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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005194
Report Date: 05/05/2022
Date Signed: 05/05/2022 12:12:27 PM


Document Has Been Signed on 05/05/2022 12:12 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:GOLDEN TOUCH GUEST HOMEFACILITY NUMBER:
306005194
ADMINISTRATOR:ENCARNACION, JOEYFACILITY TYPE:
740
ADDRESS:10688 LEHNHARD AVETELEPHONE:
(714) 875-8494
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:6CENSUS: 5DATE:
05/05/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:02 AM
MET WITH:Joko Encarnacion, Caregiver LeadTIME COMPLETED:
12:26 PM
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 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, COVID-19 screened and granted entry into the facility by Caregiver Lead (CGL) Joko Encarnacion. LPA Rosie Quiroz explained the nature of the visit to (CGL) Joko Encarnacion. Licensee/Administrator (L/AD) Joey Encarnacion and (AD) Mari Zonia Encarnacion arrived to facility shortly after. Facility indicated screening all incoming visitors prior to entering the facility.
On or about 9:17am, LPA Rosie Quiroz along with (CGL) Joko Encarnacion began the tour of the inside and outside of the facility. There are five residents in care and there are no active COVID-19 cases in the facility. LPA Quiroz observed one of five residents in living room area resting and relaxing, one of five residents in her bedroom resting, two of five residents in staff room watching television supervised by staff and one of five residents in dining-room eating his breakfast. Five of five residents appeared to be clean and well taken care of. LPA Quiroz observed a COVID-19 check in station in the entry of the facility; LPA Quiroz observed required department COVID-19 precautionary postings in the facility as well as hand washing signs throughout the facility.
All restrooms observed to have a supply of soap, appeared to be clean and water temperatures were recorded to be within 118-120 degrees Fahrenheit. LPA Quiroz inspected resident’s bedrooms and appeared to be clean. All bedrooms observed to have all required components. LPA Quiroz observed the emergency and disaster and evacuation plan. Facility has a supply of emergency food, water and PPE in backyard shaded area readily available for staff and residents. LPA Quiroz toured the outside of the facility and observed seating and shaded area for resident and visitor's enjoyment. The facility has completed the LIC 808 Mitigation Plan. The LIC 808 plan was received by the Department on February 18, 2021. During today's visit, LPA Quiroz reviewed and approved LIC 808 Mitigation Plan dated February 18, 2021. LPA Quiroz was informed that all residents and staff have had their COVID-19 vaccinations and Boosters and will be scheduling second booster this month. Facility is recording resident's temperatures two times per day in the morning and at bedtime.
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SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:
DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/05/2022
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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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: GOLDEN TOUCH GUEST HOME
FACILITY NUMBER: 306005194
VISIT DATE: 05/05/2022
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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.

During today's visit, LPA Quiroz provided Consultation on Title 22 throughout today's visit.

This report was reviewed with L/AD Joey Encarnacion and (AD) Mari Zonia Encarnacion, and a copy of this report and LIC 811 Confidential Names were provided at exit.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:

DATE: 05/05/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/05/2022
LIC809 (FAS) - (06/04)
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