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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336412449
Report Date: 12/04/2023
Date Signed: 12/04/2023 02:59:02 PM


Document Has Been Signed on 12/04/2023 02:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:GUIDING HANDS, RCFEFACILITY NUMBER:
336412449
ADMINISTRATOR:LUCIDA JOCSONFACILITY TYPE:
740
ADDRESS:29238 GLENCOE LANETELEPHONE:
(951) 246-3699
CITY:MENIFEESTATE: CAZIP CODE:
92584
CAPACITY:6CENSUS: 6DATE:
12/04/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Administrator, Luz PriceTIME COMPLETED:
03:15 PM
NARRATIVE
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On 12/4/2023, Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility for an unrelated matter, this report is to document deficiencies found during the visit. LPA met with Administrator, Luz Price who was informed of the purpose of the visit.

LPA reviewed two (2) resident files and found that both resident did not have a care plan on file. One (1) of the two (2) residents is on hospice, and currently does not have a care plan for LPA to audit during the visit. This deficiency was cited and plan of correction was created with administrator present during the visit.

An exit interview was conducted with Administrator, Luz Price where this report along with appeal rights, and deficiency pages were reviewed and provided to them.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 12/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/04/2023
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 2


Document Has Been Signed on 12/04/2023 02:59 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507


FACILITY NAME: GUIDING HANDS, RCFE
FACILITY NUMBER: 336412449

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/04/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/18/2023
Section Cited
CCR
87459(a)(1-7)

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(a) The facility shall assess the person's need for personal assistance and care by determining his/her ability to perform specified activities of daily living..
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The licensee agreed to send the LPA a completed function capabilities assessment for the (2) residents reviewed. This is due by POC due date.
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This requirment was not met as evidenced by: two resident files reviewed did not have a function capabilities assessment. This poses a potential health, safety or personal rights risk to residents in care.
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Licensee wil send self certified statment that all residents will have a functional assessmnet on file. This is due by the POC due date.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 12/04/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/04/2023
LIC809 (FAS) - (06/04)
Page: 2 of 2