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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336412449
Report Date: 02/29/2024
Date Signed: 02/29/2024 01:03:20 PM

Document Has Been Signed on 02/29/2024 01:03 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: 5DATE:
02/29/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Filipiniana Corpus, CaregiverTIME COMPLETED:
01:15 PM
NARRATIVE
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Licensing Program Analyst (LPA), Stephanie Martinez, conducted a follow up visit to the facility to complete the required annual inspection that was first initiated on 02/21/2024. The LPA was allowed entrance into the facility by staff member, Filipiniana Corpus, and later spoke with Administrator, Luz Price, via telephone. The LPA informed the Administrator of the purpose for the visit.

Physical Plant: The facility consists of four (4) resident bedrooms, one staff bedroom, one dining area, a living space, an open kitchen, a laundry room, a garage space, and a covered patio with sufficient seating and space for activities. There are no bodies of water located on the property. According to S2, there are no weapons stored in the home. The facility is being maintained at a comfortable temperature. All outdoor and indoor areas were free of debris and other trash. There are grab bars for each toilet, bathtub and shower used by residents. Resident showers have non-skid mats or strips present. The carbon monoxide and smoke detectors were tested by facility staff and were observed to be in operating condition. The hot water was tested and found to be within the required temperature guidelines.

Medication Review: A medication review was completed for all resident's medications. All medications were maintained separate. No Medication Administration Record (MAR) is currently being utilized by the facility, according to S2. One medication was observed to not be labeled for R4 and one supplement was observed not to be labeled for R3. S2 could not show the LPA that a physician's order was available for either the medication or supplement.

An exit interview was conducted with Licensee Lucida Jocson over the phone; this report was reviewed, and a copy was provided along with the LIC 811, LIC 9098 and instructions on appeal rights.
SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Stephanie Martinez
LICENSING EVALUATOR SIGNATURE: DATE: 02/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/29/2024
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 25
Document Has Been Signed on 02/29/2024 01:03 PM - It Cannot Be Edited


Created By: Stephanie Martinez On 02/29/2024 at 11:09 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 02/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87411(f)
Personnel Requirements - General
(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee didn't comply w/ the section cited above in 2 our of 5 personnel files not containing the health screening reports. According to Licensee, Lucida Jocson, her & her husband's (Federico) records may have been stolen by a previous staff member two years ago. She stated the records were not recreated. This poses a potential health, safety and personal rights risk to residents.
POC Due Date: 03/29/2024
Plan of Correction
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The Licensee stated a health screening will be obtained for her and her husband and placed on file at the facility.

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 Stamps
LICENSING EVALUATOR NAME:Stephanie Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/29/2024


LIC809 (FAS) - (06/04)
Page: 2 of 25
Document Has Been Signed on 02/29/2024 01:03 PM - It Cannot Be Edited


Created By: Stephanie Martinez On 02/29/2024 at 11:09 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 02/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.618(c)(3)
Other Provisions
(c)The facility shall employ, and the administrator shall schedule, a sufficient number of staff members to do all of the following: (3) Ensure that at least one staff member who has cardiopulmonary resuscitation (CPR) training and first aid training is on duty and on the premises at all times. This paragraph shall not be construed to require staff to provide CPR.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview & record review, the licensee didn't comply w/ the section cited above in 1 out of 2 care staff members, who didn't have the above training. S2 didn't have proof of CPR or First Aid training. According to S2, they have completed the training, however, couldn't provide a timeline of when the training was completed. No other staff member with the training was present during the end of the LPA's visit on 02/29/2024. This poses a potential health, safety or personal rights risk...
POC Due Date: 03/29/2024
Plan of Correction
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The Licensee stated training will be provided to S2 and proof will be submitted to the Department by the POC due date.
Section Cited
Other Provisions
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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 Stamps
LICENSING EVALUATOR NAME:Stephanie Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/29/2024


LIC809 (FAS) - (06/04)
Page: 3 of 25
Document Has Been Signed on 02/29/2024 01:03 PM - It Cannot Be Edited


Created By: Stephanie Martinez On 02/29/2024 at 11:09 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 02/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1569.69(a)(2)
Other Provisions
(a) Each residential care facility for the elderly licensed under this chapter shall ensure that each employee of the facility who assists residents with the self-administration of medications meets all of the following training requirements: (2) In facilities licensed to provide care for 15 or fewer persons, the employee shall complete 10 hours of initial training. This training shall consist of 6 hours of hands-on shadowing training, which shall be completed prior to assisting with the self-administration of medications, and 4 hours of other training or instruction, as described in subdivision (f), which shall be completed within the first two weeks of employment.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in one out of two care staff who has no proof of the initial training. Initial medication training was observed on file for S2; however, the training was provided by another facility on 06/24/2008. This poses a potential health and safety risk to persons in care.
POC Due Date: 03/29/2024
Plan of Correction
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Licensee stated medication training will be provided to S2 and proof of the training will be submitted to the Department by the POC due date.
Type B
Section Cited
CCR
1569.625(b)(2)
(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in that 2 out of 2 care staff members did not have the above required training. Proof of training was not observed on file for S2 or S3. This poses a potential health, safety and personal rights risk to persons in care.
POC Due Date: 03/29/2024
Plan of Correction
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According to Licensee, the above required training will be provided to S2 and S2 and proof will be submitted to the Department by the POC due date.
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 Stamps
LICENSING EVALUATOR NAME:Stephanie Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/29/2024


LIC809 (FAS) - (06/04)
Page: 4 of 25
Document Has Been Signed on 02/29/2024 01:03 PM - It Cannot Be Edited


Created By: Stephanie Martinez On 02/29/2024 at 11:09 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 02/29/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87467(a)(3)
Resident Participation in Decisionmaking
(a) Prior to, or within two weeks of the resident's admission, the licensee shall arrange a meeting with the resident, the resident's representative, if any, appropriate facility staff, and a representative of the resident's home health agency, if any, and any other appropriate parties, to prepare a written record of the care the resident will receive in the facility, and the resident's preferences regarding the services provided at the facility. (3) The licensee shall arrange a meeting with the resident and appropriate individuals identified in Section 87467(a)(1) to review and revise the written record as specified, when there is a significant change in the resident's condition, or once every 12 months, whichever occurs first. Significant changes shall include, but not be limited to occurrences specified in Section 87463, Reappraisals.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that 2 out of 5 residents did not have an existing or current written record of care. No written record of care was observed on file for R1. R4 has their original written record of care; however, it was not updated within 12 months. This poses a potential health, safety and personal rights risk...
POC Due Date: 03/29/2024
Plan of Correction
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Licensee stated a written record of care will be created and/or updated for residents in care.

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 Stamps
LICENSING EVALUATOR NAME:Stephanie Martinez
LICENSING EVALUATOR SIGNATURE:
DATE: 02/29/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/29/2024


LIC809 (FAS) - (06/04)
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