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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881550
Report Date: 08/19/2024
Date Signed: 08/19/2024 03:08:35 PM

Document Has Been Signed on 08/19/2024 03:08 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:JOYFUL HEARTS SENIOR CAREFACILITY NUMBER:
331881550
ADMINISTRATOR/
DIRECTOR:
MANGENTE, KRISTINEFACILITY TYPE:
740
ADDRESS:9268 MARTHA WAYTELEPHONE:
(954) 598-5414
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY: 6CENSUS: 0DATE:
08/19/2024
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:10 PM
MET WITH:Applicant AbnerTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 8/19/24 Licensing Program Analyst's (LPA) Valerie Flores, Andrei Castillo, Abdoulaye Zerbo made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA's Flores, Zerbo, and Castillo met with Applicant Abner Laudato, who accompanied LPA's for the tour of the facility. The Applicant has submitted an application for 6 residents. On 5/14/24 the Riverside County Fire Department approved a fire clearance for five (5) non-ambulatory residents and one (1) bedridden resident.

The home is a single-story structure consisting of four (4) bedrooms, two (2) bathrooms, a kitchen, formal dining room, two (2) living rooms, garage, and a backyard. The bedrooms were observed to have met the required bedding lighting, and furniture. The bathrooms had non-skid mats, and grab bars. There are plenty of extra linen (sheets, blankets, towels) that were observed to be in good repair located in the hallway. A fully charged fire extinguisher located in the kitchen. A locked drawer was observed in the kitchen that stored knifes and other sharp objects; a separate locked cabinet that contained disinfectants. A locked cabinet was observed in the dining room for centrally stored medication. The carbon monoxide and smoke detector were tested and were deemed to be in good working condition.

The hot water temperature was measured at 110.9 degrees Fahrenheit meeting the required limits. The facility has an emergency disaster plan and approved infection control training plan on file. The facility has a sufficient supply of dishes, cooking and eating utensils, that were observed to be in good repair. There is a fully stocked first aid kit. Indoor and outdoor passageways were free of obstruction. LPA's observed an outdoor patio with a shaded seating area available for all resident use. There are no bodies of water observed on the premises. Per Applicant Abner, there are no firearms or ammunition on the premises.

LPA's observed the required postings of the emergency disaster plan, resident personal rights, employee rights, facility sketch, Administrator Certification and the Long-Term Care Ombudsman poster.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE: DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/19/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: JOYFUL HEARTS SENIOR CARE
FACILITY NUMBER: 331881550
VISIT DATE: 08/19/2024
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During today's visit, LPA's Flores, Castillo, and Zerbo did not observe any issues or concerns. Applicant is schedule to attend COMP III on 8/20/24 at the Riverside Regional Office. Final approval of licensure will be determined by Centralized Application Bureau (CAB). A exit interview and a copy of this report was given to Applicant Abner.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Valerie Flores
LICENSING EVALUATOR SIGNATURE:

DATE: 08/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2024
LIC809 (FAS) - (06/04)
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