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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005695
Report Date: 10/27/2021
Date Signed: 10/27/2021 12:17:48 PM

Document Has Been Signed on 10/27/2021 12:17 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:GOOD HANDS LOVING CARE-FRANCISCOFACILITY NUMBER:
306005695
ADMINISTRATOR:YOO, DANIELFACILITY TYPE:
740
ADDRESS:21063 VIA FRANCISCOTELEPHONE:
(949) 878-0137
CITY:YORBA LINDASTATE: CAZIP CODE:
92887
CAPACITY: 6CENSUS: 4DATE:
10/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Daniel Yoo, AdministratorTIME COMPLETED:
11:15 AM
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA was greeted and granted entry into the facility by Administrator. LPA met with Daniel Yoo, Administrator and explained the nature of the visit.

LPA Martinez accompanied by Administrator began the tour of the inside and outside of the facility. There are four residents in care and there is no active covid-19 case in the facility. LPA observed two residents in the living room upon entry to the facility. All residents appeared to be clean and well taken care of. LPA observed a check in station in the entry of the facility, where visitors are screened upon entry. LPA observed required department postings and covid-19 precautionary postings signs throughout the facility. Bathrooms were observed to have supply of soap and appeared to be clean. LPA inspected residents’ bedrooms and they appeared to be clean and sanitary. All bedrooms observe to have all required components. LPA observed the emergency disaster and evacuation plan. Facility has supply of emergency food and water, as well as PPE supply in the kitchen and attached garage. LPA toured the outside of the facility and observed a gated pool and shaded seating for resident’s enjoyment. The facility has a second floor in the facility and no residents reside in the second floor. The facility has completed the LIC808 Mitigation Plan, LPA reviewed and approved the plan on today’s visit. LPA emailed the signed and approved plan to the Administrator for their records.

Based on the observation made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with the Administrator and a copy of this report was provided to the facility.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2021
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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