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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005976
Report Date: 05/31/2022
Date Signed: 05/31/2022 09:43:49 AM


Document Has Been Signed on 05/31/2022 09:43 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:JOY IN LIFE HOMES IIFACILITY NUMBER:
306005976
ADMINISTRATOR:HANNA, BAHIRAFACILITY TYPE:
740
ADDRESS:19041 WOODWARD LANETELEPHONE:
(951) 741-3267
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92646
CAPACITY:6CENSUS: 3DATE:
05/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:13 AM
MET WITH:Caregiver Sandra MattisTIME COMPLETED:
10:00 AM
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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit.

During the visit LPA toured the facility with Caregiver Sandra Mattis. Facility is a 7 bedroom (6 resident rooms, 1 staff room) and 3 bathroom single story home. There are 3 Residents in care. LPA observed proper department postings near front entrance of facility as well as sign in temperature check station. LPA observed copy of Administrators Certificate expiring 8/20/2023. LPA toured all Residents rooms, all rooms contained required furniture per regulations. All restrooms observed contained a working wash basin, soap, toilet paper and paper towels. LPA observed an outside visitation area with ample seating and shading. Residents were observed relaxing inside bedrooms watching TV. Facility has smoke detectors and 1 fire extinguisher which is fully charged and mounted. Facility has emergency food and water supply. Facility has 2 fridges and pantry with perishables and non perishables. Facility has required Emergency Disaster Plan posted inside facility. Facility has a secured location for resident medication and files. Residents have a 30 day supply of medications. Facility has a secured location for toxins and hazardous supplies. LPA reviewed resident files. LPA observed 3 of 3 resident files. Resident files have updated Emergency contact info and Physician's reports. LPA observed facility does not have 30 day PPE supply and discussed the importance to staff about maintaining supply.


No deficiencies noted during todays visit. An exit interview was conducted with Caregiver Sandra Mattis and a copy of this report was left at facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Jenifer TirreTELEPHONE: (714) 703-2840
LICENSING EVALUATOR SIGNATURE:
DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/31/2022
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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