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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 415600832
Report Date: 02/10/2025
Date Signed: 02/10/2025 12:43:14 PM

Document Has Been Signed on 02/10/2025 12:43 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 BRUNO RO, 851 TRAEGER AVE., SUITE 360
SAN BRUNO, CA 94066
FACILITY NAME:JOYFUL CHAPTERFACILITY NUMBER:
415600832
ADMINISTRATOR/
DIRECTOR:		ROBERT WONGFACILITY TYPE:
740
ADDRESS:340 ALTA VISTA DRIVETELEPHONE:
(650) 827-5228
CITY:SOUTH SAN FRANCISCOSTATE: CAZIP CODE:
94080
CAPACITY: 49CENSUS: 45DATE:
02/10/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:43 AM
MET WITH:Sharon WongTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 2/10/2025, LPA Grace Donato made an unannounced case management to the facility. LPA met with Administrator Sharon Wong. LPA explained the purpose of the visit.

On 1/30/2025, LPA received an email regarding an inquiry on the refund for a resident (R1). R1 had a conservator sign the admission agreement. R1 did not move in to the facility, however, on 1/11/2024, R1s belongings were moved to the facility including clothing, toiletries and medications. R1, after several attempts to convince to move in, did not go through with living in the facility. The conservator (C1) did send an email of intent to vacate the room on 2/6/2024. Residents items were fully moved out on 2/13/2024.

On 1/9/2024, C1 was authorized by the court to temporarily place R1 at Joyful Chapter or an equivalent assisted living facility for R1s safety due to dangerous living conditions in the home, including the presence of black mold, feces, animal blood and hazardous conditions, and to shield temporary conservatee from any violence or altercations in the home.

Per the admission agreement signed by C1 it is stated that "Prior to moving in, resident shall pay a last month's service fee, which will be applied to resident's last month of occupancy." The facility followed the refund conditions in the admission agreement.

The facility has provided the breakdown of the fees and the amount of refund given back to C1.

No deficiencies cited today. Report is reviewed and copy is provided.
SUPERVISORS NAME: Andrea Medlin
LICENSING EVALUATOR NAME: Grace Donato
LICENSING EVALUATOR SIGNATURE: DATE: 02/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/10/2025
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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