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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600832
Report Date: 10/20/2021
Date Signed: 07/05/2023 01:49:44 PM

Document Has Been Signed on 07/05/2023 01:49 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
SF COASTAL AC/SC, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:JOYFUL CHAPTERFACILITY NUMBER:
415600832
ADMINISTRATOR:ROBERT WONGFACILITY TYPE:
740
ADDRESS:340 ALTA VISTA DRIVETELEPHONE:
(650) 827-5228
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 26CENSUS: DATE:
10/20/2021
TYPE OF VISIT:Case Management - OtherANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Robert WongTIME COMPLETED:
03:30 PM
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On October 20, 2021 at 1315hrs, Licensing Program Analyst (LPA) Komal Charitra and Jaime Vado conducted an announced pre-licensing inspection visit in relation to the change of capacity at the facility. Upon arrival, LPA's were COVID screened. LPAs met with Administrator, Robert Wong and Sharon Wong and explained the purpose of today's visit. The facility increased their capacity from 26 to 49 residents. The existing facility layout accommodated 26 residents and the new expansion will be adding another 23 residents, in total of 49 residents. The new expansion consists of 15 resident rooms, 10 half bathrooms, 2 communal showers, 1 staff break room, and a centralized communal living room.

LPAs toured the facility and grounds with the administrators and observed the new expansion area. No accessible bodies of water or fire safety hazards observed. LPA's observed a centralized communal living room area for residents. LPA's examined Room 35, a single private room with required furniture and sufficient lighting. Bathroom in Room 35 contained liquid soap and paper-towels. Water temperature was 105F.

LPAs continued to tour the facility and were shown the shared room, Room 29. The rooms had two beds, 6ft apart from one another also had a half bathroom, equipped with liquid soap and paper-towels.

The communal showers are full bathrooms with water temperature of 108F. All bathrooms contained grab bars and non-skid mats. Staff break room was observed by LPAs, water temperature measured at 105F and lighting was in place.

Report was reviewed with Administrator Robert Wong and Sharon Wong.

No citations issued.
SUPERVISORS NAME: Julio Montes
LICENSING EVALUATOR NAME: Komal Charitra
LICENSING EVALUATOR SIGNATURE: DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/20/2021
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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