Facility Evaluation Report, 12/13/2021 — G & G Home Care INC., Mission Viejo CA

Licensing Program Analyst (LPA) Kimberly Lyman made an announced visit to conduct a pre-licensing inspection. LPA identified herself and discussed the purpose of the visit with Administrator/ Licensee Gemma Deoso and Licensee Rainelda Reyes. An initial application to operate a Residential Care Facility for the Elderly was received by CCL on 10/27/2021 for a capacity of four non-ambulatory residents and two bedridden.

LPA Lyman along with Administrator and Licensee toured the facility at 9:10 AM and observed the following:

Structure: Facility is a one story, 6 bedroom, 5 bathroom house with an attached garage and a light exterior. The exit gates are closed and unlocked. Living Room/ Dining Room : Adequate seating is available in the dining room and living room. Bedrooms Residents: Rooms will be a mix of single and double occupancy. All rooms are equipped with appropriate lighting, chair, night stand and ample closet space. Bathrooms: All resident bathrooms have a working toilet/ wash basin as well as grab bars and non-skid surface in the shower. Linens & Hygiene Supplies: Facility has bedding and towels for residents in care. Emergency Phone Numbers and Exit Plan: To be posted in entrance of facility. Food Service: Facility to obtain 2 day perishables upon acceptance of residents Facility has 7 day non-perishables. Smoke Detectors: Smoke detectors/ carbon monoxide detectors are centrally wired and were tested operational. Fire extinguishers are mounted and charged. Appliances: Stove, oven, refrigerator, microwave, washer, and dryer are clean and operational. Toxins / Sharps : Facility to obtain locks for sharps and cleaning supplies in kitchen. Water Temperature: Tested and recorded between 78 and 130 degrees F. in facility bathrooms. Emergency Supplies: LPA observed ample emergency food. Facility to obtain emergency water supply. Medications, First-Aid Kit & Book: First aid kit observed contained all required items. Medication to be stored and locked in a locked cabinet in the office. CONTINUED ON LIC 809C DATED 12/13/2021.