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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604594
Report Date: 02/21/2023
Date Signed: 02/21/2023 02:14:13 PM

Document Has Been Signed on 02/21/2023 02:14 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:JOSTER CHATEAUFACILITY NUMBER:
374604594
ADMINISTRATOR:TUSCANO, MISCHELLE MFACILITY TYPE:
740
ADDRESS:8666 OCTANS STREETTELEPHONE:
(858) 935-9646
CITY:SAN DIEGOSTATE: CAZIP CODE:
92126
CAPACITY: 4CENSUS: 4DATE:
02/21/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Applicants, Ira Jean and Candy MenesesTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA), Natasha Persaud conducted a Prelicensing inspection. An initial application to operate a Residential Care Facility for the Elderly was received on 06/14/22 The facility was approved to care for four (4) Non-Ambulatory Elderly Residents. LPA was greeted and allowed entry into the facility by Administrator, Michelle Tuscano. LPA met with Applicants, Ira Jean and Candy Meneses and Licensee, Herminia Santos.

Structure- The facility is a single story structure with 6 bedrooms and 4 bathrooms. There is an outdoor covered area for resident use. No bodies of water were observed.
Bedrooms Residents- Rooms #1-#4 may be used for Non-Ambulatory.
Bedrooms Staff- There is 1 office and 1 break room.
Bathrooms- All bathrooms have a working toilet, sink, grab bars and tub/showers with non-skid mats.
Linens & Hygiene Supplies- Adequate supply.
Emergency Phone Numbers, Exit Plan and Required Postings- Posted.
Smoke Detectors and Carbon Monoxide Detectors- Interconnected and hardwired.
Appliances- Stove burners, oven, microwave, washer, and dryer working.
Toxins- Stored in a locked cabinet.
Water Temperature- Measured at 119 degrees F.
Medications- Centrally stored and locked in a cabinet.
First-Aid Kit- Stored in a locked cabinet.
Resident & Staff Files- Located in the office.
Activities- Adequate supplies to include exercising, painting, and puzzles for resident's use.
Fire clearance- Approved on 07/25/22 .
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2023
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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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: JOSTER CHATEAU
FACILITY NUMBER: 374604594
VISIT DATE: 02/21/2023
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Component III- Conducted at the Pre-Licensing visit. Information provided about how to operate the facility within substantial compliance.

All items reviewed during the visit are in compliance. Prelicensing is complete and this facility has no deficiencies. Facility appears to be ready for licensure pending final review. An exit interview was conducted and a copy of this report was provided to Applicants, Ira Jean and Candy Meneses signature below confirms receipt of these rights.
SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Natasha Persaud
LICENSING EVALUATOR SIGNATURE:

DATE: 02/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2023
LIC809 (FAS) - (06/04)
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