567609703-2-21-2025-29-AS-ECOZ-DE533S-20250221165400

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 567609703
Report Date: 02/21/2025
Date Signed: 02/21/2025 04:54:20 PM

Document Has Been Signed on 02/21/2025 04:54 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
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME:	REESEJOY CARE HOME		FACILITY NUMBER:	567609703
ADMINISTRATOR/ DIRECTOR:	DELA VEGA RAMIREZ, ROBERTO		FACILITY TYPE:	740
ADDRESS:	1355 JUANITA AVE		TELEPHONE:	(805) 278-4043
CITY:	OXNARD	STATE: CA	ZIP CODE:	93030
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS: 5	DATE:	02/21/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	11:15 AM
MET WITH:	Susan Vincecruz		TIME VISIT/ INSPECTION COMPLETED:	05:00 PM

NARRATIVE

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Licensing Program Analyst (LPA) Esther Cortez arrived at the facility unannounced to conduct a required annual visit at 11:15 a.m. LPA was greeted by staff, and staff contacted the Administrator via telephone to inform them of the visit. Administrator Roberto Ramirez arrived at approximately 3:00 p.m. At the time the LPA arrived there were four (4) residents present, during the visit a fifth resident was admitted to the home.

Record Review: At 11:20 a.m., a review of facility files was initiated. Facility records are stored in a locked cabinet. The LPA observed documentation of Disaster prevention and last Disaster drill (conducted on 1/20/2025). The LPA obtained Resident Roster, Staff Roster and Insurance liability. The LPA reviewed four (4) out of five (5) resident files and the following was observed: Three residents (R1, R2, R3) did not have the Identification and Emergency Information form (LIC601) and a signed Residents Personal Rights form (LIC613) on file. R2 ’s file contained a positive TB test. No chest x-ray was present at the time of the file review. The LPA reviewed four (4) out of five (5) staff files as one (1) staff's (S1's) file was missing. Additionally, S1 is not associated to the facility. There was no annual training on file for S2. S3 who was present during the visit is also not associated to the facility.

At 1:30 p.m. the LPA and staff toured the physical plant areas inside and outside to ensure there are no health and safety hazards and the facility is in compliance with Title 22 Regulations. Carbon monoxide and smoke alarms were tested and functioned properly. The fire extinguisher appeared fully charged and was last serviced on 1/3/2025.

BEDROOMS: The resident bedrooms were furnished appropriately with clean linens, appropriate furnishings and sufficient lighting. Two bedrooms are share bedrooms, and two are single occupancy. There is also a staff room.

Report will continue on LIC809-C, 2nd page.

Kasandra Lopez	TELEPHONE: (818) 596-4343
Esther Cortez	TELEPHONE: (747) 230-2225
	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: REESEJOY CARE HOME	FACILITY NUMBER: 567609703
	VISIT DATE: 02/21/2025

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(continued from 809)
RESTROOMS: There are two restrooms for resident use. Restrooms were observed to be clean and sanitary and in operating condition with grab bars and non-skid surfaces. The LPA did not observed soap in both restroom. Hot water temperature was within regulatory requirements (105*F-120*F); it was measured at 108.3*F.

COMMON SPACES: In the common areas, walls and flooring were checked for cleanliness and good condition. At the time of the visit, common seating area and dining room furniture was observed to be in good condition. The LPA observed the required postings in the common hallway. The backyard has a covered outdoor area equipped with furniture for resident use. There were no bodies of water noted. Laundry room was locked and contained storage cabinets for laundry supplies. The garage was observed locked.

KITCHEN: Kitchen appliances were in operable condition. The facility has a sufficient supply of perishable and non-perishable food. All knives and cleaning supplies were observed to be locked and properly stored at the time of the visit.

Medications: Medications review began at 2:40 p.m.; medications are centrally stored and locked in a cabinet near the kitchen; medications are labeled and checked for expiration dates. Medications are properly documented on the centrally stored medications and destruction record.

INTERVIEWS: LPA interviewed two residents and one staff; no concerns noted.

Pursuant to Title 22 of the CA Code of Regulations, the following deficiencies were cited (refer to LIC 809-D): Exit interview conducted and copy of the report and appeal rights provided to Administrator.

SUPERVISOR'S NAME: Kasandra Lopez	TELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther Cortez	TELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 02/21/2025 04:54 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: REESEJOY CARE HOME	FACILITY NUMBER: 567609703
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

87355(e)(3)

Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (3) Request a transfer of a criminal record clearance as specified in Section 87355(c) or This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in two out of six staff that were not associated to the facility which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 02/22/2025
	Plan of Correction
1 2 3 4	Licensee agreed to submit a transfer of a criminal record clearance for all staff not associated to the facility by 02/22/2025. Licensee will submit proof of clearance to LPA via email by end 02/22/2025.

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.

Kasandra Lopez	TELEPHONE: (818) 596-4343
Esther Cortez	TELEPHONE: (747) 230-2225
	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

LIC809 (FAS) - (06/04)

Page: 2 of 8

Document Has Been Signed on 02/21/2025 04:54 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: REESEJOY CARE HOME	FACILITY NUMBER: 567609703
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

87412(a)

Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in one out of five staff that did not have a staff file at the facility which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/04/2025
	Plan of Correction
1 2 3 4	Licensee will submit a complete employee file for the identified employee to CCLD no later than POC due date

Type B

Section Cited

HSC

1569.625(b)(2)

Other Provisions

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in one out of five staff that did not have annual training on file which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/04/2025
	Plan of Correction
1 2 3 4	Licensee agrees staff will complete all required annual training and submit proof to licensing by POC due date.

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

Kasandra Lopez	TELEPHONE: (818) 596-4343
Esther Cortez	TELEPHONE: (747) 230-2225
	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

LIC809 (FAS) - (06/04)

Page: 3 of 8

Document Has Been Signed on 02/21/2025 04:54 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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

FACILITY NAME: REESEJOY CARE HOME	FACILITY NUMBER: 567609703
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/21/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

87458(c)(1)(A)

Medical Assessment

(c) The medical assessment shall include, but not be limited to: (1) A physical examination of the resident indicating the licensed medical professional's diagnosis or diagnoses and results of an examination for all of the following: (A) Communicable tuberculosis. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in one out of five residents that had a positive TB test on file and no chest X-ray which posesa potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/04/2025
	Plan of Correction
1 2 3 4	Licensee will submit proof of a negative chest X-ray to CCL no later than POC due date.

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.

Kasandra Lopez	TELEPHONE: (818) 596-4343
Esther Cortez	TELEPHONE: (747) 230-2225
	DATE: 02/21/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2025

LIC809 (FAS) - (06/04)

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