306005695-3-5-2024-22-AS-AJLO-D3LT96-20240322143122

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005695
Report Date: 03/05/2024
Date Signed: 03/05/2024 09:40:24 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/21/2021 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20211021104246

FACILITY NAME:	GOOD HANDS LOVING CARE-FRANCISCO		FACILITY NUMBER:	306005695
ADMINISTRATOR:	YOO, DANIEL		FACILITY TYPE:	740
ADDRESS:	21063 VIA FRANCISCO		TELEPHONE:	(949) 878-0137
CITY:	YORBA LINDA	STATE: CA	ZIP CODE:	92887
CAPACITY:	6	CENSUS: 2	DATE:	03/05/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Daniel Yoo		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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-Facility is retaining a resident that requires a higher lever of care

-Facility is not assisting resident with transfers

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Martinez visited the facility to deliver findings for the investigation into the above identified complaint allegations. LPA arrived at facility greeted and granted entry by Daniel Yoo, Administrator and explained the nature of the visit.

Based on the information obtained during this investigation the department has concluded the investigation into the above mentioned allegations. Findings are based upon this investigation which included interviews conducted and copy of pertinent documents obtained. It is alleged that facility is retaining a resident that requires a higher level of care. Per records review indicates that resident (R1) was admitted to the facility with a diagnosis of Parkinsons’s Disease, and Dementia per admissions R1 was admitted under hospice care. Per records review reflects that there was 2-3 staff onsite on any given shift to assist with care, at the

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20211021104246

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: GOOD HANDS LOVING CARE-FRANCISCO	FACILITY NUMBER: 306005695
	VISIT DATE: 03/05/2024

NARRATIVE

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time of investigation the facility had a census of 4 residents. Interview with 1 of 1 staff indicated that there was never any issue caring for R1, since R1 was on hospice there was no care concerns. R1 since admitted to the family did not have a change of condition and therefore staff was able to care for R1. Admissions paperwork appraisal determined by Administrator that facility was able to provide care for R1.

It is alleged that facility is not assisting resident with transfers. Records review revealed that R1 required help with transferring in and out of bed, assist with bathing, help with personal care, toileting needs and move about the facility. Facility notes reflect the major concerns with R1 was general weakness and required food intake to be soft or Interview with staff 2 of 2 indicated that staff would help with R1’s transfers and when required two staff would help with transfers. Interviews with 2 of 2 residents indicated that facility staff help them with their needs, help when needed and see staff helping other residents with transfers.

Based on the information gathered during the investigation, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated.

This report was reviewed with Administrator and a copy was furnished to the facility.

SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2024

LIC9099 (FAS) - (06/04)

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