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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006125
Report Date: 04/14/2022
Date Signed: 04/15/2022 08:24:17 AM

Document Has Been Signed on 04/15/2022 08:24 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 HANDS CARE HOMEFACILITY NUMBER:
306006125
ADMINISTRATOR:ENCARNACION, JOEYFACILITY TYPE:
740
ADDRESS:5132 EDINGER AVETELEPHONE:
(714) 594-3646
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92649
CAPACITY: 6CENSUS: 0DATE:
04/14/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:48 AM
MET WITH:License Joey Encarnacion Administrator Marizonia LlorinTIME COMPLETED:
12:45 PM
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Licensing Program Analyst (LPA) Shobhana conducted announced inspection for the purpose of conducting a pre-licensing inspection and COMP III. LPA met with and discussed the
purpose of the inspection. LPA Frank toured the facility along with the Licensee Joey Encarnacion.
Application was submitted to Community Care Licensing on 11/5/2021.
LPA observed COVID - visitation station equipped with hand sanitizer, thermometer, Gloves, visitors log,
COVID posters throughout the facility.
During the inspection, LPA observed the following.
This is a single story home. Facility is a 5 bedroom and 2 bathroom, house with attached garage that is
being used for storage. There is a back yard with a patio cover for the residents. Backyard exit gate is operational and unlocked. Backyard has shaded area for outdoor activities and
sufficient seating for residents. The facility has an in-ground pool which is appropriately fenced to make the pool inaccessible to the residents. LPA observe the facility to be clean and in good repair, Physical Plant and Safety of Environment/Operational as CCL Requirements.
Facility telephone number is ( 714-594-3646). The 5 residents bedrooms are spacious and easily accommodate the residents furnishings. Lamps, chairs, linens, and storage for each residents bedroom. Bathrooms were inspected and observed to be clean, faucets and toilets were operational. Water temperature was tested 109.6 F degrees. Linens & Hygiene Supplies. New linens and fully stocked linen closets were observed.Emergency Phone Numbers-714-875-0485, Exit Plan & Menu: Reviewed. Food Service. 2 days perishable and 7 days nonperishable food supply observed. Carbon Monoxide, Smoke Detectors, Fire Extinguisher were observed and tested, including the wired smoke detector/carbon monoxide detector. Appliances. Stove burners, microwave, washer, and dryer inspected. Knives: observed locked/stored in the kitchen cabinet. Toxins: observed in the locked cabinet in the garage. Medication cabinet is locked. First-Aid Kit & Activity Supplies: observed and available. Fire clearance was approved by Orange County Fire Authority on 1/18/22.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Shobhana Frank
LICENSING EVALUATOR SIGNATURE: DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/14/2022
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 HANDS CARE HOME
FACILITY NUMBER: 306006125
VISIT DATE: 04/14/2022
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Emergency Phone Numbers-714-875-0485, Exit Plan & Menu: Reviewed. Food Service. 2 days perishable and 7 days nonperishable food supply observed. Carbon Monoxide, Smoke Detectors, Fire Extinguisher were observed and tested, including the wired smoke detector/carbon monoxide detector. Appliances. Stove burners, microwave, washer, and dryer inspected. Knives: observed locked/stored in the kitchen cabinet. Toxins: observed in the locked cabinet in the garage. Medication cabinet is locked. First-Aid Kit & Activity Supplies: observed and available. Fire clearance was approved by Orange County Fire Authority on 1/18/22.

During the inspection, LPA explained the process of this application and about the post licensing inspection once the facility is licensed. Licensure was informed today that the facility is ready for licensure and final approval will be processed by the CAU supervisor in Sacramento.
An exit interview was conducted and a copy of this report was discussed with and provided to Licensure.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Shobhana Frank
LICENSING EVALUATOR SIGNATURE:

DATE: 04/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2022
LIC809 (FAS) - (06/04)
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