247209177-12-15-2021-24-AS-KBRN-C9QSL2-20211215125737

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 247209177
Report Date: 12/15/2021
Date Signed: 12/15/2021 12:58:02 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME:	JOY JOYCE RESIDENTIAL CARE HOME		FACILITY NUMBER:	247209177
ADMINISTRATOR:	MUTUA, CATHERINE N		FACILITY TYPE:	740
ADDRESS:	263 ARROYO CT		TELEPHONE:	(510) 292-1577
CITY:	MERCED	STATE: CA	ZIP CODE:	95341
CAPACITY:	6	CENSUS:	DATE:	12/15/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Catherine Mutua		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) Katie Brown arrived at the facility to conduct the Pre-Licensing Inspection. LPA met with Administrator Catherine Mutua and Kenneth Kinyanjui. LPA began the tour by entering through the front door of the home. An Emergency Evacuation Plan and additional required postings were observed upon entry. Furniture in common rooms observed to be in good repair with adequate lighting throughout. Door and walkways were observed free of obstruction. Smoke and Carbon Monoxide detectors present and in working order. LPA observed a supply of extra bed linens, towels, paper products. New bedroom furniture and mattresses observed with linens and blankets. Hot water temperature in bathrooms measured at 116 degrees F. Soap and paper towels were placed in bathrooms along with covered trash cans. Kitchen observed to have supply of dishes, cups, plates, utensils, pots and pans and cooking utensils in good repair. LPA observed a 7 day of non-perishable food. Counter tops and cabinets are clear and appropriate for food storage and preparation. Knives are kept in a locked drawer. Cleaning supplies and chemicals are locked and stored. A Washer and Dryer were observed in the laundry room with additional shelving for storage. All appliances observed to be in working order and at proper temperature. A locked storage closet for medications, First Aid Kit and PPE was observed and located in the hallway. First aid kit contains all required items. A fire extinguisher is present in the kitchen. Outside of the facility toured. The home does not have a pool, bodies of water or other hazards were observed. Outdoor activity space with shaded areas and seating were observed on the backyard patio. LPA observed a self-releasing gate and windows have screens in good repair. See LIC809-C for continuation

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

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 2

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: JOY JOYCE RESIDENTIAL CARE HOME	FACILITY NUMBER: 247209177
	VISIT DATE: 12/15/2021

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

LPA called the designated facility phone (916) 469-8006 during the visit. The phone is set up and in working order.

Issues observed to be corrected include: Required furniture to be placed in bedrooms, bedrooms to be evaluated to accommodate easy passage and comfortable usage. LPA provided CCR 87307 to Administrator via email. Long Term Care Ombudsman poster to be posted.

Licensee to contact LPA once corrections are made. LPA will return a different time.

A copy of this report was provided, and an exit interview was conducted with the Administrator.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 12/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2