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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 371881431
Report Date: 05/01/2023
Date Signed: 05/01/2023 11:46:26 AM

Document Has Been Signed on 05/01/2023 11:46 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:JOY AND LOVE HOME CARE, LLCFACILITY NUMBER:
371881431
ADMINISTRATOR:SARAPAT, AILA J.FACILITY TYPE:
740
ADDRESS:1178 EVERGREEN LANETELEPHONE:
(661) 754-0261
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY: 18CENSUS: 8DATE:
05/01/2023
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:03 AM
MET WITH:Applicant, Siva MullapudiTIME COMPLETED:
11:55 AM
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Licensing Program Analyst (LPA) Janira Arreola, conducted an announced visit for the purpose of conducting the prelicensing visit. LPA met with Applicant, Siva Mullapudi, who was informed of the purpose of the visit. The applicant is seeking a change of ownership where the ownership is changing to JOY AND LOVE HOME CARE, LLC. The population served is elderly ages 60 and over. The capacity will be for (18) residents.

LPA conducted a walk through of the interior and exterior of the facility. The building is a (2) story building with a deck that wraps around upstairs and has (2) exits to the down stairs and parking lot area. Total amount of rooms amounts to 12. The fire clearance conducted by Vista Fire Department was approved for (12) non-ambulatory and (6) bedridden residents. LPA observed the residents bedrooms which had the appropriate furniture such as bed, dresser, closet space, light, and chair. The facility has first aid kit with required items.. The facility kitchen was observed to be clean and posses equipment to conduct meal preparation for residents The kitchen had the appropriate food items for the capacity of the facility. LPA observed the bathrooms in the facility to have hand hygiene supplies. The facility possesses cleaning supplies to conduct regular cleaning of the facility. The smoke alarms and carbon monoxide detectors were found to be in operating condition. The dining room has enough seating for all residents with dining area. The outdoor space has enough seating to accommodate residents with a shaded areas. The hot water temperature was recorded at 113F, and the land line was observed to be operational. The facility has a call button system which was observed to be functional at the time of the visit. The facility also has a stair case which has a latched gate to safe guard residents, and a functioning elevator with current inspection through September 2023. The facility has a locked gate around a koi pond outside which has a pump system. No firearms are being kept in the facility. Kitchen knifes will be kept in designated area inaccessible to residents. The medications were observed to be locked in the facility medications room.

An exit interview was conducted where this report was reviewed and provided to applicant, Siva Mullapudi.
SUPERVISORS NAME: Joel Esquivel
LICENSING EVALUATOR NAME: Janira Arreola
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2023
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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