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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306006060
Report Date: 01/13/2022
Date Signed: 01/13/2022 09:14:39 AM

Document Has Been Signed on 01/13/2022 09:14 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:G & G HOME CARE INC.FACILITY NUMBER:
306006060
ADMINISTRATOR:DEOSO, GEMMAFACILITY TYPE:
740
ADDRESS:24952 VIA MARFILTELEPHONE:
(949) 316-7820
CITY:MISSION VIEJOSTATE: CAZIP CODE:
92692
CAPACITY: 6CENSUS: DATE:
01/13/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:26 AM
MET WITH:Gemma Deoso and Rainelda ReyesTIME COMPLETED:
09:30 AM
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Licensing Program Analyst (LPA) Kimberly Lyman made an announced visit to conduct a follow up to a pre-licensing inspection conducted on 12/13/2021. LPA identified herself and discussed the purpose of the visit with Administrator/ Licensee Gemma Deoso and Licensee Rainelda Reyes.

LPA Lyman along with Administrator and Licensee toured the facility at 8:40 AM and observed the following:
  • Administrator certificate for Gemma Deoso is posted with an expiration date of 04/26/2023.
  • Facility emergency disaster plan, activity schedule, and sample menu are posted in the facility as well as the "Let Us No" poster in regulation size.
  • Facility has a thirty day supply of PPE including masks, gloves, gowns and face shields.
  • Facility has an ample supply of sheets and drinking glasses.
  • Locks have been installed to secure sharps and toxins.
  • Hand washing signs are posted in all restrooms.
  • Water temperature measured between 105 and 111 degrees F during today's visit.
  • Self latching locks have been installed on exit gates.
  • Pipes in backyard have been removed.
  • Locks have been installed on backyard storage areas.
  • Facility has ample supply of emergency water and food stored in facility.

Facility is ready to be licensed.

Exit interview conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Kimberly Lyman
LICENSING EVALUATOR SIGNATURE: DATE: 01/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2022
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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