Good Hands Home Care

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Nancy Guillen made an unannounced visit for the purpose of conducting a required annual Inspection. LPA was greeted and granted entry by care provider Mariana Gonzalez after explaining the purpose of the visit. LPA observed the Administrator certificate was current and expires November 28, 2026. This is a Residential Care Facility for the Elderly (RCFE) licensed to six non-ambulatory residents with a hospice waiver for six. The facility is a one story home with three resident bedrooms, one staff bedroom, two bathrooms, and an attached garage. During the inspection, LPA and care provider conducted a tour of the inside and outside of the facility, common areas, resident rooms, kitchen, garage and observed the following: LPA observed residents watching television in the living room and respective bedrooms. LPA observed six residents in care and two staff present. LPA observed the See Something Say Something Poster (PUB 475) was posted by the facility entrance. All resident bedrooms had the required furnishings. LPA observed all resident beds had linens and blankets with additional linens stored in the hallway storage closet. Per observation and staff interview, Resident 4 (R4) requires assistance in turning and repositioning in bed and is unable to independently transfer to and from bed. Staff uses hoyer lift to transfer resident; a deficiency was cited. LPA observed bathrooms were clean and equipped with grab bars and non skid floor mats. Bathrooms were observed to be free of debris and mildew, faucets and toilets were tested operational. Water temperature tested between 113.1 and 130.5 degrees Fahrenheit. LPA toured the outside of the facility and all passageways were free of obstruction. LPA observed the backyard had a shaded sitting area with furniture for resident use. Continued on LIC 809C LPA observed the facility had a 2-day supply of perishables and a 7-day supply of non-perishable food as required by regulations. Smoke detectors and carbon monoxide detectors tested operational. Fire extinguisher was observed to be fully charged with a service date of July 5th, 2025 and located by the kitchen. Gas stove, microwave, dishwasher, washer and dryer were inspected and observed to be operable. Medication cabinet was observed to be locked and centrally stored in kitchen cabinet. LPA reviewed six resident records. All the required documentation were present and current in the residents’ files reviewed, with the exception of Resident 1 who is missing an admissions agreement; a deficiency was cited. LPA reviewed two employee records. All employee’s present have a criminal record clearance and were associated to the facility. LPA observed records reviewed have a current First Aid certificate. LPA observed Staff 1 did not have a health screening report or TB test at the time of visit; a deficiency is being cited. Based on the observations made during today’s inspection, deficiencies are being cited per Title 22 of the California Code of Regulations. An exit interview was conducted, and a copy of this report, LIC 809C, LIC 858, LIC 859, LIC 809D, appeal rights, civil penalty assessment and Legionnaire’s Disease fact sheet was left at the facility.the state’s words, verbatim · CDSS document, May 6, 2026

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Fred Arias made an unannounced visit for the purpose of conducting a case management visit. LPA was greeted and granted entry by staff and explained the purpose of the visit. The facility was cited on May 23, 2025 for having a unpermitted room built into the garage. LPA toured the facility with staff. LPA verified the room is still standing in the garage and is being used as a staff room. Licensee Tin Le has not obtained a building permit to remove the room. A deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. A civil penalty is being assessed. This report was discussed with the facility representative and a copy was provided along with appeal rights and the LIC 421FC.the state’s words, verbatim · CDSS document, Mar 18, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87305(a) · Plan of correction due date: Apr 15, 2026

(a) Prior to construction or alterations, all facilities shall obtain a building permit. This requirement is not met as evidenced by: Based on LPA observation, the staff room construction in the garage did not have evidence of a permit which poses a potential health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Mar 18, 2026

Plan of correction: AD stated building permit is being worked on. Waiting for city to provide additional direction. AD to provide permit or additional information by POC due date.

Type of visit: Office

An Informal Conference was held on this date at the Orange County Adult and Senior Care Regional Office, in Orange, California. The informal meeting purpose and process was explained to Licensee. Present during the meeting were Licensing Program Manager (LPM) Alisa Ortiz, Licensing Program Analyst (LPA) Fred Arias, and Licensee/Administrator Tin Le. LPM Ortiz reviewed the following items with Licensee: LPA Arias conducted the Annual visit on May 23, 2025. During Plan of Correction visit on June 5, 2025, Licensee stated to LPA Arias the room built into the garage was already there when licensed. Based on the facility sketch and pre-licensing inspection, Licensee made an untruthful statement to the Department. Licensee was issued a type A deficiency on May 23,2025 for falsifying training records for three out of three staff based on interviews and record review. LPM Ortiz discussed the seriousness of falsification of records and Importance of providing truthful facts to the Department. LPM Ortiz discussed the Importance of keeping the Department aware of absences and ensuring a designated Administrator back up is available. Licensee has not submitted completed documents to the city of Huntington Beach to obtain a building permit. LPM Ortiz discussed the importance of correcting citations by POC due date. Licensee acknowledged understanding and agreed as follows: Licensee confirmed all required documentation to obtain a building permit have been submitted to the city of Huntington Beach. Licensee to submit proof of request for building permit via confirmation from city inspector's office by close of business September 5, 2025. Licensee will not engage in conduct inimical and ensure all records and statements made are truthful and correct. Licensee stated all staff training is now provided online by a third party and will follow up with staff to verify completion is done timely. Licensee will communicate absences to the Department and ensure a capable, authorized back up Administrator is present when not available. Licensee has designated a backup qualified Administrator for the facility. Licensee will provide an LIC 308 along with qualifications for one additional backup administrator to the Department by September 5, 2025. Licensee has chosen to decline participation in the Technical Support Program at this time but has stated he will reach out in the future if he finds the need for support. A copy of this report was read and provided to Licensee/Administrator Tin Lethe state’s words, verbatim · CDSS document, Sep 3, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Fred Arias made an unannounced visit for the purpose of conducting a Plan of Corrections Inspection for deficiencies issued on 05/23/2025 during the required annual inspection. LPA was greeted and granted entry by staff and discussed the purpose of the inspection. LPA toured the facility to check if the deficiency had been corrected with staff. LPA reviewed documents obtained. LPA reviewed Type A deficiency CCR 87305(a) and at this time, the Licensee Tin Le has not obtained a building permit for the room built into the garage, thus not correcting the deficiency by the Plan of Correction (POC) due date of 5/24/2025. However, the Licensee has begun the process of applying for a building permit as of 06/08/2025. Licensee sent LPA screenshot of the building permit application with the City of Huntington Beach to demolish the room in the garage. Based on LPA's observation and record review on today's visit, the Plan of Corrections have not been fully completed by the POC due date. An exit interview was conducted with staff and a copy of this report was provided to the facility representative.the state’s words, verbatim · CDSS document, Jun 18, 2025

Type of visit: POC

Licensing Program Analyst (LPA) Fred Arias made an unannounced visit for the purpose of conducting a Plan of Corrections Inspection for deficiencies issued on 05/23/2025 during the required annual inspection. LPA was greeted and granted entry by staff and discussed the purpose of the inspection. Administrator (AD) Tin Le arrived shortly to assist with the inspection. LPA toured the facility to check if the deficiencies had been corrected with staff. LPA observed corrections and reviewed documents. The following deficiencies were corrected: Type A deficiencies: CCR 87309(a) - cleaning supplies were locked away during inspection on 05/23/2025 CCR 87412(c) - Staff 3 (S3) completed new hire training on 06/04/2025 using a third party service HSC 1569.625(b)(2) - Staff 1 (S1) completed annual training on 05/30/2025 using a third party service CCR 87465(a)(6) - In service medication administration training was provided by hospice nurse CCR 87465(h)(2) - Medication cabinet lock was replaced and now functional CCR 87608(a)(5)(B) - Full bed rails were removed for resident 2 and replaced with half rails with orders CCR 87207 - Licensee signed a statement of acknowledgement with regards to falsifying records CCR 87405(a) - Licensee has designated a qualified back up Administrator for the facility Type B deficiencies: CCR 87507(l) - Personal Rights document signed and placed in resident 3's file. HSC 1569.695(a)(2) - Emergency water was purchased for facility. HSC 1569.695(c) - Disaster drills were completed on 05/30/2025 Continued on LIC809-C dated 06/06/2025 LPA reviewed Type A deficiency CCR 87305(a) and at this time, AD has not obtained a building permit for the room built into the garage, thus not correcting the deficiency by the Plan of Correction (POC) due date of 5/24/2025. LPA reviewed Type A deficiency CCR 87465(a)(5)(A) and at this time, one medication which requires the use of a nebulizer is not being administered per physician order for Resident 1 (R1), thus not correcting the deficiency by the POC due date of 5/24/2025. Based on LPA's observation and record review on today's visit, the Plan of Corrections have not been fully completed by the POC due date. Civil penalties for failure to correct deficiencies are being assessed. See LIC421FCs An exit interview was conducted with Administrator Tin Le and a copy of this report was provided to the facility representative.the state’s words, verbatim · CDSS document, Jun 5, 2025

Type of visit: Required - 1 Year

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is licensed for 6 non-ambulatory residents. Facility has an approved hospice waiver for 6 residents and the home currently has 5 residents, with 1 resident on hospice. Staff provided liability insurance that expires on 10/19/2025. LPA along with staff member 2 (S2) toured the facility at 8:35 AM. LPA toured the physical plant, checked food service and facility documentation. The home consists of 3 resident bedrooms, living room, dining room, kitchen, two staff rooms with one built into the garage, as well as 2 bathrooms. LPA toured the kitchen and observed sharps locked in a cabinet during today's visit. At 8:40 AM, LPA observed a kitchen cabinet with a broken lock containing medication. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. LPA observed the emergency food. At 8:58 AM, LPA observed there is no emergency water at the facility. 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. At 9:09 AM, LPA observed unlocked bathroom cabinet with cleaners such as Comet bleach powder and Clorox wipes inside bathroom in bedroom 3. Water temperature measured between degrees 114.4 F and 114.9 in all bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. Auditory exit alarms were operational during today's visit . Smoke detectors tested operational during today's visit. Fire extinguishers were fully charged. Continued on LIC809-C dated 5/23/2025. LPA observed a staff room built into the garage. This room does not appear in the approved facility sketch and was built after licensure without informing the Department. At 9:30 AM, LPA observed closet by the main entrance is unlocked, containing cleaning supplies. Outside grounds were toured. Walkways around the home were clear of hazards. First aid kit contained all required items including tweezers, scissors and thermometer. There is shaded outdoor seating for residents. Exit gate is unlocked and operational. LPA reviewed five resident files and three staff files. Resident files did not contain all the required documentation. Resident 1 (R1) did not have a signed Personal Rights form on file. Personal Rights documents for resident 2 (R2), resident 3 (R3), resident 4 (R4), and resident 5 (R5) were not fully completed. R2's file did not contain bed rail orders. LPA observed R2's bed with full bed rails. Staff files reviewed did not contain required documentation as it was revealed through LPA's record review and interviews that training files for Staff 1 (S1), S2, and staff 3 (S3) are falsified . LPA reviewed medication storage and administration. Medications are stored in a kitchen cabinet. Based on LPA observation and record review, medications are not being administered per physician order for R1, R3, and R5. During today's inspection, it was revealed the Administrator is out of the country and there is no designated backup Administrator available. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Based on LPA record review and interviews, no disaster drills are conducted at the facility. Based on the observations made during today’s visit, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided along with appeal rights.the state’s words, verbatim · CDSS document, May 23, 2025

The state marks this report as 11 pages; the online copy we transcribed has 10. You can request the full file from the county licensing office.

Type of visit: Prelicensing

Licensing Program Analyst's (LPA) Jenifer Tirre and Michael Tea made an announced inspection visit to follow up on corrections identified during Pre Licensing visit on 05/3/2024. LPA's identified themselves and discussed the purpose of the visit with Licensee Tin Le. An initial application to operate a Residential Facility Care for the Elderly was submitted to CCL on 3/10/2024. There are 0 residents in care during today's visit. LPA's observed the following: At 2:00 PM, LPA's toured the facility and observed the following: a secure door knob/lock was observed on staff room Facility has First Aid kit & First Aid Manual Facility has a tablet device with internet for resident use Adequate perishable & non- perishable foods Adequate Emergency food & water supply Facility has Department postings Skid proof mat provided in restroom 1 Facility has Fire Extinguisher tagged by Fire department Audible alarms are operational on all sliding doors Facility has call buttons for resident rooms that notify inside kitchen area Licensee ordered Pub 475 poster in correct size and waiting to receive. Licensee to provide proof of poster upon delivery to LPA. Licensee confirmed that phone company is scheduled to set up land line phone on 5/8/24. Licensee to provide proof of phone set up with new land line phone number by 5/8/24. Licensee using cell phone number until land line is operable Noted items from visit on 05/03/2024 have been addressed. The facility is ready to be licensed. Exit interview conducted with Licensee and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 7, 2024

Type of visit: Prelicensing

Licensing Program Analyst's (LPA's) Jenifer Tirre and Michael Tea visited this facility for the purpose of conducting a Pre-Licensing evaluation for change of location. Facility is a single story residential home. LPA's along with Licensee/Administrator Tin Le toured facility at 2:10 PM and observed the following: Fire clearance approval was received on 03/14/24. Structure: Facility is a one story, 4 bedroom (3 Residents bedrooms and 1 live in staff bedroom) 2 bathroom house with attached garage and a white exterior. Living Room/ Dining Room: Adequate seating is available in the dining room and living room. Bedrooms Residents: All Residents bedrooms need additional furnishings such as beds. Bathrooms: All resident bathrooms have a working toilet, wash basin, and bathtub/shower as well as grab bars. One of two restrooms has a non-skid surface in the shower. Linens & Hygiene Supplies: Facility has adequate supply of linens and towels. Emergency Phone Numbers and Exit Plan: Facility has Emergency Plan. Food Service: Facility does not have 2 day perishables & 7 day non-perishables in the pantry/ refrigerator, as well as emergency food and water supply. Smoke Detectors: Smoke detectors/ carbon monoxide detector are centrally wired and were tested operational. Facility has one fire extinguisher which is mounted and charged. Facility has audible alarms on entry/exit doors. Appliances: Gas Stove and refrigerator are operational. Toxins: LPA observed toxins secured in storage area.. Water Temperature: Tested and recorded at 106.7 degrees F. in facility bathrooms. Reading Material Games, and Equipment: facility did not have activity supplies at time of visit. Medications, First-Aid Kit & Book: Facility did not have first aid kit or First aid manual present at the facility. Facility has a secured location for medications and facility files. Backyard: LPA observed the facility perimeter is secured by wall with a self latching gate on right side of facility as required. LPA observed shaded outdoor seating. Component III Orientation was waived during this pre-licensing visit due to Administrator presently operating several facilities. CONTINUED ON 9099C Licensee to address the following corrections by 5/6//2024: Facility to provide a secure door knob/lock on staff room Facility to provide First Aid kit & First Aid Manual Facility to provide a tablet device with internet for resident use Facility to provide Adequate perishable & non- perishable foods Facility to provide Emergency food & water supply Facility to provide Department postings Facility to provide skid proof mat for restroom 1 Facility to provide a updated Fire Extinguisher tagged by Fire department Facility to provide audible alarms on all sliding doors Facility to provide a land line phone on premise Facility to provide call buttons for room The facility is not ready to be licensed. Licensee to contact LPA when corrections are complete. An exit interview was conducted with Licensee and a copy of this report was left at the facility.the state’s words, verbatim · CDSS document, May 3, 2024