306005695-12-2-2024-22-AS-MTEA-DBKR52-20241202114225

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 306005695
Report Date: 12/02/2024
Date Signed: 12/02/2024 11:54:16 AM

Document Has Been Signed on 12/02/2024 11:54 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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME:	GOOD HANDS LOVING CARE-FRANCISCO		FACILITY NUMBER:	306005695
ADMINISTRATOR/ DIRECTOR:	YOO, DANIEL		FACILITY TYPE:	740
ADDRESS:	21063 VIA FRANCISCO		TELEPHONE:	(949) 878-0137
CITY:	YORBA LINDA	STATE: CA	ZIP CODE:	92887
CAPACITY: 6	TOTAL ENROLLED CHILDREN: 0	CENSUS:	DATE:	12/02/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	08:00 AM
MET WITH:	Daniel Yoo & Jun Yoo		TIME VISIT/ INSPECTION COMPLETED:	11:55 AM

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Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit. The purpose of today’s visit was to conduct the Annual Required inspection. At around 8:00 AM, LPA Tea was greeted and granted entry into the facility by administrators (AD), Daniel Yoo and Jun Yoo and explained the reason for the visit. The facility is licensed for four ambulatory and two non-ambulatory, non-ambulatory in one room only and hospice waiver for three. Currently there are four residents, one is on hospice during today's visit.

Around 8:08 AM, LPA Tea reviewed four resident files and three staff files. Resident files and staff files contained all required documentation. Upon review of records, the facility is up to date with required quarterly emergency disaster drills, which was last conducted on October 30, 2024. AD Jun Yoo’s administrator certificate expires on May 22, 2026 and AD Daniel Yoo’s certificate expires on January 6, 2026.

LPA Tea along with AD Daniel Yoo toured the facility at 9:00 AM. LPA toured the physical plant, checked food service, and the first aid kit. The facility is a two-story home, the first floor consists of 3 resident bedrooms, private staff room, 2 bathrooms, living room, dining room, kitchen, laundry room and attached garage. The second floor is only for staff where live in care staff resides, no residents reside on the second floor. LPA observed smoke detectors/carbon monoxide in common areas and bedrooms are operational. Resident bedrooms had the required furniture, 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, and showers were free of mold/mildew. Water temperature measured around 116.6 F degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, doorways were free of obstructions. First aid kit had all the required elements including bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. LPA observed sharps locked and inaccessible to residents in a kitchen drawer. LPA also observed toxin substances secured underneath the kitchen sink and in cabinets in the laundry room and garage.

Annual continuation on LIC809-C

Alisa Ortiz	TELEPHONE: (714) 287-4084
Michael Tea	TELEPHONE: 714-703-2840
	DATE: 12/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024

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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: GOOD HANDS LOVING CARE-FRANCISCO	FACILITY NUMBER: 306005695
	VISIT DATE: 12/02/2024

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The fire extinguishers are fully charged throughout the facility. Kitchen appliances are operational during today's visit. LPA toured the outside grounds and there is ample seating underneath a shaded patio area in the backyard. There is a barbecue grill and pool that is secured and gated. There is one exit gate that is self-latching and operational on the right side of the house. LPA observed PPE supplies, emergency food and water stored in the garage. Facility provides activities based on their personal choice and physical limitations. Residents like to play bingo and do exercises. The staff also takes residents outside to the backyard if the weather permits. At the time of the visit, LPA observed residents lounging around the facility and their rooms.

At 9:23 AM LPA reviewed medication storage and administration. Medications are stored in a locked cabinet in the kitchen area. Medications are being administered per physician order. LPA interviewed residents regarding their quality of care and spoke to staff present regarding care provided.

Based on the observation made during today’s visit, no deficiencies were noted today in the areas inspected per Title 22 Division 6 of the California Code of Regulations.

This report was reviewed with Administrators Daniel Yoo and Jun Yoo and a copy of this report LIC809, along with the 809-C, LIC858, and LIC859 were read and provided to the facility

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 287-4084
LICENSING EVALUATOR NAME: Michael Tea	TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:	DATE: 12/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/02/2024

LIC809 (FAS) - (06/04)

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