306003965-10-5-2021-22-AS-RQUZ-C7HTWK-20211005150539

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306003965
Report Date: 10/05/2021
Date Signed: 10/05/2021 03:05:43 PM

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:	LENDING HANDS ELDERLY CARE		FACILITY NUMBER:	306003965
ADMINISTRATOR:	AMELIA ACEVEDO		FACILITY TYPE:	740
ADDRESS:	25391 CLASSIC DRIVE		TELEPHONE:	(949) 837-4348
CITY:	MISSION VIEJO	STATE: CA	ZIP CODE:	92691
CAPACITY:	6	CENSUS: 5	DATE:	10/05/2021
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	01:10 PM
MET WITH:	Amelia Acevedo, Administrator		TIME COMPLETED:	03:20 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

On today’s date, Licensing Program Analyst (LPA) LPA Rosie Quiroz conducted an unannounced visit for the purpose of conducting a required annual inspection. LPA Quiroz was greeted and granted entry into the facility by Administrator Amelia Acevedo, and explained the nature of the visit.

This facility is licensed to provide services to 6 Non-Ambulatory Residents, and has a hospice waiver for two (2) residents. Administrator Amelia Acevedo has an Administrator Certificate with expiration date of 10/15/2022.

On or about 1:22pm LPA Quiroz along with Administrator Acevedo toured the inside and outside of facility. There are five residents in care and there are no active COVID-19 cases. During today's inspection visit, LPA Quiroz observed three residents in their bedrooms resting, one resident in family room watching television and one resident in dining room area visiting with their Family.

LPA Quiroz observed five of five residents in care appeared to be clean and well taken care of. LPA Quiroz observed required department postings in the facility as well as hand washing signs in the restrooms. All restrooms observed to have ample soap/sanitizer and appeared clean. LPA Quiroz inspected residents’ bedrooms and appeared clean and sanitary. All bedrooms observed to have all required components. LPA Quiroz observed a check in station in the main entry of the facility. Facility is taking temperatures daily and documenting results. LPA Quiroz observed the emergency disaster and evacuation plan.

Facility has back-up emergency food supply, water and PPE supplies readily available. LPA Quiroz toured the outside of the facility and observed seating area with table and chairs for resident’s enjoyment in backyard area and facility front porch. Facility has completed the LIC 808 Mitigation plan and LPA Quiroz approved the plan on today’s visit.

CONTINUED ON NEXT PAGE...

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021

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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: LENDING HANDS ELDERLY CARE	FACILITY NUMBER: 306003965
	VISIT DATE: 10/05/2021

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

During today's inspection visit, LPA Quiroz reviewed five of five resident records. Administrator Acevedo indicated "all residents and staff at facility are vaccinated for COVID-19 at this facility."

Based on the observation made during today’s visit, no deficiencies were noted today per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with Administrator Amelia Acevedo, and a copy of this report was provided to Administrator Acevedo at exit.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 10/05/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/05/2021

LIC809 (FAS) - (06/04)

Page: 2 of 2