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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601232
Report Date: 01/04/2024
Date Signed: 01/04/2024 03:39:13 PM

Document Has Been Signed on 01/04/2024 03:39 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: 6DATE:
01/04/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Licensee Ligaya SandersTIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Dang Nguyen and Liliana Silveira conducted an unannounced visit to continue a Required Annual Inspection which they began on 12/28/2023. The facility file was reviewed prior to the visit. LPAs were welcomed by, identified themselves to, and discussed the purpose of the visit with Licensee Ligaya Sanders.

For the annual inspection, LPAs toured the facility, reviewed staff and client records, and interviewed multiple staff and multiple clients. [See LIC811 Confidential Names List for a description of person identifiers used in this report.]

During facility tour, LPAs observed that Licensee did not ensure that cleaning chemicals and laundry detergents were inaccessible to clients, as required.

Record review, corroborated by licensee and staff interviews, showed: Licensee did ensure that the facility’s present Administrator on record, Staff #1 (S1), was currently certified by CDSS, as required. Also, no other staff at the facility held such certification. For 3 of 3 direct care staff [S1, Staff #2 (S2), Staff #3 (S3)], Licensee did not ensure that each had current First Aid Training from a qualified agency, as required. For 3 of 6 clients [Client #1 (C1), Client #2 (C2), and Client #3 (C3)], Licensee did not maintain on file written proof of a negative tuberculosis test result, as required. Also, Licensee did not perform quarterly disaster drills with direct care staff on each shift, as required.

[CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/04/2024
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 6
Document Has Been Signed on 01/04/2024 03:39 PM - It Cannot Be Edited


Created By: Dang Nguyen On 01/04/2024 at 02:31 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: 01/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80087(g)
Building and Grounds
(g) Disinfectants, cleaning solutions, poisons, firearms and other items that 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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4
Based on LPA observation, Licensee did not ensure that disinfectants and cleaning solutions which could pose a danger if readily accessible to clients were stored where inaccessible to 6 of 6 clients (C1 through C6). This posed an immediate safety risk to clients in care.
POC Due Date: 01/04/2024
Plan of Correction
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During LPA’s visit, facility staff locked/secured all disinfectants and cleaning solutions, resolving the immediate risk. Licensee agreed to retrain its staff that such items must be locked on an ongoing basis when not used by staff. Licensee agreed to submit the training sign-in sheet to LPA, by 02/03/2024.
Section Cited
Deficient Practice Statement
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4
POC Due Date:
Plan of Correction
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2
3
4
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:Dang Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2024


LIC809 (FAS) - (06/04)
Page: 2 of 6
Document Has Been Signed on 01/04/2024 03:39 PM - It Cannot Be Edited


Created By: Dang Nguyen On 01/04/2024 at 02:31 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: 01/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85064(b)
Administrator Qualifications and Duties
(b) All adult residential facilities shall have a qualified and currently certified administrator.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and staff interview, Licensee did not ensure that the facility administrator was currently certified by CDSS. This posed a potential health, safety, and personal rights risks to 6 of 6 clients in care (C1 through C6).
POC Due Date: 02/03/2024
Plan of Correction
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4
Licensee agreed to hire (and associate to the facility roster) an administrator who is in possession of a current ARF-Administrator Certificate issued by CDSS, by the POC due date.
Type B
Section Cited
CCR
80075(f)
Health-Related Services
(f) Staff responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and staff interview, Licensee did not ensure that 3 of 3 direct care staff (S1 through S3) received current training in first aid from a qualified agency. This posed a potential health and safety risk to 6 of 6 clients in care (C1 through C6).
POC Due Date: 02/03/2024
Plan of Correction
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Licensee agreed to arrange for all current and future direct care staff to be trained in First Aid, and to maintain proof of current certification in those persons’ staff files on an ongoing basis. Licensee agreed to E-mail current First Aid training certificates for S1, S2, and S3 to LPA, by the POC due date.
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:Dang Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2024


LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 01/04/2024 03:39 PM - It Cannot Be Edited


Created By: Dang Nguyen On 01/04/2024 at 02:31 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: 01/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80072(a)(8)(B)
Personal Rights
(B) A written order from the client's physician indicating the need for the postural support shall be maintained in the client's record. The licensing agency shall be authorized to require additional documentation if needed to verify the order.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and staff interview, for 1 of 6 clients (C4), who used a postural support, the Licensee did not maintain in the client’s record the written order from the client’s physician indicating the need for it. This posed a potential personal rights risk to persons in care.
POC Due Date: 02/03/2024
Plan of Correction
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Licensee agreed to coordinate with C4’s physician and/or social worker, as needed, to obtain a copy of a written doctor’s order to support their use of their leg brace. Licensee agreed to E-mail to LPA a copy of this order, by the POC due date.
Type B
Section Cited
CCR
80069(c)(1)
Client Medical Assessments
(c) The medical assessment shall include the following: (1) The results of an examination for communicable tuberculosis and other contagious/infectious diseases.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and staff interview, Licensee did not ensure that medical assessments for 3 of 6 clients (C1, C2, and C3) included the results of an examination for communicable tuberculosis. This posed a potential health and safety risk to persons in care.
POC Due Date: 02/03/2024
Plan of Correction
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Licensee agreed to coordinate with physicians and/or social workers, as needed, to have tuberculosis testing conducted on C1, C2, and C3. Licensee agreed to place written proof of negative test results in each client’s respective care binder next to their latest LIC602 Physician’s Report, and to E-mail such results to LPA, by the POC due date.
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:Dang Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2024


LIC809 (FAS) - (06/04)
Page: 4 of 6
Document Has Been Signed on 01/04/2024 03:39 PM - It Cannot Be Edited


Created By: Dang Nguyen On 01/04/2024 at 02:31 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: 01/04/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80075(b)(1)(A)
Health-Related Services
(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications. (1) In adult CCFs, facility staff who receive training may assist clients with metered-dose inhalers, and dry powder inhalers if the following requirements are met: (A) In ARFs, facility staff must receive training from a licensed professional.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and staff interview, Licensee did not ensure that 3 of 3 staff (S1, S2, and S3) who assist 1 of 6 clients (C1) with their inhaler, received training on inhaler-use from a licensed professional. This posed a potential health and safety risk to persons in care.
POC Due Date: 02/03/2024
Plan of Correction
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Licensee agreed to coordinate with a licensed medical professional (such as a nurse, doctor, or therapist) to train S1, S2, S3, and any future staff, on how assist clients with inhaler-use. Licensee agreed to E-mail the training sign-in sheet (which will include the name, title, agency, and contact information for the instructor) to LPA, by the POC due date.
Type B
Section Cited
HSC
1565(c)
Other Provisions
(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of individuals served by the facility is not required during a drill. While a facility may provide an opportunity for individuals served by the facility to participate in a drill, it shall not require that participation. Documentation of the drills shall include the date, the type of emergency covered by the drill, and, if applicable, the names of staff participating in the drill.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review and staff interview, for 1 of 6 clients (C4), who used a postural support, the Licensee did not maintain in the client’s record the written order from the client’s physician indicating the need for it. This posed a potential personal rights risk to persons in care.
POC Due Date: 02/03/2024
Plan of Correction
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Licensee agreed to perform one disaster drill on each shift (i.e, AM shift, PM shift, and overnight shift) and to document such drills in writing (i.e., date, type of emergency simulated, and names of staff participating). Licensee agreed to E-mail to LPA the documentation of the drills, by the POC due date.
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:Dang Nguyen
LICENSING EVALUATOR SIGNATURE:
DATE: 01/04/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/04/2024


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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: JOY'S HOMECARE
FACILITY NUMBER: 374601232
VISIT DATE: 01/04/2024
NARRATIVE
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[CONTINUED FROM LIC 809]

Per staff interviews: S1, S2, and S3 (who were not themselves licensed professionals) assisted C1 with their prescribed powdered inhaler. However, Licensee did not ensure that these staff received training on inhalers from a licensed professional, as required. Also, Client #4 (C4) used a physician-prescribed orthopedic leg brace device. However, Licensee did not maintain in C4's care records a written order from their physician indicating the need for this postural support, as required.

Six (6) deficiencies were cited per California Code of Regulations, Title 22, and one (1) deficiency was cited per California Health and Safety Code (refer to the attached LIC 809-D pages). Plans of Correction were jointly developed with the Licensee.

An exit interview was conducted with Sanders, to whom a copy of this report, the LIC 809-D pages, the LIC 811 Confidential Names List pages, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 01/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/04/2024
LIC809 (FAS) - (06/04)
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