Purple Hearts Home Care

Type of visit: Case Management - Incident

On 05/05/2026 at 10:30AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct a case management visit in regard to incident report received on 04/21/2026. LPA met with Caregiver, Merle Guevarra and explained the purpose of the visit. Incident report dated 04/21/2026 revealed that R1's slipped off the bed during brief change, resulting in bruising on left side near ribs on 04/20/2026. S1 was assisting R1 with brief change when R1 fell off the bed. S1 called emergency personnel and R1 were transported to hospital to be examined. During visit, LPA interviewed R1, S1 and S2. LPA also reviewed incident report, R1’s after visit summary dated 04/20/2026-04/22/2026. LPA observed R1’s after visit summary did not indicate any bruising or injury to R1’s left side ribs. No deficiencies were cited during the visit. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, May 5, 2026

Allegation investigated: Staff are not properly trained Staff did not provide adequate care and supervision to a resident Staff are inappropriately restraining a resident

On 04/15/2026 at 10:23AM, Licensing Program Analyst (LPA), T. Syess-Gibson arrived unannounced to deliver findings for the allegations above. LPA met with Maria Walker, Caregiver and explained the reason for the visit. Administrator, Joy Bisaha arrived at approximately 11:09AM, LPA explained reason for visit. During the course of investigation LPA toured facility, conducted interviews with witness (W1) and staff (S1, S2 and S3). LPA reviewed and obtained residents’ roster, staff schedule, staff training logs, resident’s (R1’s) admission agreement, medication log, physician’s report (LIC602) and unusual incident reports. Continue on LIC9099... Substantiated Continued from LIC9099 Staff did not provide adequate care and supervision to a resident Interview with W1 revealed S2 and S3 are older and fragile and can’t provide physical care for R1, it’s difficult for S2 and S3 to handle R1 without assistance. Interviews with S2 and S3 revealed R1 was difficult to work with when R1 first arrive to facility, when R1 didn’t have medication to help with behaviors. Now that R1 is on medication, R1 is much easier to work with. Interview with S1 revealed facility is in the process of hiring more staff, which will allow more supervision of residents in care. Staff are not properly trained Record review revealed, staff received 20hrs of training in dementia care, postural support, restricted health conditions, hospice care, and medication administration. Record review and interviews with S2, and S3 revealed, staff have not received training related to residents’ behavioral challenges Staff are inappropriately restraining a resident Interviews with W1 revealed facility is keeping R1 restraint to keep R1 in the wheelchair. Interview with S1 revealed there was no physician order for the wheelchair belt, the facility was given permission from R1’s children to place a belt on the wheelchair to prevent R1 from sliding out and possibly falling on the floor. Continued on LIC9099C..... LIC9099C.... Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), are being cited on the attached LIC 9099D. Exit interview conducted and a copy of report was given. Continued from LIC9099 Staff are not meeting the needs of a resident Interviews with S1, S2 and S3 revealed R1’s needs are being me, R1 is given showers, meals three times a day with snack in between meals, and toileting needs are met daily. Staff are not meeting a resident's incontinence needs Interviews with W1, S1, S2 and S3 revealed staff have a difficult time changing R1. Interviews with S2 and S3 revealed they would have R1 stand against the wall, holding the grab bar in order to change R1’s diaper. Interviews also revealed licensees will come in a couple of days a week to assist with R1’s Based upon the information obtained during investigation. The above allegations are unsubstantiated. A finding that the complaint is UNSUBSTANTIATED means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and a copy of report was given.the state’s words, verbatim · CDSS document, Apr 15, 2026 · control 15-AS-20251215141851

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Apr 25, 2026

(a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. Additional staff shall be employed as necessary... This requirement is not met as evidenced by: Based on interviews and record review the Licensee did not comply with the section cited above in not having sufficient supervision for residents, which posed a health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Apr 15, 2026

Plan of correction: By POC date. Licensee agreed to implement a plan to assist with staffing and submit plan to CCL.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(1) · Plan of correction due date: Apr 25, 2026

(1) Ensuring staff receive the following training as part of the training requirements specified in Section 87208 Plan of Operation: (A) Dementia care, including, but not limited to, knowledge about hydration, nutrition, skin care, communication, therapeutic activities, behavioral challenges, the environment, and assisting with activities of daily living.... This requirement is not met as evidenced by: Based on record review and interviews the Licensee did not comply with he section cited above in not having staff trained as specified in section 87208, which posed a health and safety risk to persons in carethe state’s words, verbatim · CDSS document, Apr 15, 2026

Plan of correction: By POC date. Licensee agreed to implement a plan on providing staff training and send plan to CCL

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(3) · Plan of correction due date: Apr 25, 2026

(a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself. Postural supports may be used under the following conditions. 3) A written order from a physician indicating the need for the postural support shall be maintained in the resident’s record. The licensing agency shall be authorized to require other additional documentation if needed to verify the order. This requirement is not met as evidenced by: Based on interview and record review, the licensee did not comply with the section cited above in not having doctor orders for wheelchair belt for R1 which posed a potential health, safety or personal rights risk to persons in carethe state’s words, verbatim · CDSS document, Apr 15, 2026

Plan of correction: BY POC date. Licensee agreed to read regulation 87608 and send a self certifying email to CCL

Type of visit: Required - 1 Year

On 04/09/2026 at 10:10AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct a required 1- year inspection. LPA met with Caregiver, Augustine Bonete. Administrator, Joy Bisaha, arrived at 10:53AM, and LPA explained the purpose of the visit. The facility’s fire clearance was approved for four (4) ambulatory, three (3) non-ambulatory and three (3) bedridden residents LPA toured facility with Administrator, including but not limited to bedrooms, bathrooms, kitchen, common area and backyard. The facility consists of six (6) total bedrooms, one (1) bedroom occupied by staff and three (3) bathrooms. All outdoor and indoor passageways are kept free of obstruction. There are no bodies of water observed. A comfortable temperature is maintained at 71 degrees Fahrenheit. LPA observed lighting in all rooms is adequate for the comfort and safety of the residents. The hot water temperature in the resident’s shared bathroom was measured at 109.1 degrees Fahrenheit. Residents’ bathrooms are equipped with grab bars and non-skid mats. There is a minimum 7-day supply of nonperishable and 2 days of perishable foods. Smoke detectors and carbon monoxide detectors were in operating condition during visit. Fire extinguisher was last purchased on 05/13/2025. First aid kit was observed to be complete. Fire drill was last conducted on 01/30/2026. Continue on LIC809C…. Continued from LIC809 LPA reviewed four (4) resident records, LPA reviewed four (4) staff records all four (4) staff members were associated and have FirstAid/CPR. LPA observed the following deficiencies: At 10:46am LPA, was informed of Administrator not working at facility since February 16, 2026 At 11:07am, LPA observed hospital bed with rail in room#2, during file review LPA observed no physician orders for hospital bed with rails for R2. At 11:12am, LPA observed medication in a cup next to bed where R1 was laying in watching television. At 11:13am, LPA observed an unlocked kitchen drawer with sharps inside. At 1:45pm, LPA observed during file review and interviews, R1 was placed on hospice without physicians’ orders/knowledge. At 1:50pm, LPA observed during file review and interview, licensee did not notify CCL of R1 being placed on hospice within 5 days. At 2:11pm, LPA observed during file review, licensee did not update R1’s appraisal needs and service plan. At 2:35pm, LPA observed during file review, S3 and S4 do not have health screening and TB. At 2:37pm, LPA observed during file review, S2, S3 and S4 do not have training At 3:47pm during review of medication and Medication Administration Record (MAR), LPA observed facility was administering melatonin 10mg to R4 without physician orders. Continue on LIC9099C... Continued from LIC9099C..... LPA requested the following documents to be submitted to CCLD by 04/16/2026. LIC 308 Designation of Administrative Responsibility LIC 309 Administrative Organization LIC 500 Personnel Report LIC 610E Emergency Disaster Plan (last page) Liability Insurance Updated Facility Sketch Administrator Certificate Deficiencies were cited from Title 22 California Code of Regulations (see LIC809D). Failure to submit proof of corrections by plan of correction due date, and any repeat violations within 12-month period may result in civil penalties. Exit interview conducted. A copy of this report and appeal rights provided.the state’s words, verbatim · CDSS document, Apr 9, 2026

Type of visit: Post Licensing

On 09/09/2025 at 10:50AM, Licensing Program Analyst (LPA) T. Syess-Gibson arrived unannounced to conduct a post licensing inspection. LPA met with Caregiver, Dornapauyan Padil. Administrator, Joy Bisaha, arrived at 11:28AM, and LPA explained the purpose of the visit. The facility’s fire clearance was approved for four (4) ambulatory, three (3) non-ambulatory and three (3) bedridden residents. LPA inspected the facility with Administrator including but not limited to the bedrooms, bathrooms, kitchen, common area, storage areas, and the backyard. LPA observed all bedrooms were equipped with required furniture for the comfort and safety of the residents. LPA observed grab bars in shared residents’ bathrooms. Hallways and passages are free of obstruction. Hygiene supplies and toiletries were available. Facility temperature is maintained at 76 degrees F. Hot water temperature measures 105.1 degrees F. in residents' shared bathroom. Fire extinguishers were last purchased on 05/13/2025. First aid kit was complete with manual. Carbon monoxide and smoke detectors were observed operational during visit. Facility inspection matches the sketch that was provided. Continued on LIC809C. Continued from LIC809 LPA reviewed two (2) residents records, and they were complete. LPA also reviewed Medication Administration Record (MAR) during visit. LPA observed the following deficiencies: At 12:12PM, LPA observed laundry detergent, fabric softener, glass cleaner, pine glo, bleach and furniture polish in an unlocked cabinet. At 12:47PM, LPA observed personnel records were not at the facility Deficiencies were cited from Title 22 California Code of Regulations (see 809D). Failure to submit proof of corrections by plan of correction due date, and any repeat violations within 12-month period may result in civil penalties. Exit interview conducted. A copy of appeal rights and this report provided.the state’s words, verbatim · CDSS document, Sep 9, 2025

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87309(a) · Plan of correction due date: Sep 10, 2025

(a) Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances..... This requirement is not met as evidenced by: Based on observation, the licensee did not comply with the section cited above by having laundry detergent, fabric softener, glass cleaner, bleach, pine glo, and furniture polish in an unlocked cabinet which posed a potential health, safety or personal rights risk to persons in carethe state’s words, verbatim · CDSS document, Sep 9, 2025

Plan of correction: Administrator immediately locked cabinet. Deficiency cleared during visit.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87412(f) · Plan of correction due date: Sep 16, 2025

All personnel records shall be available to the licensing agency to inspect, audit, and copy upon demand during normal business hours..... This requirement is not met as evidenced by: Based on observation and interview, the licensee did not comply with the section cited above by not having personnel records available for licensing to inspect during business hours which poses a potential health, safety or personal rights risk to persons in carethe state’s words, verbatim · CDSS document, Sep 9, 2025

Plan of correction: Administrator agreed to read regulation 87412(f), agree to having personnel records available and send a self certifying email to CCLD by POC date.

Type of visit: Prelicensing

On 04/29/2025 at 1:30PM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted a pre- licensing inspection and met with Applicant/Licensee ,Weis Naderi and Administrator, Joy Bisaha. This pre-licensing is a change of ownership from old facility J AND R HOME CARE LLC# 079200970. During the visit, LPA observed (0) residents. This is in continuation from pre-licensing visit on 03/18/2025. All six (6) bedrooms are designated for residents. The facility received a fire clearance dated 04/22/2025 with an approval for a total capacity of ten (10) residents, three (3) non-ambulatory, four (4) ambulatory and three (3) bedridden residents. LPA observed the facility has made all corrections from previous visit. On 03/18/2025, 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. Passageways and hallways are free of obstruction. Locked cabinets available to store medications, toxins and sharps. Continue on LIC809C Continue from LIC809 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 04/26/2024. No Issues were noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required. Exit interview conducted and a copy of this report provided.the state’s words, verbatim · CDSS document, Apr 29, 2025

Type of visit: Case Management - Other

On 04/29/2025 at 2:22PM, Licensing Program Analyst (LPA) T. Syess-Gibson conducted a face-to-face Component III presentation on 04/29/2025 starting at 2:25pm. LPA conducted Component III with Licensee, Weis Naderi and Administrator, Joy Bisaha. LPA presented Component III power point and discussed the regulations embodied in the power point. LPAs observed participants gained knowledge about running and maintaining the facility in accordance with regulations. No deficiencies cited. Exit interview conducted and a copy of report provided.the state’s words, verbatim · CDSS document, Apr 29, 2025

Type of visit: Prelicensing

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 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.the state’s words, verbatim · CDSS document, Mar 18, 2025

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.