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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004786
Report Date: 01/31/2025
Date Signed: 01/31/2025 10:49:33 AM

Document Has Been Signed on 01/31/2025 10:49 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:J.O.Y. HOMECAREFACILITY NUMBER:
306004786
ADMINISTRATOR/
DIRECTOR:		MARIFEL ANTONETTE V. IVERSFACILITY TYPE:
740
ADDRESS:20181 CROWN REEF LANETELEPHONE:
(714) 369-2780
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92646
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
01/31/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
07:18 AM
MET WITH:Marifel IversTIME VISIT/
INSPECTION COMPLETED:
11:15 AM
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On January 31, 2025 Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced required visit using the CARE Inspection Tool. LPA was greeted by Administrator Marifel Ivers and granted entry after stating the purpose of the visit. Administrator (Admin) Marifel Ivers assisted with the facility inspection on today's date.

The facility is licensed for six (6) non-ambulatory residents with approved hospice waiver for four (4) residents. Currently, there are two (2) Hospice residents present during today’s visit.

This is a single story home with a detached garage facility. The facility has four bedrooms (three shared resident rooms and one staff room) and two full bathrooms.

At around 7:31 AM, LPA conducted a tour of the physical plant accompanied by Administrator Ivers, and the following was observed: There were no bodies of water on the premises. All rooms were inspected. Beds and bedding supplies were in operational condition, lighting was provided, and storage for the client's personal belongings was observed. Bed linens, comforters, and bath towels were available during the visit. Bathrooms were operational with water temperature measured at 118.6 degrees F. A comfortable temperature of 71 degrees F. was maintained in the facility.



LPA observed the facility to be furnished at the time of the visit. Storage areas for personal hygiene and sharps objects were stored and not accessible to residents. The kitchen was inspected, appliances were operational and sufficient perishable and non-perishable food was maintained adequately. Facility has pantry, two fridges and two freezers. Facility has emergency food and water supply. Facility has two fire extinguishers fully charged and mounted on walls. A review of the Medication Records Administration (MAR) was conducted, and LPA observed the records are in compliance.

CONTINUED ON 809C
Lourdes MontoyaTELEPHONE: (714) 703-2870
Jenifer TirreTELEPHONE: (714) 401-6844
DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2025
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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: J.O.Y. HOMECARE
FACILITY NUMBER: 306004786
VISIT DATE: 01/31/2025
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During the visit, LPA observed the facility's infection control practices. LPA observed sanitizing stations in common areas and restrooms. LPA observed the facility has supply of Personal Protective Equipment (PPE). All mandated inspection control posters were posted.

LPA observed First Aid Kit was maintained. A working landline phone was operational. The last fire drill was conducted on January 7, 2025. The facility had operational smoke and carbon monoxide in bedrooms and common areas. The facility has current liability insurance on file effective 4/8/2024 - 4/8/2025.

A review of six residents (R1-R6) service files and two staff (S1-S2) personnel files revealed to be complete. The facility has the current administrator's certification active on certificates list on file for Marifel Ivers # 7033541740 application received 11/7/2024.

No deficiencies during this inspection visit.

An exit interview was conducted with Administrator Marifel Ivers, and a copy of the report was provided.
SUPERVISOR'S NAME: Lourdes MontoyaTELEPHONE: (714) 703-2870
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 401-6844
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2025
LIC809 (FAS) - (06/04)
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