<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336427442
Report Date: 07/31/2024
Date Signed: 07/31/2024 10:05:23 AM


Document Has Been Signed on 07/31/2024 10:05 AM - 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 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:
07/31/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Ray Cruz, Facility ManagerTIME COMPLETED:
10:15 AM
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), Stephanie Martinez, conducted an unannounced visit to the facility to follow up on the status of the change of ownership of the facility by the licensees, Rosita Banares and Antonio Banares. The LPA met with Facility Manager, Ray Cruz, and informed him of the purpose for the visit. Licensee Rosita Banares was contacted via telephone and notified of the visit.

The LPA toured the facility, reviewed records and took copies of relevant documentation. There are currently five (5) residents in care. The LPA observed residents receiving breakfast at the time of the visit. Utilities were observed to be in working order. Residents were interviewed and reported no concerns regarding the home. No health and safety concerns were observed at the time of the visit.

Licensee Rosita reported she and her husband, Antonio, are currently out of the country and may return in about two (2) months. She reported she is still managing the facility and understands she is responsible for the operation of the facility. She reported there are currently two (2) staff working in the home with two relievers. Both staff and relievers were observed to be fingerprint cleared and listed on the facility's personnel report.

Facility Manager Cruz reported the application to obtain a license has not been submitted as of this date; however, it would be expected to be submitted by 08/31/2024. Manager Cruz agreed to update the Department once the application has been submitted.

This report was reviewed with Cruz and a copy was provided.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie MartinezTELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:
DATE: 07/31/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/31/2024
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 1