565801555-7-6-2023-29-AS-KLOZ-CTGR4Q-20230706124155

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 565801555
Report Date: 07/06/2023
Date Signed: 07/06/2023 04:36:34 PM

Document Has Been Signed on 07/06/2023 04:36 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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	JOYCE NEIL CARE HOME		FACILITY NUMBER:	565801555
ADMINISTRATOR:	SAMUEL N. GONZALES		FACILITY TYPE:	735
ADDRESS:	3851 BOSTON DRIVE		TELEPHONE:	(805) 488-7146
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY: 6		CENSUS: 6	DATE:	07/06/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:33 AM
MET WITH:	Vanessa Garcia		TIME COMPLETED:	12:50 PM

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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced Required 1 Year inspection at the facility today. When the LPA arrived there were two staff and three clients present. The other clients are currently at their day programs. Assistant Administrator Vanessa Garcia arrived at the facility at 9:57 AM.
This home is vendored by Tri-Counties Regional Center as a level 4-G home.

The LPA toured the physical plant areas inside and outside to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. The following was observed:

KITCHEN: The kitchen and food storage areas were observed. Kitchen appliances appeared to be in operable condition. The facility has a sufficient supply of perishable and non-perishable food stored. Items that could pose a danger including sharp items and cleaning supplies were in a locked office. Facility has a three day supply of emergency food and water. Medications are stored in a locked cabinet in the dining room area.

COMMON SPACES: In the common areas, furniture, walls, and flooring were clean and in good condition at the time of the inspection. All indoor and outdoor passages were free of obstruction. The fire extinguisher was fully charged. At 9:48 AM, the carbon monoxide detector and smoke detectors in the common areas and bedrooms were tested and were operational. The backyard has outdoor seating for client use.

RESTROOMS: The facility has one private and one common restroom for client use. Restrooms were observed to be clean and sanitary with hand soap, toilet paper and paper towels. At 9:45 AM the hot water temperature was measured in the hallway common restroom and it measured at 120 degree F.

BEDROOMS: There are three client bedrooms. The LPA observed the client bedrooms to be furnished appropriately with clean linens, appropriate furnishings and sufficient lighting.

Report continued on LIC809-C.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: JOYCE NEIL CARE HOME	FACILITY NUMBER: 565801555
	VISIT DATE: 07/06/2023

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MEDICATIONS: Medications are locked and centrally stored in a locked cabinet in the dining room area. At 9:52 AM medications for three clients were reviewed. All medications are labeled and maintained in compliance with label instructions, and state and federal law. All medications reviewed were recorded on the centrally stored medication and destruction record. The LPA inspected the first aid kit, which was complete.

RECORDS: At 9:57 AM the LPA reviewed P&I money and records with Ms. Garcia. Cash resources for all five resident whom they store funds for, were separate and not be commingled with facility funds or petty cash. Although, the cash amount for all five clients and the P&I records were inaccurate and there were discrepancies between $.80 and $6.40 for all the clients. Ms. Garcia made each account whole during the inspection and added any additional monies needed. The facility has a current surety bond and liability insurance on file.

The six client files reviewed were found to be complete. Five staff files were reviewed and also found to be complete. Disaster drills are conducted quarterly. The facility has a 30 day supply of personal protective equipment and an emergency disaster plan.

INTERVIEWS: Interviews with two staff was conducted. No issues or concerns observed. The LPA was unable to conduct interview any clients do their cognitive abilities.

The following deficiencies were observed (See LIC 809-D.) and cited from the California Code of Regulations, Title 22 and California Health and Safety Code. Failure to correct the deficiencies may result in civil penalties. Exit interview conducted. A copy of the report and appeal rights were provided.

SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Kasandra Lopez
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 07/06/2023 04:36 PM - It Cannot Be Edited

Created By: Kasandra Lopez On 07/06/2023 at 12:17 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: JOYCE NEIL CARE HOME	FACILITY NUMBER: 565801555
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/06/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

80026(e)

80026 Safeguards for Cash Resources, Personal Property, and Valuables of Residents (e) Cash resources, personal property, and valuables of clients shall be separate and intact, and shall not be commingled with facility funds or petty cash. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation and record review, the licensee did not comply with the section cited above in five out of five clients with cash resources had inaccurate records with the cash on hand which poses a potential personal rights risk to persons in care.
	POC Due Date: 07/13/2023
	Plan of Correction
1 2 3 4	The assistant administrator made each account whole again during the inspection. The Administrator shall submit proof that staff who assist with cash resources receive training regarding regulation 80026. Proof of training shall be submitted by 07/13/2023

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME:

Desaree Perera

LICENSING EVALUATOR NAME:

Kasandra Lopez

LICENSING EVALUATOR SIGNATURE:

DATE: 07/06/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC809 (FAS) - (06/04)

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