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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006125
Report Date: 08/15/2024
Date Signed: 08/15/2024 11:03:02 AM

Document Has Been Signed on 08/15/2024 11:03 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/
DIRECTOR:		ENCARNACION, JOEYFACILITY TYPE:
740
ADDRESS:5132 EDINGER AVETELEPHONE:
(714) 594-3646
CITY:HUNTINGTON BEACHSTATE: CAZIP CODE:
92649
CAPACITY: 6CENSUS: 5DATE:
08/15/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:25 AM
MET WITH:Joey EncarnacionTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced Plan of Correction (POC) visit to follow up on deficiencies cited on 07/31/2024. LPA was greeted and granted entry into the facility and explained the reason for the visit.

Deficiency cited under Title 22 Regulation 87705(f)(1) pertaining to Care of Persons with Dementia has been cleared. During today's visit, sharps are secured.. Licensee has complied with the POC.

Deficiency cited under Title 22 Regulation 87555(b)(28) pertaining to Food Service has been cleared. During today's visit, food is observed to be of good quality and fresh. Licensee has complied with the POC.

Licensee has been advised to maintain compliance in all items previously cited.









Exit interview conducted and a copy of this report was provided.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE: DATE: 08/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/15/2024
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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