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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 336427442
Report Date: 10/10/2024
Date Signed: 10/10/2024 09:53:19 AM


Document Has Been Signed on 10/10/2024 09:53 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:
10/10/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Ray Brian CruzTIME COMPLETED:
10:00 AM
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Licensing Program Analysts (LPAs),Abdoulaye Zerbo and Armando Perez conducted an unannounced visit to the facility for a case management. The LPAs met with Facility Manager Ray Cruz, and informed him of the purpose for the visit and were granted access.

The facility is a single story building and consists of two (2) staff rooms, four (4) resident rooms and three (3) bathrooms. The LPAs took copies of relevant documentation. There are currently five (5) residents in care. LPAs toured the facility for the purpose of a health and safety check and no concerns were observed at the time of the visit.

Previous licensee was reported to be on vacation and the new applicant is the current the facility manager. Ray Cruz obtained his Administrator’s certificate on 10-1-24 expiring on 9-30-26 and his current CPR certification expires on 11/02/2025. LPAs observed current personnel to be fingerprint cleared and listed on the facility's personnel report.

An exit interview was conducted, and a copy of this report was provided to facility manager Ray Cruz.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Abdoulaye ZerboTELEPHONE: (951) 248-2222
LICENSING EVALUATOR SIGNATURE:
DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/10/2024
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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