Georgetown Loving Home

Type of visit: Required - 1 Year

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 caregiver staff and explained the reason for the visit. Administrator (AD) Jimmy Briones arrived shortly to assist with the visit. Facility is licensed for six non-ambulatory residents with a hospice waiver for six. Currently there are six residents, of which four are on hospice during today's visit. LPA Tea reviewed six resident files and two staff files. Resident files and staff files contained all the required documentation. The administrator certificate expires on December 18, 2025, AD Briones completed all course work for renewal and is currently pending renewal. LPA Tea along with AD Briones toured the facility. LPA toured the physical plant, checked food service, and the first aid kit. The facility is a one-story home with five resident bedrooms, two bathrooms, living room, family room, kitchen, dining area, laundry area, backyard and an attached car garage. 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 shower was free of mold/mildew. The water temperature measured around 112.2 Fahrenheit degrees. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked at time of visit. Common areas were clean and clear of hazards, and doorways were free of obstructions. First aid kit had all the required elements including dressing, bandages, tweezers, thermometer, and scissors. Kitchen was inspected. Kitchen appliances are operational during today's visit. Perishable and non-perishable food supply were checked and adequately stocked at time of visit. LPA observed sharps locked and secured in drawers. LPA (Annual inspection continued on LIC809-C) also observed toxin substances to be secured and locked and inaccessible to clients in the laundry area and in the locked storage shed in the backyard. The fire extinguisher in the dining area is fully charged with a service date of April 9, 2025. The facility’s last disaster drill was conducted on September 4, 2025. LPA toured the outside grounds and there is ample seating with shade and there is a gate on the right side of the facility that is self-latching and operational. LPA observed emergency supplies, food and water in the garage. Activities are based on resident’s personal preference or health condition. Some residents read. Some residents go walking. At the time of the visit, LPA observed residents watching television. LPA then reviewed medication storage and administration. Medications are stored in a locked cabinet in the family room. Medications are being administered per physicians 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 the facility and a copy of this report LIC809, 809-C, LIC858, LIC859 was read and provided to the facility.the state’s words, verbatim · CDSS document, Nov 4, 2025

Type of visit: Prelicensing

Licensing Program Analyst (LPA) Dwayne Mason Jr. made an announced inspection to the facility for purpose of conducting a pre-licensing inspection for a change of ownership. LPA arrived at the facility and was greeted and granted entry by Administrator Jimmy Briones (AD). An application to operate a Residential Care Facility (RCFE) for (6) capacity, (0) ambulatory, (6) non-ambulatory, and (0) bedridden residents was received by Community Care Licensing (CCL) on 2/1/2024. The facility is a one-story home with five resident bedrooms, two bathrooms, living room, family room, kitchen, dining room, laundry area, backyard and attached two car garage. There is one exit gate in the back yard. The backyard has two shaded seating areas. All resident bedrooms had the necessary furnishings. LPA observed all resident beds had linens and blankets. LPA observed all windows were screened. The bathrooms have working plumbing. Hot water measured at between 105 and 120 degrees Fahrenheit in both bathrooms. LPA observed toxins are inaccessible to residents and will be stored in locked cabinets in the dining room. Medication and First Aid Kit are stored in a locked cabinet in the living room. LPA observed the fire extinguishers to be fully charged as indicated by the arrow pointing in the green zone. Extinguishers were serviced on 4/11/2024. Fire clearance was approved by a fire inspector of Orange County Fire Authority on 4/23/2024. LPA provided the Component III presentation to provide information about how to operate the facility within compliance. The facility has games, art supplies, puzzles, electronics and more for activities. A supply of extra linen and hygiene supplies are stored in the hallway closets. Emergency Phone Numbers, Exit Plan and Menu are posted and available for review. There is 2-day supply of perishable food and a 7-day supply of non-perishable food on hand. Smoke detectors and carbon monoxide detectors were tested and observed to be operational. Appliances tested operational. The designated AD was notified that the final application approval will be issued by the Centralized Applications Bureau in Sacramento. Exit interview was conducted and a copy of this report was provided to designated ADthe state’s words, verbatim · CDSS document, Nov 1, 2024

Type of visit: Office

Component II completion: Successful Facility Type: Residential Care Facility for the Elderly (RCFE) Application Type: Change in Ownership (CHOW) Capacity: 6 Census (if any clients in care): 6 COMP II Participants: Jimmy Broines, Applicant/Administrator Interview Method: Telephone interview On October 2, 2024 at 1:00 PM, Applicant/Administrator participated in COMP II. Identification of the Applicant/Administrator was verified through interview questions based on photo ID and other identifying personal information. During COMP II, Applicant/Administrator confirmed that they have read and understand community care facility licensing laws included in the Health and Safety Codes and the California Code of Regulations Title 22. Signed LIC 809 with copy of photo ID have been obtained. During COMP II, CAB analyst confirmed Applicant/Administrator’s understanding of following areas: 1. Facility Operation: License type, client/resident populations, and program. 2. Admission Policies 3. Staffing Requirements & Training 4. Restrictive/Prohibited Health Conditions 5. General Provisions 6. Emergency Preparedness 7. Complaints & Reporting 8. Pre-licensing Readiness Exit interview conducted with Applicant/Administrator. Report sent via email and informed to return sign copy back to CAB by end of business day today.the state’s words, verbatim · CDSS document, Oct 2, 2024