331800084-3-17-2025-56-AS-MBRN-DEUS98-20250317134020

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 331800084
Report Date: 03/17/2025
Date Signed: 03/17/2025 01:41:01 PM

Document Has Been Signed on 03/17/2025 01:41 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
, CA 92507

FACILITY NAME:	HEART OF JOY HOME CARE		FACILITY NUMBER:	331800084
ADMINISTRATOR/ DIRECTOR:	MESINA, JOSEPHINE O		FACILITY TYPE:	740
ADDRESS:	597 HAMILTON DR		TELEPHONE:	(951) 432-7528
CITY:	CORONA	STATE: CA	ZIP CODE:	92879
CAPACITY: 5	TOTAL ENROLLED CHILDREN: 0	CENSUS: 4	DATE:	03/17/2025
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:15 AM
MET WITH:	Licensee/Administrator Josephine Mesina		TIME VISIT/ INSPECTION COMPLETED:	01:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 03/17/2025 at 09:15 AM, Licensing Program Analyst (LPA) Melody Brown made an unannounced visit to the facility. The purpose of the visit was to conduct the required comprehensive annual inspection. LPA Brown met with a staff and was granted entry to the facility. Licensee/Administrator Josephine Mesina was informed of the visit and arrived during the visit. LPA Brown informed Licensee/Administrator Mesina of the purpose of the visit. At the time of the visit there were two (2) staffs present, and four (4) residents present. The facility is a five (5) bedroom, two (2) bathroom home with a kitchen/dining area, living room/activity room, laundry room and an attached garage. The facility is Residential Care Facility for the Elderly (RCFE). The facility is licensed for a capacity of five (5) non-ambulatory residents. The facility’s approved for four (4) hospice waiver. The current census is four (4) residents. LPA Brown was accompanied by Staff #2 (S2) to conduct a general overall inspection, which included, but was not limited to the following: Physical Plant: LPA Brown observed Resident #1 (R1) and Resident #3 (R3) were reported bedridden by their physician and the facility does not have an approved fire clearance for bedridden residents. Deficiency will be issued today, 03/17/2025 and an immediate civil penalty of $500.00 will be assessed and will continue to be assessed until corrected. There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature of 71 degrees Fahrenheit (F). LPA Brown inspected resident bedrooms; they are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA Brown observed sufficient furniture and lighting throughout the facility. LPA Brown measured and observed the water temperature in the resident bathroom to be at 106.5 degrees F. The facility is equipped with operating smoke detectors and carbon monoxide alarms. Charged fire extinguisher was also observed at the facility. Posters such as personal rights, Ombudsman poster, and the disaster plan, House Rules and Theft and Loss Policy were posted in a common area. However, LPA Brown observed the Residential Care Facility for the Elderly (RCFE) Complaint Poster (PUB 475) was not posted at the facility. Technical Violation will be issued. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. *Continuation in LIC809C *

Efren Malagon	TELEPHONE: (951) 202-6356
Melody Brown	TELEPHONE: 951-897-2187
	DATE: 03/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025

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 5

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
, CA 92507

FACILITY NAME: HEART OF JOY HOME CARE	FACILITY NUMBER: 331800084
	VISIT DATE: 03/17/2025

NARRATIVE

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There is a medicine cabinet with the resident’s medications locked. LPA Brown observed a complete first aid kit and first aid book at the facility. Moreover, LPA Brown noted that the facility has the required emergency supplies, emergency food and emergency water maintained at the facility.

Food Service: More than seven (7) days’ supply of non-perishable foods and more than two (2) days’ supply of perishable food supply were observed and sufficient for the number of residents in care.

Care & Supervision: The facility has an Administrator present at the facility with appropriate and enough hours to appropriately manage the facility. The facility has sufficient number of staff to provide care and supervision to the residents in care. LPA Brown noted that the facility has a staff scheduled to work at night, awake and on duty as required for facility with dementia residents.

Record Review: LPA Brown noted that the facility has an updated Infection Control Plan, Emergency Disaster Plan and updated Liability Insurance. LPA Brown reviewed four (4) resident files for admission agreements, updated physician reports, pre-placement appraisals, centrally stored medication list/physician orders and needs and services plans. LPA Brown noted that Resident #1 (R1) and Resident #2 (R2) Admission Agreements were not signed and dated by the Licensee or LIcensee's Designated Representative. Deficiency will be issued. Moreover, LPA Brown noted that Resident #4 (R4) half bed rail has written order from R4's physician indicating the need for half bed rail for mobility. LPA Brown reviewed three (3) staff files for First Aid/CPR certification, criminal record clearance, trainings, and health screenings with tuberculosis (TB) test result. LPA Brown observed that staff files reviewed were complete.

During medication audit, LPA Brown observed that staffs at the facility are assisting their residents with their medications per their doctor's order. No issues observed.

Based on the observations made during today’s visit, deficiencies were cited per Title 22, Division 6, Chapter 8 of the California Code of Regulations (CCR).

An exit interview was conducted, and this report (LIC809), LIC809D, LIC421 IM and Appeal Rights were discussed and provided to Licensee/Administrator Josephine Mesina.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Melody Brown	TELEPHONE: 951-897-2187
LICENSING EVALUATOR SIGNATURE:	DATE: 03/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 03/17/2025 01:41 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: HEART OF JOY HOME CARE	FACILITY NUMBER: 331800084
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

87202(a)(2)

Fire Clearance

(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal: (2) Bedridden persons This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that the facility has an approved fire clearance for bedridden residents as evidenced of accepting Resident #1 (R1) and Resdident #3 (R3) into care who are both bedridden residents which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 03/18/2025
	Plan of Correction
1 2 3 4	Licensee stated to submit an updated Application for a Community Care Facility or Residential Care Facility for the Elderly License (LIC200) the Department and submit proof to LPA Brown by the 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.

Efren Malagon	TELEPHONE: (951) 202-6356
Melody Brown	TELEPHONE: 951-897-2187
	DATE: 03/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025

LIC809 (FAS) - (06/04)

Page: 3 of 5

Document Has Been Signed on 03/17/2025 01:41 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: HEART OF JOY HOME CARE	FACILITY NUMBER: 331800084
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/17/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Section Cited

CCR

87507(c)

Admission Agreements

(c) Admission agreements shall be signed and dated, acknowledging the contents of the document, by the resident or the resident's representative, if any, and the licensee or the licensee's designated representative no later than seven days following admission. Attachments to the agreement may be utilized as long as they are also signed and dated as prescribed above. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, interview and record review, the licensee did not comply with the section cited above by not ensuring that Resident #1 (R1) and Resident #2 (R2) Admission Agreements were signed and dated by the Licensee or LIcensee's Designated Representative which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 03/24/2025
	Plan of Correction
1 2 3 4	LIcensee signed R1 and R2 Admission Agreements during the visit today, 03/17/2025. Plan of Correctionn (POC) cleared.

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.

Efren Malagon	TELEPHONE: (951) 202-6356
Melody Brown	TELEPHONE: 951-897-2187
	DATE: 03/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/17/2025

LIC809 (FAS) - (06/04)

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