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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005194
Report Date: 06/03/2024
Date Signed: 06/04/2024 08:41:01 AM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 06/04/2024 08:41 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/
DIRECTOR:		ENCARNACION, JOEYFACILITY TYPE:
740
ADDRESS:10688 LEHNHARD AVETELEPHONE:
(714) 875-8494
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY: 6CENSUS: 6DATE:
06/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:31 PM
MET WITH:Lisa Encarnacion, Administrator and Joey Encarnacion, Licensee/AdministratorTIME VISIT/
INSPECTION COMPLETED:
03:23 PM
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On today's date, Licensing Program Analyst (LPA) LPA Rosie Quiroz made an unannounced visit on this day for the purpose of conducting an Annual Required-1 year inspection visit. LPA was greeted by Administrator (AD) LIsa Encarnacion and discusses purpose of today's visit. Licensee (L) Joey Encarnacion arrived during today's visit
The facility is a one story home which consists of: 2 shared resident bedrooms, 2 private residents bedrooms, 2 caregiver bedrooms, 3 bathrooms designated for residents, 1 bathroom designated for visitors and staff, living-room, family room, kitchen with dining area, back yard with ample shade and outdoor furniture, garage with operational washer and dryer.
The facility is licensed for age range 60 and over, approved for capacity of 6 Non-Ambulatory residents and has a hospice waiver for five (5) residents. There are currently (4) one resident receiving hospice care services.
(AD) Lisa Encarnacion has a current Administrator's certificate which expired 3/5/2023. (AD) Lisa Encarnacion indicated completed AD renewal, pending certificate and agreed to submit copy of AD Certificate to CCLD upon receiving.
LPA along with AD Lisa Encarnacion toured the interior and exterior of facility. LPA observed kitchen for proper sanitation and cleanliness. LPA observed sharp objects locked and secured in cabinet in kitchen area, and observed toxin substances to be locked and inaccessible to residents in care in locked and secured closet in garage area. The food was observed to meet the minimum requirement of two days perishable and seven days nonperishable food supply for residents in care.
Resident bedroom areas were observed to have required furnishings including but not limited to: lamp, bed, mattress, night stand and clean linen. LPA interacted and interviewed with residents and staff during today's facility tour. The water temperature in resident bathrooms were measured to be within normal limits. The Grab bars and non-slip mats were observed in resident bathrooms and shower room. Room temperature inside the facility was recorded to be 72 degrees F. The outside grounds were inspected during facility tour, and no bodies of water were observed. No pool available at this facility. CONTINUE LIC 809-C PAGE...
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE: DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/03/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 HOME
FACILITY NUMBER: 306005194
VISIT DATE: 06/03/2024
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CONTINUED... Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. LPAs observed and tested functional and operational carbon monoxide and smoke alarms. LPA Quiroz observed two fire blankets.

(L/AD) Joey Encarnacion reports fire drills are conducted quarterly with staff and residents. Last facility fire drill was conducted on 1/5/2024.

LPA Quiroz reviewed whether the facility is operating within capacity limitations and reviewed repeated violations, no repeated violations assessed.

During today's visit, LPAs reviewed six of six resident records, centrally stored medications and four personnel files. Resident and personnel files were found to be within Title 22 California Code of Regulations.

Based on the observations made during today’s visit; there are no deficiencies being cited per Title 22 Division 6 of the California Code of Regulations. This report was read and reviewed with L/AD Joey Encarnacion, and a copy of this report, LIC 858s, LIC 859 were provided at exit.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:

DATE: 06/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/03/2024
LIC809 (FAS) - (06/04)
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