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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306004543
Report Date: 02/25/2025
Date Signed: 02/25/2025 12:00:10 PM

Document Has Been Signed on 02/25/2025 12:00 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:GOLDEN TUSCANY CAREFACILITY NUMBER:
306004543
ADMINISTRATOR/
DIRECTOR:		DANIEL RESCIAFACILITY TYPE:
740
ADDRESS:2825 E. DUTCH AVENUETELEPHONE:
(714) 234-6348
CITY:ANAHEIMSTATE: CAZIP CODE:
92806
CAPACITY: 6CENSUS: 5DATE:
02/25/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Harris Mendoza- AdministratorTIME VISIT/
INSPECTION COMPLETED:
12:20 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jessica Cho arrived unannounced for the purpose of conducting the Required 1-Year annual evaluation using the Care Inspection Tool. LPA was greeted and granted entry by Caregiver Eric Fonseca and explained the reason for the visit. Approximately 10:15am, Administrator Harris Mendoza arrived. Administrator Daniel Rescia has a valid administrator's certificate expiring on December 13, 2025.

The facility is a single story structure and is licensed to operate for six non-ambulatory residents, in which one may be bedridden. Facility maintains a hospice waiver for four residents. There are five residents in care with one resident under hospice and two caregivers on duty. There are five resident bedrooms and three resident bathrooms. There are two staff private bedrooms. All common areas were inspected including the the attached two car garage. The residents' bedrooms were appropriately furnished. Beds and bedding supplies were in good condition, adequate lighting was provided, sufficient storage space for each residents' personal belongings were observed. Bathrooms were found to be in compliance, clean, and operational. The hot water temperature measured at 107.7, 107.0, and 118.7 degrees Fahrenheit. Toxins, disinfectants, sharps, and medications were secured and inaccessible. LPA observed sufficient two-day supply of perishables and seven-day supply of non-perishable food available. The fireplace was properly screened. LPA toured the exterior portion of the facility. The outdoor passageway is free of obstruction. One out of the two exit gates were not self-closing and self-latching. LPA observed sufficient seating and shading. The fire extinguisher was charged, mounted, and serviced on June 18, 2024. The auditory devices and smoke/carbon monoxide detectors were tested and operational, however the volume for one smoke detector in one resident's bedroom was not as audible in comparison to remaining smoke detectors. LPA observed sufficient emergency food/water/generator in the garage. Emergency evacuation drills are conducted quarterly. The first aid kit contains all necessary elements. The facility land line number, (714) 632-5813, was tested and remains available. The liability insurance is valid expiring on November 20, 2025. The 'See Something, Say Something' (PUB 475) poster was observed in the correct size in the entry way.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE: DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/25/2025
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 6
Document Has Been Signed on 02/25/2025 12:00 PM - It Cannot Be Edited


Created By: Jessica Cho On 02/25/2025 at 11:12 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: GOLDEN TUSCANY CARE
FACILITY NUMBER: 306004543

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87456(a)(3)
Evaluation of Suitability for Admission
(a) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (3) Obtain and evaluate a recent medical assessment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited by obtaining a current LIC 602 in two out of the five residents which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/11/2025
Plan of Correction
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Administrator stated that the LIC602s will be obtained and will submit proof to LPA via email by POC due date.
Type B
Section Cited
CCR
87608(a)(3)
87608 Postural Supports (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:
Deficient Practice Statement
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Based on observation and record review, the licensee did not comply with the section cited above in four out of five residents which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/11/2025
Plan of Correction
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Administrator will obtain the bed rail orders for four residents and will submit a copy to LPA via email by POC due date.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lourdes Montoya
LICENSING EVALUATOR NAME:Jessica Cho
LICENSING EVALUATOR SIGNATURE:
DATE: 02/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 02/25/2025 12:00 PM - It Cannot Be Edited


Created By: Jessica Cho On 02/25/2025 at 11:23 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: GOLDEN TUSCANY CARE
FACILITY NUMBER: 306004543

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/25/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87411(f)
87411 Personnel Requirements - General (f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in two out of two staff which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/11/2025
Plan of Correction
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Administrator stated that TB test results will be submitted to LPA via email by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Lourdes Montoya
LICENSING EVALUATOR NAME:Jessica Cho
LICENSING EVALUATOR SIGNATURE:
DATE: 02/25/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/25/2025


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: GOLDEN TUSCANY CARE
FACILITY NUMBER: 306004543
VISIT DATE: 02/25/2025
NARRATIVE
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LPA conducted a file review of all residents and two staff. Discrepancies noted. Two out of five residents did not have a current medical assessment and two staff did not have a TB test result on file. Medications were audited and no concerns noted. Interviews were conducted.

The following items were addressed: to increase the volume for one smoke detector in the room of Resident #2 (R2), ensure one exit gate self-latches, obtain bed rail orders for R1-R3 & R5, obtain a current physician's report for R2 and R4, obtain Tuberculosis (TB) tests for Staff #1 (S1) and Staff #2 (S2), request in writing to update the current facility telephone number, amend the current Emergency Disaster Plan (LIC 610E) to have the same content, and to ensure annual dues are paid timely due May 23, 2025.

Based on the observations made during today's visit, deficiencies are being cited. Advisory Notes (LIC9102s) are also being issued.

An exit interview was conducted with Administrator Harris Mendoza, and a copy of this report (LIC809/LIC809-C), LIC809-Ds, LIC9102s, LIC811s, appeal rights, and a copy of the LIC610E were provided at the end of the visit.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:

DATE: 02/25/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/25/2025
LIC809 (FAS) - (06/04)
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