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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366424546
Report Date: 09/02/2022
Date Signed: 09/02/2022 11:59:11 AM


Document Has Been Signed on 09/02/2022 11:59 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507



FACILITY NAME:JOY RESIDENTIAL CARE IIFACILITY NUMBER:
366424546
ADMINISTRATOR:AMABEL SAMPANGFACILITY TYPE:
740
ADDRESS:21160 HIGHWAY 18TELEPHONE:
(909) 755-1178
CITY:APPLE VALLEYSTATE: CAZIP CODE:
92307
CAPACITY:6CENSUS: 4DATE:
09/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:56 AM
MET WITH:Amabel SampangTIME COMPLETED:
12:00 PM
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Licensing Program Analysts (LPAs) Anna Bueno and Rayshaun Nickolas made an unannounced visit to the facility for the purpose of conducting a required annual inspection, with an emphasis on infection control due to the COVID-19 pandemic. LPAs met with administrator Amabel Sampang who confirmed that there are currently no active cases/exposures of COVID-19 within the facility.

During the inspection, LPA Bueno and administrator conducted a brief tour of the facility inside and outside. LPA Bueno made observations pertaining to the facility's infection control measures. The facility is equipped with sufficient hand hygiene and cleaning/disinfecting supplies. Administrator is the designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained and cleaning and disinfection provisions are in adequate quantities, and ensuring staff are trained in the proper use and disposal of PPE. The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolating/quarantining clients, and properly caring for clients with COVID-19 positive results and/or exposures. The facility also has a plan in place to monitor residents regularly for any changes in condition and to subsequently notify the resident's physician and emergency personnel in the event the client presents any COVID-19 symptoms.

LPAs Bueno and Nickolas observed no health and safety concerns at the time of visit. Based on observations made during today’s inspection, no deficiencies were cited per Title 22, Division 6, of the California Code or Regulations. An exit interview was conducted where this report was discussed with and a copy was provided to Ms. Sampang at the conclusion of the inspection.
SUPERVISOR'S NAME: Nedra BrownTELEPHONE: (951) 202-5776
LICENSING EVALUATOR NAME: Anna BuenoTELEPHONE: 951-204-4307
LICENSING EVALUATOR SIGNATURE:
DATE: 09/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/02/2022
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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