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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 079201423
Report Date: 03/18/2025
Date Signed: 03/18/2025 02:59:36 PM

Document Has Been Signed on 03/18/2025 02:59 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
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:PURPLE HEART HOME CAREFACILITY NUMBER:
079201423
ADMINISTRATOR/
DIRECTOR:		BISAHA, JOYFACILITY TYPE:
740
ADDRESS:1206 DAINTY AVETELEPHONE:
(510) 894-5509
CITY:BRENTWOODSTATE: CAZIP CODE:
94513
CAPACITY: 10CENSUS: 0DATE:
03/18/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:45 AM
MET WITH:Licensee, Wais Naderi/Administrator, Joy Bisaha,TIME VISIT/
INSPECTION COMPLETED:
03:15 PM
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On 03/18/2025 at 10:45AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived announced to conduct a pre licensing visit. LPA met with Licensee, Wais Naderi/Administrator, Joy Bisaha and explained the purpose of the visit. The facility currently has no residents. The facility’s fire clearance was approved for four (4) non-ambulatory and six (6) bedridden resident.


LPA toured facility with Licensee, Wais Naderi/Administrator, Joy Bisaha including but not limited to six (6) bedrooms, three (3) bathrooms, kitchen and common areas. Bedrooms and living rooms were equipped with the proper furniture. Bathrooms were equipped with grab bars and non-skid mats. Linens and hygiene supplies were observed inside a cabinet. There is sufficient lighting throughout facility.

Room temperature was maintained at 71 degrees F and hot water temperature was maintained at 105.7 degrees F. First-aid kit was observed to be complete. Smoke detectors and carbon monoxide were operational. Fire extinguisher was last purchased on 04/26/024.


Continue on LIC809C
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE: DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/18/2025
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 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: PURPLE HEART HOME CARE
FACILITY NUMBER: 079201423
VISIT DATE: 03/18/2025
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Continued from LIC809


The following will need to be completed before recommending licensure to Centralized Application Bureau (CAB):


1.) LPA observed facility doesn't have an accurate fire clearance STD850 identifying bedridden rooms.

2.) LPA observed facility doesn’t have telephone service.

3.) LPA observed facility doesn’t have an outdoor activity area that is easily accessible to the residents, protected from traffic, and have adequate shady areas.

4.) LPA observed facility doesn't have a dementia care plan that address behaviors such as ingestion of toxic chemicals and wandering behaviors.

Licensee/Applicant will submit proof of corrections to CCLD on or before 03/25/2025

LPA will conduct face-to-face comp III presentation on next visit.


Exit interview conducted and a copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Tonica Syess-Gibson
LICENSING EVALUATOR SIGNATURE:

DATE: 03/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/18/2025
LIC809 (FAS) - (06/04)
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