<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006595
Report Date: 02/11/2025
Date Signed: 02/11/2025 03:17:23 PM

Document Has Been Signed on 02/11/2025 03:17 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:GOLDEN GROVE CAREFACILITY NUMBER:
306006595
ADMINISTRATOR/
DIRECTOR:		ATTRAH, AMEERFACILITY TYPE:
740
ADDRESS:12252 HAGA STREETTELEPHONE:
(562) 544-9167
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY: 6CENSUS: 0DATE:
02/11/2025
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:03 PM
MET WITH:Lorenzi Nunez, Ahmed Attrah, Ameer AttrahTIME VISIT/
INSPECTION COMPLETED:
03:32 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Michael Tea made an announced visit to the facility for the purpose of conducting a pre-licensing inspection. LPA Tea met with designated Licensee/Administrators (LE/ADs) Lorenzi Nunez, Ahmed Attrah, and Ameer Attrah.

An application to operate a Residential Care Facility for the Elderly (RCFE) was received by our agency on July 8, 2024 for a total capacity of six ambulatory clients. Fire clearance was approved by a fire inspector from the Orange County Fire Authority on August 21, 2024.

The facility is a one-story home with three resident bedrooms, two bathrooms, a living room, a kitchen, a small dining area, and storage room. Resident bedrooms had the required furnishings. LPA observed all beds had linens and blankets. There are extra linens and blankets in each room. Smoke detectors and carbon monoxide detectors tested operational. All bathrooms have working plumbing. Toilets and water faucets worked properly. Hot water temperatures in the bathrooms measured at 105.2 F degrees.

LPA observed Administrator certificates, See Something, Say Something poster (PUB 475), Personal Rights, Facility sketch and Emergency Disaster Plan in the facility mounted on the wall by the front entry way near the door. The first aid kit is also stored in the living room and has all the required elements. Reading materials, games and puzzles were observed in the living room. There are cameras placed in the common areas of the facility without audio for the safety of residents in care.

A supply of two days/seven-days of perishable and non-perishable food was observed. Gas burner stove, dishwasher, refrigerator, microwave, washer, and dryer are operational. All toxic chemicals, cleaning solutions, and disinfectants are inaccessible to clients are stored and locked underneath kitchen sink. Emergency food and water and additional supplies were observed to be well stocked in the kitchen pantry and kitchen area. A phone is in the kitchen for residents to use. Medications will be stored in locked cabinets

Continuation of Pre-licensing on LIC 809-C
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE: DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: GOLDEN GROVE CARE
FACILITY NUMBER: 306006595
VISIT DATE: 02/11/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
in the kitchen area. Staff and client records will also be stored in the locked cabinets in the kitchen. There are laptops and iPads for residents to use. The fire extinguisher is in the kitchen and is fully charged.

All exiting doors had alarm notifications. There is one gate on the left side of the house that is self-latching and unlocked. There is a shaded seating area for clients and LPA did not observe any obstacles or hazards in the backyard.

The facility is ready to be licensed. LPA conducted the Component Three Orientation with LE and AD. Licensee was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. An exit interview was conducted, and a copy of this report was provided to the Licensee.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 02/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/11/2025
LIC809 (FAS) - (06/04)
Page: 2 of 2