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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005194
Report Date: 09/28/2021
Date Signed: 09/28/2021 10:08:58 AM

Document Has Been Signed on 09/28/2021 10:08 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, 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:
09/28/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Joey Encarnacion, Licensee/AdministratorTIME COMPLETED:
10:09 AM
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 On today's date, Licensing Program Analyst (LPA) LPA Rosie Quiroz reviewed Epidemic Outbreak Mitigation Plan Report (LIC 808) dated 5/28/2021, which was uploaded on 7/6/2021.

During today's visit, LPA Quiroz provided consultation to Licensee/Administrator Joey Encarnacion regarding Epidemic outbreak mitigation plan LIC 808.

During today's visit, LPA Quiroz conducted a facility tour along with Licensee/Administrator Joey Encarnacion. 5 of 6 residents were observed to be in family room watching television, dressed weather appropriately. 1 of 6 residents were observed to be in their bedroom resting. 6 of 6 residents appeared to be well taken care of.

Based on today's observations, no deficiencies were noted during todays visit. An exit interview was conducted with Licensee/Administrator Joey Encarnacion and a copy of report was provided at exit.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE: DATE: 09/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/28/2021
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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