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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336427442
Report Date: 05/10/2022
Date Signed: 05/10/2022 04:02:24 PM


Document Has Been Signed on 05/10/2022 04:02 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
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:GOLDEN HANDS FAMILY HOME CARE LLCFACILITY NUMBER:
336427442
ADMINISTRATOR:BANARES, ROSITA DFACILITY TYPE:
740
ADDRESS:1022 SAW TOOTH LANETELEPHONE:
(951) 537-9850
CITY:HEMETSTATE: CAZIP CODE:
92545
CAPACITY:6CENSUS: 5DATE:
05/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:10 PM
MET WITH:Rosita Barares AdministratorTIME COMPLETED:
04:08 PM
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On 05/10/2022 at 3:10pm Licensing Program Manager J.Harris (LPM) and Licensing Program Analyst (LPA) V. Mixson were greeted and granted entry for an annual inspection by staff Mayela. LPA Mixson introduced self and stated the purpose of the visit. With an emphasizes on infection control. There was 2 staff and 5 residents and no COIVD cases at time of visit.

LPA Mixson observed signs at the front door and LPM and LPA toured the facility and made observations pertaining to the facility's infection control measures. LPM and LPA observed sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions and the proper use of face coverings. No deficiencies were observed.

The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, and cleaning and disinfection provisions are in adequate quantities. LPA later discussed infection control practices a nd procedures with Administrator.

An exit interview was conducted, and a copy of this report, along with the LIC 811 was provided to Administrator Rosita Banares.
SUPERVISOR'S NAME: Jazmond D HarrisTELEPHONE: (951) 248-0318
LICENSING EVALUATOR NAME: Venus MixsonTELEPHONE: (951) 897-7936
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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