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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366424593
Report Date: 09/17/2021
Date Signed: 09/17/2021 04:10:03 PM

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
RIVERSIDE, CA 92507
FACILITY NAME:JOY OF LIVING TFH, INC.FACILITY NUMBER:
366424593
ADMINISTRATOR:JOYCE DECHIMOFACILITY TYPE:
740
ADDRESS:12465 FELIPE DRIVETELEPHONE:
(760) 684-2002
CITY:VICTORVILLESTATE: CAZIP CODE:
92392
CAPACITY:5CENSUS: 5DATE:
09/17/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:05 AM
MET WITH:Theresa SilvaTIME COMPLETED:
12:40 PM
NARRATIVE
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Licensing Program Analyst (LPA) Stephanie Williams conducted an unannounced visit to the facility. The purpose of the visit was to conduct a required annual inspection, with an emphasis on infection control due to the COVID-19 pandemic. LPA Williams arrived and met with Caregiver, Theresa Silva. Silva confirmed that there are currently no cases/exposures of COVID-19 within the facility. LPA Williams was screened for COVID-19 symptoms and asked to sign-in upon arrival.

During the inspection, LPA Williams conducted a brief tour of the facility and made observations pertaining to the facility's infection control measures and other health and safety concerns. LPA Williams did not observe appropriate postings throughout the facility, including hand-washing etiquette, face coverings, and COVID-19 symptoms postings. LPA observed that two of the two staff members present at the facility during time of visit were not utilizing face coverings. LPA observed that the facility was also equipped with sufficient hand hygiene supplies, sufficient cleaning/disinfecting provisions, and a supply of Personal Protective Equipment (PPE). However, LPA observed cleaning supplies in several rooms, which were accessible to residents in care. The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities, and that staff are trained in the facility's infection control measures. The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolating/quarantining residents, and properly caring for residents with COVID-19 positive results and/or exposures. LPA observed that several over the counter medications were located in the kitchen and accessible to residents in care. LPA also tested the carbon monoxide alarm located in the facility's hallway, which did not appear to be operating.

Deficiencies cited. See attached LIC 9099-D for specific violations cited. Also, three Technical Advisory's were issued for facility staff not wearing face coverings, facility not ensuring COVID-19 postings are posted
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
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 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: JOY OF LIVING TFH, INC.
FACILITY NUMBER: 366424593
VISIT DATE: 09/17/2021
NARRATIVE
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throughout facility, and staff not ensuring N-95 fit testing is completed. See LIC 9102's attached. An exit interview was conducted where this report was discussed and a copy of this report was sent to the email address on file.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2021
LIC809 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: JOY OF LIVING TFH, INC.
FACILITY NUMBER: 366424593
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87309(a)
87309 Storage Space (a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA observed a hand saw located in the backyard, which is accessible to residents. LPA also observed several solutions accessible in several rooms throughout the facility (garage, kitchen, and staff room) which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/24/2021
Plan of Correction
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The licensee shall remove all dangerous items from the rooms stated above and will conduct training with staff members on regulation 87309. The licensee shall send proof of the training to the Department by POC date of 9/24/2021.
Type B
Section Cited
CCR
87705(f)(2)
87705 Care of Persons with Dementia (f) The following shall be stored inaccessible to residents with dementia: (2) Over-the-counter medication, nutritional supplements or vitamins, alcohol, cigarettes, and toxic substances such as certain plants, gardening supplies, cleaning supplies and disinfectants.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation the licensee did not comply with the section cited above. LPA observed that three over the counter medications were accessible to clients in the facility's kitchen, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/24/2021
Plan of Correction
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The Licensee shall remove all over the counter medication from the facility and place in a locked and inaccessible area. Licensee shall conduct training on regulation 87705 and send proof to the Department by POC date of 9/24/2021.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:
DATE: 09/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2021
LIC809 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: JOY OF LIVING TFH, INC.
FACILITY NUMBER: 366424593
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1503.2
1503.2 Carbon monoxide detectors required; inspection
Every facility licensed or certified pursuant to this chapter shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [observation, the licensee did not comply with the section cited above in 1 of 1 carbon monoxide detectors.LPA observed that a carbon monoxide detector in the hallway was not operational, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/24/2021
Plan of Correction
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The Licensee shall equip the facility with operating carbon monoxide detectors and send photos to the Department by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 248-0337
LICENSING EVALUATOR NAME: Stephanie WilliamsTELEPHONE: (951) 248-0317
LICENSING EVALUATOR SIGNATURE:
DATE: 09/17/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/17/2021
LIC809 (FAS) - (06/04)
Page: 4 of 4