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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306003965
Report Date: 08/16/2022
Date Signed: 08/16/2022 10:27:13 AM


Document Has Been Signed on 08/16/2022 10:27 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:LENDING HANDS ELDERLY CAREFACILITY NUMBER:
306003965
ADMINISTRATOR:AMELIA ACEVEDOFACILITY TYPE:
740
ADDRESS:25391 CLASSIC DRIVETELEPHONE:
(949) 837-4348
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 5DATE:
08/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Amelia Acevedo, Administrator
Antoinetta Sazo, caregiver		TIME COMPLETED:
10:40 AM
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On 08/16/2022 at 9:30am, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility in order to conduct a required annual inspection. LPA was greeted and granted entry by Administrator Amelia Acevedo after explaining the purpose of the visit.

At approximately 9:45am, LPA accompanied by administrator toured the physical plant of the facility. LPA observed a check-in station where visitor temperatures are being documented and PPE is being stored. There are currently five (5) residents in care, none of which are receiving hospice care. The residents are observed relaxing in the common area or in their respective bedrooms and appear clean and well taken care of. The four (4) bedrooms include all necessary components. An ample supply of linen is observed. The bathrooms are equipped with grab bars and slip mats. Facility is clean, sanitary and free of odors in all areas inspected.

Sharp instruments are stored in a kitchen drawer secured by a magnetic lock. LPA observed a sufficient supply of food and water present. A 30-day supply of medication is centrally stored in a locked room under the stairwell. Cleaning supplies are located in the locked attached garage as well as in a locked cabinet under the sink. LPA observed the facility has COVID-19 Precautions posters and all required department postings as well as hand-washing signs in the bathrooms. The facility has an adequate supply of PPE. A fire extinguisher is present and charged.

Staff present is correctly cleared and fingerprinted in Guardian.

CONTINUED ON FORM LIC809-C
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: 714-703-2851
LICENSING EVALUATOR SIGNATURE:
DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/16/2022
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: 08/16/2022
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CONTINUED FROM FORM LIC809

LPA and administrator toured the outside of the facility and observed it to be free of obstructions. Outdoor furniture is present for the enjoyment of residents and visitors. The perimeter gate is self-latching and can easily be opened in an evacuation. There is a fully fenced swimming pool in the backyard. The self-latching gate for the pool fence is unlocked as required by the Building Code.

Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was reviewed with facility representative and a copy of this report was provided and left at facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Kevin Saborit-GuaschTELEPHONE: 714-703-2851
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2