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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881646
Report Date: 03/07/2025
Date Signed: 03/07/2025 10:59:08 AM

Document Has Been Signed on 03/07/2025 10:59 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 RAY HOME CAREFACILITY NUMBER:
331881646
ADMINISTRATOR/
DIRECTOR:		CRUZ, RAY BRIAN S.FACILITY TYPE:
740
ADDRESS:1022 SAW TOOTH LANETELEPHONE:
(951) 537-9850
CITY:HEMETSTATE: CAZIP CODE:
92545
CAPACITY: 6CENSUS: 0DATE:
03/07/2025
TYPE OF VISIT:PrelicensingANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:30 AM
MET WITH:Licensee- Lyka CruzTIME VISIT/
INSPECTION COMPLETED:
11:30 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
On Friday, 03/07/25, Licensing Program Analyst (LPA) Debbie Palacios conducted an announced visit to the pending facility to conduct a pre-licensing inspection. LPA met with Applicant Lyka Cruz and Ray Brian Cruz. Fire clearance has been granted for six (6) Residents age range 60 and over. Applicant Ray Brian's Administrator certificate expires on 09/30/26.

LPA conducted a tour of the facility’s interior and exterior. Facility is in the process of change of ownership, therefore, LPA observed four (4) residents in care. The facility is made up of a one-story home with six (6) bedrooms, four (4) resident bedrooms, one (1) Staff bedroom, one (1) Office room; three (3) bathrooms, a kitchen, living/family room, laundry room and garage. LPA did not observe bodies of water on the premises. The physical plant is in good repair. Indoor and outdoor passageways are free of obstruction. An outdoor shaded seating area is available for the residents. LPA observed one (1) charged fire extinguisher mounted next to the Office room near the kitchen last serviced 03/01/25. LPA tested the smoke alarms and carbon monoxide detectors and found them to be operational. LPA observed that the office room has the resident files and the centrally stored medications in a locked cabinet.

Resident bedrooms had the required bedding, furniture, closet storage, and functional lighting. Additional linen and towels are available for the residents.

LPA toured the kitchen and observed that food was stored in a safe and healthful manner. The facility had a 2-day supply of perishable food items and 7-day supply of nonperishable food items. Sharps and knifes are in a locked kitchen cabinet.

SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE: DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/07/2025
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 RAY HOME CARE
FACILITY NUMBER: 331881646
VISIT DATE: 03/07/2025
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
LPA toured the bathrooms and observed bathrooms to be in safe and sanitary conditions. LPA observed that the laundry room has the cleaning solutions and detergents locked in a cabinet.

Living/family room has a working television and adequate seating in common areas. Fireplace in the living room has an appropriate barrier. The facility has a central heating and air conditioning system installed with a central panel located in the hallway to control entire house.

Emergency disaster plans, personal rights, and complaint procedures were posted in the wall near the entrance. LPA observed a complete first aid kit and manual.

During today’s visit, LPA did not observe any issues or concerns. Licensee will complete COMP III and final approval of licensure will be granted by the Centralized Application Bureau analyst.



An exit interview was conducted where a copy of this report was discussed and provided.
SUPERVISORS NAME: Tricia Danielson
LICENSING EVALUATOR NAME: Debbie Palacios
LICENSING EVALUATOR SIGNATURE:

DATE: 03/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/07/2025
LIC809 (FAS) - (06/04)
Page: 2 of 2