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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 366423728
Report Date: 09/14/2022
Date Signed: 09/14/2022 12:08:14 PM


Document Has Been Signed on 09/14/2022 12:08 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
SAN BERNARDINO, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:GOLDEN CASCADEFACILITY NUMBER:
366423728
ADMINISTRATOR:DANIEL RESCIAFACILITY TYPE:
740
ADDRESS:15453 ELM LANETELEPHONE:
(909) 606-8719
CITY:CHINO HILLSSTATE: CAZIP CODE:
91709
CAPACITY:6CENSUS: 5DATE:
09/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:19 AM
MET WITH:Ewell ThompsonTIME COMPLETED:
12:10 PM
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Licensing Program Analyst (LPA) Natalie Ibarra made an unannounced visit to conduct an annual inspection, with emphasis on infection control. LPA was greeted and allowed entry by caregiver Asenath "Azzy" Lainez. Administrator Ewell "Joaquin" Thompson was contacted and arrived towards the end of the inspection.

LPA Ibarra toured inside and outside of the facility and went over COVID-19 best practices for infection control and prevention. The facility has a plan in place which follows Community Care Licensing Division guidelines for COVID-19 testing, isolating/quarantining residents and properly caring for residents with COVID-19 positive results and/or exposures. 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, cleaning and disinfection provisions are in adequate quantities. The entrance of the facility has a check in process for visitors that includes a temperature check and a symptom check. The residents have hand sanitizer available to them throughout the facility, and the bathrooms were stocked with hand soap and paper towels. LPA Ibarra inspected the facility's Personal Protective Equipment (PPE) supply, which was located in the front hallway. The facility has a full thirty (30) day supply of PPE such as gloves, face shields, surgical masks, N95 masks, disinfectant, and hand sanitizer.

No deficiencies were sited during todays visit.

An exit interview was conducted and a copy of this report was discussed and provided to the Administrator.
SUPERVISOR'S NAME: Efren MalagonTELEPHONE: (951) 202-6356
LICENSING EVALUATOR NAME: Natalie IbarraTELEPHONE: (951) 290-1102
LICENSING EVALUATOR SIGNATURE:
DATE: 09/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/14/2022
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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