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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004433
Report Date: 02/24/2022
Date Signed: 02/24/2022 03:58:00 PM


Document Has Been Signed on 02/24/2022 03:58 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:JOYFUL HOME IVFACILITY NUMBER:
306004433
ADMINISTRATOR:ERIC GOLDSTEINFACILITY TYPE:
740
ADDRESS:25232 COSTEAU STREETTELEPHONE:
(949) 279-1700
CITY:LAGUNA HILLSSTATE: CAZIP CODE:
92653
CAPACITY:6CENSUS: 0DATE:
02/24/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:20 AM
MET WITH:Emmanuel Dizon TIME COMPLETED:
12:50 PM
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Licensing Program Analyst (LPA) Jerome Haley conducted an unannounced visit for the purpose of conducting a required one year infection control annual visit. Upon arrival a the facility there was no one present so LPA called the contact number on the facility profile. The Staff who answered the phone told me someone will arrive to let me in the facility. Staff arrived at the facility at 11:40am and LPA was granted entry and explained the reason for the visit. Administrator (AD) Emmanuel Dizon arrived at the facility a few minutes later to be present for the inspection. Currently the facility is vacant and there are zero clients in care. The facility will remain operational and will welcome residents in the future. LPA observed all required postings on the wall throughout the facility AD Dizon states he will have the See Something (Pub 475) poster enlarged. AD Dizon has a current administrators certificate that expires on 09/25/2023. LPA observed a screening station and screening log book near the entrance of the facility. At 11:45am LPA toured the facility with AD Dizon. There were zero residents in care at the facility. LPA began the tour checking client rooms and bathrooms. Client rooms have the necessary requirements, night stand, chair, lamp and storage space. Bathrooms were clean, operational, and equipped with soap, sanitizer, and paper towels. The kitchen was clean and organized. All knives and sharp objects were locked in a drawer. The facility has a two day supply of perishable food items and seven days supply of nonperishable food items. The stove was clean and all burners were operational. The medication locker is next to the dining room table and is empty at the moment. There is a first aid kit equipped with all required items in the medication locker. LPA observed extra linen in the hallway closets. LPA toured the backyard and it was clean and free of clutter. LPA observed an exit gate on the side of the house that was self closing and self latching. LPA observed a shaded visitation area in the backyard equipped with tables and chairs for the residents in care. There's a pool in the back yard that was surrounded and secured by a fence. All smoke detectors were tested and are operational.
No deficiencies are being cited during todays visit. An exit interview conducted and a copy of the report was provided to Administrator Emmanuel Dizon.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome HaleyTELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 02/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/24/2022
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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