336427442-4-29-2024-18-AS-JGEE-D4SRBQ-20240429125308

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 336427442
Report Date: 04/29/2024
Date Signed: 04/29/2024 12:53:12 PM

Document Has Been Signed on 04/29/2024 12:53 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:	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: 5	DATE:	04/29/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Lyka Cruz, Caregiver		TIME COMPLETED:	01:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct a 1 year required visit. LPA was greeted and granted entry Caregiver Lyka Cruz. At the time of the visit there were (2) staff and (5) residents presents. Both staff #1 and staff #2 are live in caregivers and were observed to have obtained criminal record clearance, however S1 and S2 were not associated to the facility. Upon a review of documentation, LPA observed for the licensee has taken steps to obtain access to Guardian so that the staff can be associated, therefore no deficiency or civil penalty was issued. The administrator was unavailable to come to the facility as they are currently on vacation. The facility designee is S1. LPA conducted a tour of the interior and exterior of the facility. LPA observed for the facility to be clean, clutter and odor free. The home is a single story house with 6 bedrooms at 3 bathrooms. There is no pool or bodies of water on the premises. LPA reviewed both staff (2) and (2) resident files. The staff files had the required documents and valid Cardio Pulmonary Resuscitation (CPR) and do not expire until November 2025. The Administrator certificate expires on 2/17/25. The resident files had the required documentation and will file, a copy of the appraisal as the observation period is still commencing today. Facility will email the completed appraisal to the regional office by 5pm tomorrow 4/30/24. The emergency disaster drills are being conducted on a monthly basis and the last drill was conducted on 3/30/24. The smoke and carbon monoxide were tested and observed to be operable. The water temperature was checked in both resident bathrooms and was found to be within regulatory limits measuring at 107-108 degrees F. The sharps are stored in a bottom locked cabinet next to stove. The medications are stored in a locked medication room. The medications are stored individually by each resident and are recorded using the Medication Administration Record. There are no known guns or ammunition on the premises.

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 217-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024

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 2

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: GOLDEN HANDS FAMILY HOME CARE LLC	FACILITY NUMBER: 336427442
	VISIT DATE: 04/29/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The facility food supply was observed to be adequate as there was a 2 day supply of perishable and a 7 day supply of Non perishable food items. The facility was observed to have the required postings and will post a copy of PUB 475-CCL complaint poster. Caregiver will also fax a copy of the facility liability insurance that was effective 3/18/24. Based on today's visit, no deficiencies were observed.

An exit interview was conducted a copy of this report was reviewed and provided to Caregiver, Lyka Cruz.

SUPERVISOR'S NAME: Tricia Danielson	TELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Javina George	TELEPHONE: (951) 217-3970
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2024

LIC809 (FAS) - (06/04)

Page: 2 of 2