306005219-7-15-2022-22-AS-PVEZ-CGCSRP-20220715140640

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005219
Report Date: 07/15/2022
Date Signed: 07/15/2022 02:06:46 PM

Document Has Been Signed on 07/15/2022 02:06 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:	GOOD HANDS LOVING CARE-YORBA LINDA		FACILITY NUMBER:	306005219
ADMINISTRATOR:	YOO, DANIEL		FACILITY TYPE:	740
ADDRESS:	18568 ARBOR GATE LN		TELEPHONE:	9498780137
CITY:	YORBA LINDA	STATE: CA	ZIP CODE:	92886
CAPACITY:	6	CENSUS: 6	DATE:	07/15/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Daniel Yoo - Administrator		TIME COMPLETED:	02:20 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	Licensing Program Analyst (LPA) Patricia Velazquez conducted an unannounced visit to Good Hands Loving Care - Yorba Linda. The purpose of today's visit was to conduct a Required 1 Year inspection focusing primarily on Infection Control. LPA Velazquez was allowed entry into the facility and met with Caregiver (CG) Susan Eom. Caregiver Pakning Napitupulu was also present. Administrator Daniel Yoo arrived shortly after LPA's arrival. The facility is licensed for 6 non-ambulatory residents of which 3 may bedridden. The facility also has a Hospice waiver for 3 residents. There are currently 6 residents living in the facility. The last emergency disaster drill was conducted on June 10, 2022. At 12:25 PM LPA Velazquez conducted a tour of the physical plant along with Administrator Yoo. The 2 story home consists of 4 resident bedrooms with 2 bathrooms as well as 1 staff bedroom with a bathroom downstairs. Upstairs there is a loft-like area that serves as a storage area. The facility also has a living room, family room, dining area, and kitchen. The 6 residents in the facility appeared well-groomed and well cared-for. The resident bedrooms had the required furnishings, bed linens, and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, showers were free of mold/mildew and a non-skid surface or mat was in place. Resident bath towels and personal hygiene supplies were adequately stocked. LPA Velazquez tested the hot water temperature in the resident bathrooms and the temperature measured at 116.7 degrees Fahrenheit in the first bathroom and at 117.8 degrees Fahrenheit in the second bathroom which Administrator Yoo verified. LPA Velazquez inspected the kitchen along with Administrator Yoo. Perishable and non-perishable food supply was checked and adequately stocked at the time of the visit.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022

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: GOOD HANDS LOVING CARE-YORBA LINDA	FACILITY NUMBER: 306005219
	VISIT DATE: 07/15/2022

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

The fire extinguishers were fully charged. The smoke and carbon monoxide detectors were tested and found to be operational. Medications, toxins and sharps were locked and inaccessible to residents. The auditory alarms throughout the facility were in operating condition. Administrator Yoo indicated there were Oxygen tanks in resident bedrooms and there were Oxygen in Use signs present in the facility. LPA Velazquez advised Administrator Yoo to post additional Oxygen in Use signs in different areas of the facility such as outside the front door.

LPA Velazquez along with Administrator Yoo toured the outside grounds. The facility has a swimming pool with a jacuzzi and a Koi pond in the back yard that is surrounded by a gate with 2 self-closing latches. There was shading and sufficient seating for residents. Walkways around the home were clear of hazards and all of the exit gates did have a self-closing latch. There were no security bars or weapons on the premises.

No resident or staff files were reviewed at the time of this visit. Resident medications and Medication Administration Records were not reviewed during this inspection. LPA Velazquez advised Administrator Yoo to ensure resident files contain written physician's orders for the bed rails that were observed on resident beds.

There were no deficiencies issued during the Required 1 Year inspection. An exit interview was conducted with Administrator Daniel Yoo and a copy of this report along was provided at the time of this visit.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (713) 334-2062
LICENSING EVALUATOR NAME: Patricia Velazquez	TELEPHONE: (949) 236-0556
LICENSING EVALUATOR SIGNATURE:	DATE: 07/15/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2022

LIC809 (FAS) - (06/04)

Page: 2 of 2