<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005838
Report Date: 08/14/2020
Date Signed: 08/20/2020 11:50:01 AM

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:GENTLE CARING HOMEFACILITY NUMBER:
306005838
ADMINISTRATOR:LOURDES LAT, MARIAFACILITY TYPE:
740
ADDRESS:26762 CARLOTA DR.TELEPHONE:
(949) 874-4426
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92691
CAPACITY:6CENSUS: 0DATE:
08/14/2020
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator (AD) Maria LatTIME COMPLETED:
12:30 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), Mike Barrett, conducted a follow-up Pre-licensing visit Administrator (AD), Maria Lat, via tele-visit to review the missing items identified during the inspection conducted on 8/12/20. During this inspection the following were reviewed:
  1. Non-skid mats were installed in all of the showers.
  2. Alarms were installed on all exit doors and were observed to be operational.
  3. Garage door was secured to ensure that cleaning supplies and other potentially hazardous items were inaccessible to the residents.
  4. A new and complete first aid kit was purchased and contained all of the required supplies including the first aid handbook and tweezers.
LPA observed that the facility meets all the requirements for licensure.

LPA conducted Component III Orientation with the Administrator and gave consultation for expectations and responsibilities. The facility plans to advertise for Dementia care.

An exit interview was conducted the Administrator and a copy of this report was sent via email and an electronic return read receipt confirms the delivery of this report.
SUPERVISOR'S NAME: Sheila SantosTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Michael BarrettTELEPHONE: (714) 703-2847
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2020
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 1