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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601895
Report Date: 09/29/2022
Date Signed: 09/29/2022 04:57:18 PM


Document Has Been Signed on 09/29/2022 04:57 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 & JAY HOME CAREFACILITY NUMBER:
374601895
ADMINISTRATOR:ANA OSBORNEFACILITY TYPE:
740
ADDRESS:12946 AMARANTH STTELEPHONE:
(858) 240-7883
CITY:SAN DIEGOSTATE: CAZIP CODE:
92129
CAPACITY:6CENSUS: 6DATE:
09/29/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:House Manager, Dearme Doverte, and Staff, Kenneth DoverteTIME COMPLETED:
05:15 PM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced case management visit to follow-up on a Plan of Correction for a deficiency cited on 8/24/22. The LPA was greeted by Staff Kenneth Doverte and was allowed entry, after identifying himself and disclosing the purpose of the visit. House Manager, Dearme Doverte, arrived during the visit.

Deficiency cited under 87211 Reporting Requirements (c): On August 24th, 2022. On 8/25/22, House Manager provided a tentative schedule of staff, topics, and a date of when the training would be conducted. On today's date, House Manager provided the LPA copies of staff certificates indicating the training was completed on 8/30/22 and 8/31/22. The training was conducted by an outside vendor, as agreed in the Plan of Correction.

An exit interview was conducted with House Manager, Dearme Doverte, to whom a copy of this report, Letter of Deficiencies Cleared, and Licensee Rights (LIC 9058/16) were provided to via electronic mail. An electronic mail read receipt confirms these documents were received by the House Manager.
SUPERVISOR'S NAME: Denise PowellTELEPHONE: (610) 767-2317
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/29/2022
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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