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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374601895
Report Date: 10/30/2023
Date Signed: 10/30/2023 01:13:06 PM


Document Has Been Signed on 10/30/2023 01:13 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
SAN DIEGO RO, 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: 4DATE:
10/30/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Caregivers Melisande Bauzon and Julius SevillaTIME COMPLETED:
01:25 PM
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Licensing Program Analyst (LPA) Sabel Martinez conducted an unannounced Required Annual Inspection visit. The LPA introduced himself and discussed the purpose of the visit to Caregivers Melisande Bauzon and Julius Sevilla. The facility was licensed for a capacity of six (6) non-ambulatory residents and a hospice waiver of four (4). At the time of the visit, the facility had a census of four (4) residents.


The LPA, accompanied by caregiver Bauzon, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows, screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities.

There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored. Cooking/dining equipment and utensils were present. There were no toxic chemicals/poisons accessible to clients. Medications were labeled, as required, and stored in locked areas.



No pools, nor bodies of water were witnessed on the premises. Per Staff Bauzon, no firearms nor ammunition were kept at the facility. Fire extinguisher along with smoke alarms were present. Required licensing postings were observed in visible areas of the facility.

LPA interviewed staff and reviewed multiple staff and client records/files. No deficiencies were observed nor cited during today's annual inspection.

An exit interview was conducted with Caregivers Bauzon and Sevilla, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058), were provided.
SUPERVISOR'S NAME: Lizzette TellezTELEPHONE: (619) -76-2351
LICENSING EVALUATOR NAME: Sabel MartinezTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 10/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/30/2023
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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