306005219-1-30-2024-22-AS-SSAS-CZZQAK-20240131110004

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005219
Report Date: 01/30/2024
Date Signed: 01/30/2024 12:04:53 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/30/2023 and conducted by Evaluator Jerome Haley

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20231030161210

FACILITY NAME:	GOOD HANDS LOVING CARE-YORBA LINDA		FACILITY NUMBER:	306005219
ADMINISTRATOR:	YOO, DANIEL		FACILITY TYPE:	740
ADDRESS:	18568 ARBOR GATE LN		TELEPHONE:	(949) 878-0137
CITY:	YORBA LINDA	STATE: CA	ZIP CODE:	92886
CAPACITY:	6	CENSUS: 4	DATE:	01/30/2024
		UNANNOUNCED	TIME BEGAN:	10:20 AM
MET WITH:	Daniel Yoo - Administrator		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff administered medication without authorization.
Staff did not notify Resident's Representative about resident's change in condition in a timely manner.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jerome Haley made an unannounced visit to the facility to deliver the findings on the complaint allegation above. LPA Haley was greeted by staff and explained the reason for the visit.

Regarding the allegation: Staff administered medication without authorization.

During interviews it was discovered Resident 1 (R1) tested positive for COVID and was prescribed Paxlovid by the resident’s physician on October 7, 2023. During an interview with Licensee/Administrator Daniel Yoo, he explained that R1’s nurse was notified regarding the positive test results. During an interview with R1’s nurse, she confirmed she was notified regarding the positive test results and said she went to check on the resident after she was notified by the Licensee/Administrator Yoo and R1 was doing well when the Nurse made her visit.
Continued on LIC9099C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20231030161210

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 01/30/2024

NARRATIVE

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The Paxlovid medication prescribed to treat R1 was prescribed by R1's physician and had to be administered for the health and safety of R1 and the other residents in the facility as well as facility visitors and staff.

Regarding the allegation: Staff did not notify Resident's Representative about resident's change in condition in a timely manner.

During the interviews it was discovered the Licensee/Administrator Yoo notified family members that there was a resident that was COVID positive in the facility. Copies of the October 4, 2023 text message sent to the families regarding a COVID positive case was provided. R1 responsible party was notified as well.

R1’s Nurse confirmed she was notified that R1 tested positive for COVID and R1’s physician was notified because on October 7, 2023 Paxlovid medication was prescribed to R1 to treat the recent COVID infection. During the investigation LPA Haley was provided copies of the Pazlovid prescription for R1, text messages that were sent out to family members, and an email exchange dated October 11, 2023 with R1's responsible person regarding R1’s COVID status.

Based on the information gathered during the investigation through interviews and document review, the Department is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, all allegations are deemed Unsubstantiated.

An exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3821
LICENSING EVALUATOR NAME: Jerome Haley	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2024

LIC9099 (FAS) - (06/04)

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