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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601895
Report Date: 10/25/2022
Date Signed: 10/25/2022 01:48:56 PM


Document Has Been Signed on 10/25/2022 01:48 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:
10/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator, Anna Osborne, House Manager, Dearme Doverte, and Caregiver, Agus SinomanTIME COMPLETED:
02:00 PM
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Licensing Program Analyst (LPA), Sabel Martinez, conducted an unannounced Required - 1 Year visit. The LPA was granted entry after introducing himself, and disclosing the purpose of the visit to Caregiver, Agus Sinoman. Administrator, Anna Osborne, and House Manager, Dearme Doverte, arrived during the visit.

On today's visit, the LPA observed one central entry point for universal entry screening; routine symptom screening initiated at entry for staff, residents and visitors; a sign-in policy enacted for all visitors; signs throughout the facility to promote hand hygiene; face coverings worn by staff; hand sanitizer/hand washing stations readily available; a designated visitation area; emergency agencies’ contact information posted in a location visible to staff and residents; and an adequate supply of Personal Protective Equipment (PPE). Additionally, Cleaning supplies and medications were observed to be locked in different locations and inaccessible to residents in care.

No deficiencies were cited on today's date. An exit interview was conducted with House Manager, Dearme Doverte, to whom a copy of this report along with Applicant/Appeal Rights (LIC9058 01/16) were provided via electronic mail. An electronic mail read receipt confirms the 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: 10/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/25/2022
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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