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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306001367
Report Date: 01/18/2022
Date Signed: 01/18/2022 03:46:19 PM

Document Has Been Signed on 01/18/2022 03:46 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:GENTLE CARE HOMEFACILITY NUMBER:
306001367
ADMINISTRATOR:EMERITA GARROVILLASFACILITY TYPE:
740
ADDRESS:416 S. JENNIFER LANETELEPHONE:
(714) 289-1260
CITY:ORANGESTATE: CAZIP CODE:
92869
CAPACITY: 6CENSUS: 5DATE:
01/18/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Emerita Garrovillas, Licensee/Administrator, Eric Gilber, Prospective Licensee, Susanne Anderson, Prospective Licensee, Marina Stanic, Regional Manager, Alisa Ortiz, Licensing Program Manager, Rosie Quiroz, Licensing Program Analyst.TIME COMPLETED:
11:21 AM
NARRATIVE
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On today's date, Regional Manager (RM) Marina Stanic, Licensing Program Manager (LPM) Alisa Ortiz and Licensing Program Analyst (LPA) Rosie Quiroz met virtually due to COVID-19 precautionary measures with Licensee Emerita Garrovillas on this day for the purpose of discussing change of ownership. Also present virtually was Perspective Licensees Eric Gilbert and Susanne Anderson.

The following was discussed:

  • Licensee's responsibilities of facility oversight
  • Update on facility change of application status
  • Failure to notify Community Care Licensing of change of ownership.

The following items are to be provided to the Department by Close of Business Today:

  • Lease back Agreement
  • Copy of Administrator Certificate for Perspective Administrator


The following deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. (See LIC 809-D)

An exit interview was conducted virtually with Licensee Emerita Garrovillas. A copy of this report, LIC 809, LIC 809-D, and Appeal Rights, were provided to Licensee Emerita Garrovillas via email.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Rosie Quiroz
LICENSING EVALUATOR SIGNATURE: DATE: 01/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/18/2022
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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Document Has Been Signed on 01/18/2022 03:46 PM - It Cannot Be Edited


Created By: Rosie Quiroz On 01/18/2022 at 01:54 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: GENTLE CARE HOME
FACILITY NUMBER: 306001367

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/18/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/19/2022
Section Cited

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87109(b)(b)(1) Transferability of License. ….the property and business shall not be transferred until the buyer qualifies for a license….The seller shall notify, in writing, a prospective buyer of the necessity to obtain a license…seller shall send a copy of this written notice to the licensing agency….
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….This requirement is not met as evidence by: Licensee failed to provide written notice to the Department that the property had been sold. This poses an immediate risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Alisa Ortiz
LICENSING EVALUATOR NAME:Rosie Quiroz
LICENSING EVALUATOR SIGNATURE:
DATE: 01/18/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/18/2022


LIC809 (FAS) - (06/04)
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