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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601232
Report Date: 08/15/2023
Date Signed: 08/15/2023 04:22:01 PM

Document Has Been Signed on 08/15/2023 04:22 PM - 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:JOY'S HOMECAREFACILITY NUMBER:
374601232
ADMINISTRATOR:LIGAYA SANDERSFACILITY TYPE:
735
ADDRESS:1406 I AVENUETELEPHONE:
(619) 474-0198
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY: 6CENSUS: 5DATE:
08/15/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
03:30 PM
MET WITH:Administrator Ligaya Sanders de LeonTIME COMPLETED:
04:25 PM
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Licensing Program Analyst (LPA) Rebecca Ruiz conducted an unannounced case management visit to cite deficiencies unrelated to a complaint investigation. LPA was greeted by, identified herself to, and explained the purpose of the visit to Assistant Administrator Tom Gilbert. Administrator Ligaya Sanders de Leon arrived during the visit.

During today' visit, LPA conducted a tour of the facility, interviewed staff and clients, and reviewed facility records.

Review of the facility records revealed that the Administrator did not have personnel records for Staff 1 (S1) and Staff 2 (S2). Interviews revealed that S1 & S2 have been working at the facility since May 2023. Review of the Department's background clearance database showed that both S1 and S2 were fingerprinted and had an active background clearance. Review of the facility records revealed that the Administrator did not have client files for clients 1, 2, 3, and 4 (C1, C2, C3 and C4) and Client 5's (C5) file did not have a current physician's report. [Administrator was provided with an LIC811 Confidential Names list to identify individuals] Interviews revealed that the Administrator did not know the location of the client files.

During the facility tour, LPA observed the facility's kitchen, which was cluttered with food boxes, drink bottles, fruit containers, and an uncovered egg carton. LPA observed insects crawling on the eggs and the food boxes by the kitchen door.

The following deficiencies are cited per California Code of Regulations Title 22 and noted on the attached LIC809-C pages.

An exit interview was conducted with Administrator Ligaya Sanders de Leon, whose signature below confirms receipt of a copy of this report and the Licensee Appeal Rights (LIC9058 01/16).
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2023
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 3
Document Has Been Signed on 08/15/2023 04:22 PM - It Cannot Be Edited


Created By: Rebecca A Ruiz On 08/15/2023 at 03:05 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: JOY'S HOMECARE
FACILITY NUMBER: 374601232

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/31/2023
Section Cited
CCR
80087(a)(1)

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80087 Buildings and Grounds (a) The facility shall be clean, safe, sanitary and in good repair at all times... (1) The licensee shall take measures to keep the facility free of flies and other insects.This requirement has not been met as evidenced by:
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Administrator stated that staff will clean the kitchen. Administrator stated she will create a kitchen cleaning schedule and have staff sign the document when the kitchen was cleaned. Administrator stated she will call a pest control company to address the insects.
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Based on LPA observations, the Adminstrator did not ensure that the facility was kept free of insects. This poses a potential health risk to 5 of 5 clients in care.
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Administrator will submit a copy of the schedule and pest control company invoice to the LPA by POC due date, 8/31/2023
Type B
09/15/2023
Section Cited
CCR80066(a)

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80066 Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee.
This requirement has not been met as evidenced by:
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Adminstrator stated that she will create personnel records for S1 and S2 and will keep personnel records on facility site. Administrator will submit an LIC9098 to the LPA by POC due date, 9/15/23.
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Based on interviews and records review, the Administrator did not ensure that S1 or S2 had personnel records. This poses a potential safety risk to 5 of 5 clients in care.
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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:Lizzette Tellez
LICENSING EVALUATOR NAME:Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2023


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/15/2023 04:22 PM - It Cannot Be Edited


Created By: Rebecca A Ruiz On 08/15/2023 at 03:10 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: JOY'S HOMECARE
FACILITY NUMBER: 374601232

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/15/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/15/2023
Section Cited
CCR
80070(a)

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80070 Client Records (a) The licensee shall ensure that a separate, complete, and current record is maintained in the facility for each client.
This requirement has not been met as evidenced by:
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Administrator stated that she will complete client records for C1, C2, C3, C4, and C5. The Administrator will submit an LIC9098 to the LPA by POC due date, 9/15/2023.
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Based on interviews and records review, the Administator did not ensure that Clients 1, 2, 3, 4, and 5, had complete records. This poses a potential health and safety risk to 5 of 5 clients in care.
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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:Lizzette Tellez
LICENSING EVALUATOR NAME:Rebecca A Ruiz
LICENSING EVALUATOR SIGNATURE:
DATE: 08/15/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/15/2023


LIC809 (FAS) - (06/04)
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