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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206695
Report Date: 09/30/2024
Date Signed: 09/30/2024 05:53:47 PM

Document Has Been Signed on 09/30/2024 05:53 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:JOYFUL LIVING RCHEFACILITY NUMBER:
107206695
ADMINISTRATOR/
DIRECTOR:		GALVEZ, DELIAFACILITY TYPE:
740
ADDRESS:1337 W. ROBERTS AVE.TELEPHONE:
(559) 570-8557
CITY:FRESNOSTATE: CAZIP CODE:
93711
CAPACITY: 6CENSUS: 5DATE:
09/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Administrator-Delia GalvezTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
NARRATIVE
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On 9/30/2024, Licensing Program Analysts (LPAs) J. Leffall and M. Garza arrived at the facility unannounced to conduct the Required Annual Inspection. LPAs were greeted by Staff (S1) Kimberly Clark, stated the purpose of the visit. Administrator (A1) Carlos Santos arrived sometime later. LPA’s conducted tour of facility with S1. 5 Residents present during inspection tour.

Upon facility entrance LPAs observed no chime alarm sound on front door. The facility was observed to be at a comfortable temperature, clean, in good repair with no inside passageway obstructed or fire hazards. Fire extinguisher was observed with a service date of: 8/19/2024. Kitchen was toured. An adequate supply of perishable and non-perishable food was observed to be improperly stored in freezer and refrigerator. Refrigerator temperature was observed maintained at 40 degrees F. and freezer was observed maintained at 0 degrees F. LPAs observed improperly stored food with no dates. Knobs were observed accessible and exposed on top of stove. LPAs observed pantry area with adequate non-perishable foods for residents. Chemicals were observed accessible in 2 of 4 bathrooms and 1 of 5 resident bedrooms. Resident rooms toured and observed with required furnishings and lighting. LPAs observed securely fastened grab bars next to toilet and all tub/shower areas. LPAs observed restrooms with toilet paper/paper towel not on holders in bathrooms. 1 out of 4 bathrooms observed to not have a non-skid mat in shower. Water temperature measured at 107.2 degrees F in bathroom #1, and 110.8 degrees F in bathroom #2. Laundry room hallway observed to have small hole in the wall. 2 out of 5 client room carpets observed to be in need of cleaning and torn at doorway area. Backyard observed with self-latching gate for exit. 2 chairs on patio area observed blocking walkway. Water hose observed in the middle of walkway in backyard. Backyard observed to have no shade over outdoor table. A gate was observed broken that needs to be secured.

CONT....

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2024
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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Document Has Been Signed on 09/30/2024 05:53 PM - It Cannot Be Edited


Created By: Jacques Leffall On 09/30/2024 at 03:38 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
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: JOYFUL LIVING RCHE
FACILITY NUMBER: 107206695

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/30/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87303(a)
Maintenance and Operation
The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPAs observation, the licensee did not comply with the section cited above in that improperly stored food with no dates, knobs observed accessible and exposed on top of stove, restrooms with toilet paper/paper towel not on holders, 1 out of 4 bathrooms observed to not have a non-skid mat in shower, laundry room hallway observed to have small hole in the wall, 2 out of 5 client room carpets observed to be in need of cleaning and torn at doorway area, chairs on patio area observed blocking walkway, water hose observed in the middle of walkway in backyard, seating area missing shade and gate near pool was observed broken in need of repair. Facility observed to be in need of general housekeeping. 1 of 2 chairs observed broken. Restroom #3 observed without functioning toilet, in need of repair. MARS observed incorrect. These pose a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/10/2024
Plan of Correction
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Administrator states to have medication logged immediately. Administrator states once corrections have been made, photographs will be sumbitted to CCLD by POC date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:See Moua
LICENSING EVALUATOR NAME:Jacques Leffall
LICENSING EVALUATOR SIGNATURE:
DATE: 09/30/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/30/2024


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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: JOYFUL LIVING RCHE
FACILITY NUMBER: 107206695
VISIT DATE: 09/30/2024
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CONT.....

LPAs completed a medication audit. Medications were stored in a locked medication room in a medication cabinet. MARs and medications were reviewed. Review of Centrally Stored Medication Record revealed R1’s medication log was incomplete. Based on record review, LPAs observed 1 out of 1 residents medication count was over the required amount. A sample of staff files reviewed. A sample of resident’s files were reviewed. 1 of 3 resident files reviewed, needed an updated LIC-602.

The following documents are being requested and submitted to Fresno CCL by: 10/10/24. Forms requested: LIC 308, LIC 309 (if applicable), LIC 500, LIC 610D, LIC 9282, current Administrator certificate, and control of property. A copy of this report and appeal rights was provided to Administrator, whose signature on this form confirms receipt of this report.



LPAs observed missing Restrictive Health Conditions, and Hospice/End of Life training's.

Deficiencies cited on attached 809D in accordance with California Code of Regulations, Title 22,Division 6.



An exit interview completed with Administrator, Carlos Santos. Report signed on-site; a copy of this report, deficiencies, TV’s and appeal rights were provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Jacques Leffall
LICENSING EVALUATOR SIGNATURE:

DATE: 09/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2024
LIC809 (FAS) - (06/04)
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