336427442-6-14-2023-18-AS-EMAN-CUYQTB-20230823122653

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 336427442
Report Date: 06/06/2023
Date Signed: 06/14/2023 06:26:34 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
05/21/2021 and conducted by Evaluator Paola Guerrero

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20210521103511

FACILITY NAME:	GOLDEN HANDS FAMILY HOME CARE LLC		FACILITY NUMBER:	336427442
ADMINISTRATOR:	BANARES, ROSITA D		FACILITY TYPE:	740
ADDRESS:	1022 SAW TOOTH LANE		TELEPHONE:	(951) 537-9850
CITY:	HEMET	STATE: CA	ZIP CODE:	92545
CAPACITY:	6	CENSUS: 4	DATE:	06/06/2023
		UNANNOUNCED	TIME BEGAN:	12:20 PM
MET WITH:	Rosita Banares		TIME COMPLETED:	02:49 PM

ALLEGATION(S):

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Lack of supervision of residents
Activites are not provided for residents by staff
Facility does not provide nutritious snacks for residents
Facility did not ensure adequate hydration of resident
Facility not reporting medical incidents/emergencies
Facility having resident provide care and supervision to other residents
Resident was not permitted to move about facility while using oxygen tank
Facility has locks on perimeter gates.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Paola Guerrero conducted an unannounced visit to deliver findings on the allegation listed above. LPA met with Facility Administrator Rosita Banares and explained the purpose of the visit. The investigation consisted of record review staff and resident’s interviews.
First allegation: Lack of supervision of residents.

Regarding the first allegation, Lack of supervision of residents. LPA Guerrero conducted in-person interviews with Resident #1, and Resident #2, who stated facility staff is always onsite and are never left unsupervised. LPA asked Staff #1 if clients are ever left unsupervised Staff #1 stated that residents are never left unattended or unsupervised at the facility.

Second allegation: Activates are not provided for residents by staff. Regarding the second allegation, activates are not provided for residents by staff. LPA Guerrero conducted a facility tour and observed a good number of activities provided for residents to use.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Paola Guerrero	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 18-AS-20210521103511

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
Lookup Error,
, CA

FACILITY NAME: GOLDEN HANDS FAMILY HOME CARE LLC	FACILITY NUMBER: 336427442
	VISIT DATE: 06/06/2023

NARRATIVE

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LPA conducted in-person interview with Resident #1, LPA asked Resident #1 the activities residents enjoy Resident # 1 stated cards, checkers, and snakes and ladders. Resident #2 stated because of current medical condition resident is unable to participate in activities however, Resident #2 stated on good days resident enjoys to color.

Third allegation: Facility does not provide nutritious snacks for residents.

Regarding the third allegation, Facility does not provide nutritious snacks for residents. LPA Guerrero conducted food inspection LPA observed adequate amount of perishable and nonperishable food supply that meets the number of residents in care. In addition, supply appeared to be adequate to date. Breakfast meal consisted of bacon, egg, pancakes, half of a banana, coffee, and water. For snacks LPA observed fruit cups, fruit, and fruit salad available for residents. LPA interviewed Resident #1 and Resident #2 regarding the snacks provided at the facility Resident #1-2 stated that nutritional snacks are always given or available to them (Residents).

Fourth allegation: Facility did not ensure adequate hydration of resident.

Regarding the fourth allegation, Facility did not ensure adequate hydration of resident. LPA conducted a kitchen inspection LPA observed refrigerator water dispenser equipped with an automatic ice maker both dispensers were in working condition. LPA interviewed Resident #1 who stated water is provided throughout every meal. LPA observed reusable water bottles in resident’s rooms.

Fifth allegation:

Regarding the fifth allegation, Facility not reporting medical incidents/emergencies. LPA conducted a record review and observed that facility last incident report was reported in 2023 regarding two (2) resident’s deaths both to be of natural causes. Staff #1 stated that no AWOL’s have occurred at the facility. Because facility currently has residents with dementia LPA conducted a facility inspection and observed a functioning door alarm sensor attached to the entrance door, LPA observed a second (2) door alarm sensor attached to back yard slider door. Which will alarm staff every time main entrance or backslider door opens.

Sixth allegation: Facility having resident provide care and supervision to other residents.

Regarding the sixth allegation, Facility having resident provided care and supervision to other residents. LPA conducted an in-person interview with Resident #1 who stated facility staff has not asked Resident # 1 to provide care or supervision to other residents. LPA interviewed Staff #1 regarding the allegation Staff #1 stated that staff does not have any residents provide care or supervision to other residents. LPA interviewed Resident #2 who stated that they have not witnessed Resident # 1 provide care or supervision to residents in care.

Seventh allegation: Resident was not permitted to move about facility while using oxygen tank.

Regarding the seventh allegation, Resident was not permitted to move about facility while using oxygen tank. LPA conducted a facility room inspection and observed facility to have a current census of four (4) residents in care. While conducting the room tour LPA observed no oxygen tanks at the facility. LPA asked Staff #1 if any residents are currently utilizing oxygen Staff #1 stated “NO”

Eighth allegation: Facility has locks on perimeter gates.

Regarding the eighth allegation, Facility has locks on perimeter gates. LPA conducted an interior and exterior inspection of the facility LPA observed no locks to be on perimeter gates. Due to a lack of information, the above allegations are deemed UNSUBSTANTIATED at this time.

Unsubstantiated; meaning that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted where this report was discussed and provided to Facility Administrator Rosita Banares.

SUPERVISOR'S NAME: Efren Malagon	TELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Paola Guerrero	TELEPHONE: (951) 473-7024
LICENSING EVALUATOR SIGNATURE:	DATE: 06/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/06/2023

LIC9099 (FAS) - (06/04)

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