE: CAZIP CODE:
91722
CAPACITY: 6CENSUS: 6DATE:
08/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Mary Aster ArgenteTIME COMPLETED:
04:00 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 Analyst (LPA) Kimberly Ramirez conducted an unannounced Annual Required Visit on 08/01/2023 at 8:31 am. LPA was met by Administrator Mary Aster Argente-Granada and explained the purpose of the visit. The facility is licensed serve developmentally disabled clients 18-59 years old. LPA Ramirez requested and obtained copies of Personnel Report (LIC 500), and Client Roster (LIC 9020).

LPA OBSERVATIONS: Tour began at 8:55 am and was led by S1. The facility is a single-story building located in the rear of driveway and contains: three (3) client bedrooms, one (1) staff bedroom, one (1) client bathrooms, one (1) staff bathroom, kitchen, dining room, living room, centrally stored medication closet, linen closet, front yard, backyard.

Front Yard: Was clean and well maintained. No hazards were observed.

Kitchen: LPA Ramirez observed working order. LPA Ramirez observed sufficient 2 days of perishables and 7-day supply on non-perishables. LPA Ramirez observed knives and sharps located in kitchen cabinet, to be inaccessible to six (6) out of six (6) clients in care. LPA Ramirez observed several bottles of cleaning solutions and disinfectants located in bottom kitchen cabinet to be inaccessible to six (6) out of six (6) clients in care. Surrounding walls and outer cabinet doors near stove, were observed to be dirty and contain yellowish-brown spatter. LPA Ramirez observed unknown particles near back of appliances that were on kitchen counters. LPA Ramirez issued one (1) deficiency for kitchen area.

Dining Room/Living room: Dining room was observed to contain one table with plenty of seating. Living room was observed to contain plenty of seating and lighting.

SEE 809-C

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 8
Document Has Been Signed on 08/01/2023 04:02 PM - It Cannot Be Edited


Created By: Kimberly Ramirez On 08/01/2023 at 11:14 AM
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
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: JOY HOME AND CARE
FACILITY NUMBER: 198603449

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80023(d)
Disaster & Mass Casualty Plan
(d) Disaster drills shall be conducted at least every six months.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on record review, licensee could not provide proof of facility conducting disaster drills as required, drills shall be documented and maintained in facility for 1 year, the licensee did not comply with the section cited above in 6 out of 6 clients which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 08/02/2023
Plan of Correction
1
2
3
4
Licensee will develop plan to address how facility will conduct future disaster drills, document, staff re-training and maintain Disaster drill logs. Logs and staff re-training must be completed by 8/15/23. Proof must be provide email to LPA Ramirez.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Tony Vasallo
LICENSING EVALUATOR NAME:Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023


LIC809 (FAS) - (06/04)
Page: 2 of 8
Document Has Been Signed on 08/01/2023 04:02 PM - It Cannot Be Edited


Created By: Kimberly Ramirez On 08/01/2023 at 11:14 AM
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
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: JOY HOME AND CARE
FACILITY NUMBER: 198603449

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, kitchen walls and counter were observed to contain stains, and unknown particles, client bathroom #1 smelled of urine, the licensee did not comply with the section cited above in 6 out of 6 clients which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/15/2023
Plan of Correction
1
2
3
4
Licensee will clean kitchen walls and cabinets, focusing in walls and cabinets near stove. Licensee will send picture proof to LPA Ramirez via email. Licensee will re-train staff on keeping facility kitchen clean, safe and sanitary. Proof of staff attendance must be received by 8/15/23. Submit proof via email.
Type B
Section Cited
CCR
85087(a)(2)
Building and Grounds
(2) Bedrooms must be large enough to allow for easy passage and comfortable use of any required client-assistive devices, including but not limited to wheelchairs, walkers, or oxygen equipment, between beds and other items of furniture specified in Section 85088(c).

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, client bedroom #2 closet door was cluttered with client #4 bags and boxes filled with garments and other items, closet door was unable to open, the licensee did not comply with the section cited above in 2 out of 2 clients which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/15/2023
Plan of Correction
1
2
3
4
Licensee will assist C4 in organizing bag and boxes away from closet door and to allow more space in client bedroom #2. Licensee will send photo proof of area via email by 8/15/23.
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:Tony Vasallo
LICENSING EVALUATOR NAME:Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023


LIC809 (FAS) - (06/04)
Page: 3 of 8
Document Has Been Signed on 08/01/2023 04:02 PM - It Cannot Be Edited


Created By: Kimberly Ramirez On 08/01/2023 at 11:14 AM
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
, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: JOY HOME AND CARE
FACILITY NUMBER: 198603449

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85088(c)(4)
Fixtures, Furniture, Equipment, and Supplies
(c) The licensee shall ensure provision to each client of the following furniture, equipment and supplies necessary for personal care and maintenance of personal hygiene. (4) Clean linen in good repair, including lightweight, warm blankets and bedspreads; top and bottom bed sheets; pillow cases; mattress pads; rubber or plastic sheeting, when necessary; and bath towels, hand towels and wash cloths.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, client bedroom #2 mattresses did not have required matress pad or rubber sheets, the licensee did not comply with the section cited above in 2 out of 2 clients which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/15/2023
Plan of Correction
1
2
3
4
Licensee will place mattress pad or rubber sheets on client bedroom #2 mattresses by 8/15/23. Licensee will send receipt via email.
Type B
Section Cited
CCR
85068.2(b)
Needs and Services Plan
(b) If the client is to be admitted, then prior to admission, the licensee shall complete a written Needs and Services Plan, which shall include:

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, C5 was missing Needs and Services Plan prior to admission, the licensee did not comply with the section cited above in 5 out of 5 clients which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/15/2023
Plan of Correction
1
2
3
4
Licensee will certify via email that the facility will not admit future clients unless a Needs and Services Plan is assessed. Licensee will complete Needs and Services Plan for C5 by 8/15/23 and send proof via email.
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:Tony Vasallo
LICENSING EVALUATOR NAME:Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:
DATE: 08/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/01/2023


LIC809 (FAS) - (06/04)
Page: 4 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: JOY HOME AND CARE
FACILITY NUMBER: 198603449
VISIT DATE: 08/01/2023
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
26
27
28
29
30
31
32
Linen Closet: Contained plenty linens, towels, and hygiene products.

Client Rooms 1 - 3: LPA Ramirez observed all client bedrooms#1 and 3 to contain the required linens, furnishings, and lighting. Client bedroom #2 beds did not contain required mattress pad or rubber sheets. LPA Ramirez observed several bags and boxes filled with garments and other clothing items stacked on top of each other, in front of client #4 closet door. Easy passage to and from the closet area to client #4 bed was blocked by bagged and boxes garments. LPA Ramirez issued two (2) deficiencies for client bedroom #2.

Bathrooms: Water temperature in shared bathroom#1 was measured at 117.7 degrees F which is in the required 105 – 120 degrees F. LPA Ramirez could smell urine in this area. LPA Ramirez observed coarse hairs and yellow stains around toilet bowl rim. LPA Ramirez observed trash bin located next to bathroom sink to not have tight fitting lid. Facility staff immediately began to clean and rid bathroom of urine smell. LPA Ramirez issued two (2) Technical Assistance and one (1) deficiency for client bathroom #1.

Centrally Stored Medications: LPA Ramirez observed locked living room closet door containing client medications to be inaccessible to six (6) out of six (6) clients in care. LPA Ramirez reviewed four (4) out of six (6) client medications. No discrepancies were observed.

Backyard: No large bodies of water were observed.

Emergency Drills: Facility could not provide documented proof of disaster drill. LPA Ramirez issued deficiency.

Carbon Monoxide Detectors/Fire Alarm/Fire Extinguisher & Emergency Disaster Plan: LPA observed carbon monoxide and smoke detectors in hallways. Smoke detectors were observed to be operable during visit.

Staff Personnel Files: Staff files were maintained at facility. LPA Ramirez reviewed three (3) staff files for: Criminal Record Clearance, Health Screening, Proof of Training, and Proof of First Aid Training. LPA Ramirez was able view current Administrators’ certificate.

Client Files: Six (6) client files were reviewed. Admissions agreements, Needs and Services Plan, Personal rights, Emergency Contact Information form, and Centrally Stored Record were observed in five (5) files. Client #5 was missing Needs and services Plan prior to admission. C5 was accepted into the facility on 6/3/23 and as of 8/1/23 does not have a Needs and Services Plan.

Emergency Disaster Plan/Infection Control Plan: LPA Ramirez observed Emergency Disaster Plan and facility sketch. Licensee will submit updated copy of Infection Control Plan to LPA Ramirez by 8/8/23 or LPA Ramirez may return to issue deficiency. LPA Ramirez issued Technical Violation was issued.

Deficiencies are being cited. Three (3) technical Violations was issued during visit. Exit interview was conducted administrator and a copy of this report, 809-D, LIC 9102 TV, and appeals rights were provided.

SUPERVISORS NAME: Tony Vasallo
LICENSING EVALUATOR NAME: Kimberly Ramirez
LICENSING EVALUATOR SIGNATURE:

DATE: 08/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/01/2023
LIC809 (FAS) - (06/04)
Page: 8 of 8