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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005194
Report Date: 07/13/2021
Date Signed: 07/13/2021 02:23:33 PM

Document Has Been Signed on 07/13/2021 02:23 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:GOLDEN TOUCH GUEST HOMEFACILITY NUMBER:
306005194
ADMINISTRATOR:ENCARNACION, JOEYFACILITY TYPE:
740
ADDRESS:10688 LEHNHARD AVETELEPHONE:
(714) 875-8494
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY: 6CENSUS: 6DATE:
07/13/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:58 PM
MET WITH:Administrator, Joey EncarnacionTIME COMPLETED:
02:40 PM
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Licensing Program Analyst (LPA) Jenifer Tirre conducted an unannounced visit for the purpose of conducting a required/ annual visit. LPA was greeted, granted entry into the facility and temperature checked by Staff and explained the reason for the visit.

During the visit LPA toured the facility with Administrator and Caregiver. Facility is a 5 bedroom,( 4 resident bedrooms 1 staff bedroom) and 4 bathroom single story home. There are 6 Residents in care. LPA observed proper covid signage at front entrance of facility as well as check in, sanitization and temperature check station. Facility has required Department postings. LPA observed copy of Administrators Certificate expiring April 14,2022. LPA toured all Residents rooms, all rooms where within regulations. All restrooms observed contained soap, toilet paper, and towels . Restrooms had proper hand washing signs posted. Residents were observed relaxing in bedrooms watching TV and eating lunch in kitchen. Facility has working smoke detectors and audible alarms for each door entrance/exit. Facility has 2 fire extinguishers which are fully charged. Facility has ample supply of PPE. Facility has ample food supply. LPA observed facility emergency food and water supply. Facility has required Emergency Disaster Plan posted. Facility has a secured location for resident medication and files. Facility has 30 days supply of medications for clients. LPA reviewed Clients files during visit. Clients emergency contact information and Physicians reports are current. Facility has a designated visitation area.

No deficiencies noted during todays visit. An exit interview was conducted with Administrator Joey Encarnacion and a copy of report was left at facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Jenifer Tirre
LICENSING EVALUATOR SIGNATURE: DATE: 07/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/13/2021
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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