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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 371881431
Report Date: 08/19/2024
Date Signed: 08/19/2024 12:48:18 PM

Document Has Been Signed on 08/19/2024 12:48 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:JOY AND LOVE HOME CARE, LLCFACILITY NUMBER:
371881431
ADMINISTRATOR/
DIRECTOR:		SARAPAT, AILA J.FACILITY TYPE:
740
ADDRESS:1178 EVERGREEN LANETELEPHONE:
(661) 754-0261
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 18CENSUS: 10DATE:
08/19/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:40 AM
MET WITH:LEAD CAREGIVER, ELENA SOTOTIME VISIT/
INSPECTION COMPLETED:
12:58 PM
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On August 19, 2024, Licensing Program Analyst (LPA), Venus Mixson arrived unannounced to conduct a case management health and safety visit and met with the Facility Manager. LPA Mixson introduced herself and explained the purpose of the visit.

LPA Mixson toured the facility, along with the Lead Caregiver, Elena Soto and made observations pertaining to another matter that CCL was made aware of via SIR. There were two staff present and 10 residents at the time of this case management health and safety visit. There are no imminent health and/or safety concerns observed at the time of visit. LPA Mixson requested and received pertinent documentation pertaining to R1 and S1. Staff involved in the incident has been removed from the schedule pending further investigation.

LPA Mixson did not observe any health and/or safety hazards inside or outside of the facility at the time of this visit. LPA observed the facility utilities to be operating without issue. LPA Mixson assessed the available food and observed there was a variety of food types available for the residents in care. The food supply meets the requirement of a two-day supply of perishable foods and a seven-day supply of non-perishable foods. The medications were found to be in sufficient supply, locked, and inaccessible to the residents in care.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
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)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: JOY AND LOVE HOME CARE, LLC
FACILITY NUMBER: 371881431
VISIT DATE: 08/19/2024
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 CONTINUATION

An Unusual Incident Report was submitted to CCL on August 13, 2024, Regarding Resident Number 1 (R1), Catherine Zumpone. Administrator shared that the following steps are in place to assure there are no contact with the staff who was stated to have caused the resident any type of stress.

Follow up information: Nurse evaluation is performed, and no injuries were identified, during investigations, Administrator identified change in information by the Resident probably due to cause of dementia and past UTI. As a proactive measure, alleged caregiver's access to the client room was revoked. Resident is being served majority of the times with female caregivers only.

Based on the information obtained during today's visit, there are no immediate threats to the health, safety, and/or welfare of the residents in care. No deficiencies were observed or cited during today's visit.

An exit interview was conducted, and a copy of this report was provided to Lead Caregiver Elena Soto.


No further information was obtained at this time.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
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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