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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700797
Report Date: 06/20/2024
Date Signed: 06/20/2024 10:22:24 AM


Document Has Been Signed on 06/20/2024 10:22 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827



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: 4DATE:
06/20/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:05 AM
MET WITH:Thelma Mallare, Ann TaguinodTIME COMPLETED:
10:35 AM
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Licensing Program Analyst (LPA) Christina Valerio arrived unannounced to conduct an annual required inspection. LPA met with facility staff Thelma Mallare and Ann Taguinod, and explained the purpose of the visit. LPA was later met by licensee Gerardo Moya.

LPA Valerio and staff A. Taguinod toured the facility to ensure compliance with Title 22 regulations. LPA Valerio inspected 4 resident bedrooms. All bedrooms were observed to be fully furnished, free from odors, and clean. Resident bathroom was observed to be stocked with toilet paper, hand sanitizer, hand soap, paper towels, skid mat, shower chair, handrails, and a trash can. The hot water temperature was measured with a thermometer, which read a temperature reading of 108.4 degrees F. Common areas, including the kitchen, dinning room, living room, and hallways were observed to be clean, organized, and free from debris. Medications, sharps, and cleaning supplies were observed to be locked and inaccessible to residents in care. Door sound alarms were observed to be in working condition. The facility met the regulatory food requirements and was observed to have an emergency supply readily available. The fire extinguisher was observed to be in compliance with a last annual maintenance check on 05/13/2024. The last emergency drill was conducted by staff in June of 2024. Staff were observed assisting residents with ADLs, cleaning the home, preparing meals, and engaging with resident in care. Residents were observed taking a nap, watching television, and going out for a walk during today's visit.

LPA Valerio reviewed 2 staff files and 2 resident files. Staff files were up to date with current training. Resident files were complete with current assessments and files. LPA Valerio requested the following annual documents for the facility file: LIC 500 Personnel Report, LIC 308 Designation of Responsibility, LIC 610 Emergency Disaster Plan, LIC 999 Facility Sketch, Copy of Liability Insurance

Per California Code of Regulations (CCR) - Title 22, no deficiencies are being cited. An exit interview was held, and a copy of the report was provided to Administrator Gerardo Moya.
SUPERVISOR'S NAME: Stephen RichardsonTELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina ValerioTELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:
DATE: 06/20/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/20/2024
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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