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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002965
Report Date: 02/14/2024
Date Signed: 02/14/2024 10:58:58 AM


Document Has Been Signed on 02/14/2024 10:58 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



FACILITY NAME:JOY'S CARE HOME - HICKORYFACILITY NUMBER:
315002965
ADMINISTRATOR:SUSBILLA, GLORIA JOYCE BROFACILITY TYPE:
740
ADDRESS:1411 HICKORY STREETTELEPHONE:
(916) 297-2675
CITY:ROSEVILLESTATE: CAZIP CODE:
95678
CAPACITY:6CENSUS: 0DATE:
02/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Gloria "Joy" Bron SusbillaTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Kevin Mknelly arrived at the facility unannounced on 2/14/24 to conduct a Annual Inspection utilizing the CARE inspection tool. LPA met with staff and explained the purpose of the visit. LPA requested for staff to notify Administrator that LPA is present at the facility to conduct an annual inspection. Administrator and Licensee arrived to assist.

There continue to be no residents living at this home. This inspection will note areas that need correction prior to admitting residents.

LPA toured the interior and exterior of the facility together with staff to ensure health and safety of residents in care. Areas toured include but are not limited to: common areas, resident bedrooms, bathroom, kitchen, laundry room, and backyard. In the areas toured no immediate health, safety, or personal rights violations were observed.
The smoke and carbon monoxide alarms are operational, fire extinguishers are current and all exits are clear.
The licensee will remove any of their personal belongings from resident rooms before residents occupy the room.
The home is generally clean and is in good repair. The stove needs to be cleaned. Food supplies need inventory and restock.
The pool gate , knives and chemicals will be secured.
Required postings we be placed.

Licensee will submit a copy of liability insurance when the home is occupied.

No deficiencies are being cited as a result of todays inspection.


Exit interview conducted and copy of report left at the facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:
DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/14/2024
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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