306005623-7-11-2022-22-AS-AORZ-CPFU9J-20230227142307

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005623
Report Date: 07/11/2022
Date Signed: 07/11/2022 01:58:08 PM

Unfounded

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
07/05/2022 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220705140623

FACILITY NAME:	GOOD HANDS HOME CARE		FACILITY NUMBER:	306005623
ADMINISTRATOR:	LE, TIN		FACILITY TYPE:	740
ADDRESS:	18674 SAN FELIPE STREET		TELEPHONE:	(714) 600-7083
CITY:	FOUNTAIN VALLEY	STATE: CA	ZIP CODE:	92708
CAPACITY:	6	CENSUS:	DATE:	07/11/2022
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:			TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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-Facility is in disrepair

INVESTIGATION FINDINGS:

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This unannounced visit conducted by Licensing Program Analyst (LPA) Rosie Quiroz is being conducted to initiate the 10 day visit to investigate the above mentioned complaint allegation. LPA Quiroz arrived at the facility was greeted and granted entry by Staff 4 (S4). Administrator (AD) Tine Le arrived shortly after and was explained the nature of today's visit.
During today's visit, on or about 10:36am, LPA Quiroz along with AD Tin Le toured physical plant of facility and inspected 3 of 3 bathrooms. The complainant alleged "the downstairs bathroom has water damage on the ceiling and all of the shower fixtures leak and are rusty."
AD Tin Le indicated "There was a leak but it was fixed immediately after it was observed on July 5, 2022."

Based on the preponderance of evidence gathered from LPA Quiroz's observations, invoice dated July 5,2022 and interviews conducted with interviewees, the allegation the facility is in disrepair is unfounded, meaning that the allegation was false, could not have happened and/or was without a reasonable basis.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 07/11/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/11/2022

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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