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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006718
Report Date: 04/10/2026
Date Signed: 04/10/2026 11:17:22 AM

Document Has Been Signed on 04/10/2026 11:17 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:GOLDEN GROVE CARE 1FACILITY NUMBER:
306006718
ADMINISTRATOR/
DIRECTOR:		ATTRAH, AHMEDFACILITY TYPE:
740
ADDRESS:12256 HAGA STREETTELEPHONE:
(949) 994-2900
CITY:GARDEN GROVESTATE: CAZIP CODE:
92841
CAPACITY: 6CENSUS: 0DATE:
04/10/2026
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:00 AM
MET WITH:Ahmed Attrah, Ameer AttrahTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Michael Tea conducted an announced visit to the facility for the purpose of completing a pre-licensing inspection. LPA met with the designated Administrators (AD), Ahmed Attrah and Ameer Attrah.

An application to operate a Residential Care Facility for the Elderly (RCFE) was received by the Department on March 3, 2025, for a total licensed capacity of six (6) ambulatory residents. Fire clearance was approved by the Orange County Fire Authority on May 19, 2025.

The facility is a one-story home consisting of four (4) resident bedrooms, two (2) full bathrooms, laundry area, living room, kitchen, and dining area. The home has two exit gates located on each side of the house, both of which are self-latching and secure. A shaded seating area is available in the backyard for residents’ use. LPA did not observe any safety hazards or obstructions. Recreational materials, including reading materials, games and puzzles, were observed for resident use.

LPA observed the Administrator Certificate, facility sketch, and Emergency Disaster Plan posted in the front entry way. The “See Something, Say Something” poster (PUB 475), Ombudsman poster, and Personal Rights were also prominently displayed.

Resident bedrooms were observed to be appropriately furnished. All beds were observed with adequate linens and blankets, and an ample supply of linens and towels was available. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Hot water temperature in the bathrooms measured approximately 109.9°F. Bathrooms were clean, operational, and equipped with a working toilet, wash basin, and bathtub/shower. Non-skid mats were in place to ensure resident safety. Toxic substances were observed to be secured and locked underneath the kitchen sink and laundry room.

(Inspection Report continued on LIC809C)

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Michael Tea
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 04/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/10/2026
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: GOLDEN GROVE CARE 1
FACILITY NUMBER: 306006718
VISIT DATE: 04/10/2026
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Medications will be stored in a locked cabinet in the hallway. A fully stocked first aid kit was observed as well with a first aid manual. Resident and facility records will be securely stored in the same locked cabinet. The facility also has a laptop available for residents to use to maintain communication with family.

An adequate supply of perishable and non-perishable food was observed. All appliances, including the stove, refrigerator, dishwasher, microwave, washer, and dryer, were operational. Sharp objects are stored in a secure kitchen cabinet. Emergency food, water, and additional supplies were observed to be adequately stocked in the kitchen pantry and separate container storage. The fire extinguisher in the kitchen was observed to be fully charged.

Based on today’s inspection, the facility appears ready for licensure. LPA conducted Component III Orientation with Administrators Ahmed Attrah and Ameer Attrah. The Administrator was informed that 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 Administrator.

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Michael Tea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 04/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/10/2026
LIC809 (FAS) - (06/04)
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