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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700797
Report Date: 11/19/2021
Date Signed: 11/19/2021 10:17:17 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:JOYFUL LIVING RESIDENTIAL CAREFACILITY NUMBER:
342700797
ADMINISTRATOR:MOYA, GERARDOFACILITY TYPE:
740
ADDRESS:12655 SOLSBERRY WAYTELEPHONE:
(916) 790-8163
CITY:RANCHO CORDOVASTATE: CAZIP CODE:
95742
CAPACITY:6CENSUS: 3DATE:
11/19/2021
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Gerardo Moya, AdministratorTIME COMPLETED:
10:30 AM
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On 11/19/21 at 9:30am Licensing Program Analyst (LPA) Kevin Gould arrived at Joyful Living Residential Care RCFE for the purpose of conducting Plan of Correction (POC) inspection to ensure all corrections have been made from a previous inspection. LPA met with Administrator, Gerardo Moya and together conducted a walk through of the home.

LPA tested the hot water temperature in the kitchen and recorded a temperature of 108 degrees F. which meets the 105-120 degree Fahrenheit regulation. LPA also confirmed that all staff currently working at the facility are associated to the facility and have received criminal record clearance.

LPA observed a two day supply of perishable foods, and a two week supply of non-perishable food supply. The home is clean, sanitary and in good repair. LPA inspected the back yard and observed no hazards to residents in care.

Licensee requested additional PPE supplies: disposable gowns, surgical masks, face shields, gloves (medium and large) and hand sanitizer. Supplies will be picked up on Tuesday 11/23/21 at 1:00pm from the regional office.

LPA Gould has cleared the deficiencies and a POC clearance letter will be generated and provided to the facility.

Per California Code of Regulations, Title 22 there were no deficiencies observed or cited during today's inspection. An exit interview was conducted, and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Czarrina A Camilon-LeeTELEPHONE: (916) 263-4723
LICENSING EVALUATOR NAME: Kevin GouldTELEPHONE: (619) 672-5924
LICENSING EVALUATOR SIGNATURE:

DATE: 11/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/19/2021
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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