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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107209444
Report Date: 10/14/2025
Date Signed: 10/14/2025 06:48:11 PM

Document Has Been Signed on 10/14/2025 06:48 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:HELPING HANDS SENIOR CAREFACILITY NUMBER:
107209444
ADMINISTRATOR/
DIRECTOR:		NGUYEN, ELSAFACILITY TYPE:
740
ADDRESS:825 S WILLOW AVENUETELEPHONE:
(650) 776-2280
CITY:FRESNOSTATE: CAZIP CODE:
93727
CAPACITY: 30CENSUS: 9DATE:
10/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:50 AM
MET WITH:Jessica Yglesias, Administrator AssistanctTIME VISIT/
INSPECTION COMPLETED:
07:30 PM
NARRATIVE
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On 10/14/2025, Licensing Program Analysts (LPAs) M. Medina and L. Salazar conducted an unannounced Annual Required inspection. LPAs arrived and allowed entrance by Jessica Yglesias, Administrative Assistant to conduct visit. Administrator, Elsa Nguyen was not available to conduct today's inspection.

The facility has 7 separate housing units on site that serve individuals as follows:
Building 1 address 877 S Willow, 3 bedroom, 6 non-ambulatory
Building 2 address 853 S Willow, 2 bedroom, 4 ambulatory
Building 3 address 825 S Willow, 2 bedroom, 4 ambulatory
Building 4 address 865 S Willow, 2 bedroom, 4 ambulatory
Building 5 address 841 S Willow, 3 bedroom, 6 non-ambulatory
Building 6 address 835 S Willow, 3 bedroom, 6 non-ambulatory
Building 7 address 881 S Willow, staff office

LPA's conducted facility tour of all buildings except building 3, which was locked and inaccessible. All buildings (homes) observed to be clean, odor free, and a comfortable temperature. Individual bedrooms are have required furnishings, additional linens are available in each hallway closet area. Each individual home has a washer/dryer available. Each home has a fully furnished living room and dining room that has adequate seating available for residents in each home. Each home also has a full kitchen with pots, pans, cups, plates, utensils. LPAs observed a 2-day supply of perishable foods and a 7-day supply of non-perishable food stored in the office. Each home has a refrigerator that contains small snacks, and drinks available. Meals are prepared in one kitchen and provided to individual homes. Resident bathrooms toured, fixtures observed to be operational. Bathrooms observed to have grab bars in the shower/tub areas with skid resistant applications. Water temperature ranged from 110 degrees F - 115 degrees F.
NAME OF LICENSING PROGRAM MANAGER: Sergiy Pidgirny
NAME OF LICENSING PROGRAM ANALYST: Melinda Medina
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: HELPING HANDS SENIOR CARE
FACILITY NUMBER: 107209444
VISIT DATE: 10/14/2025
NARRATIVE
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(Continued from 809)

During facility tour it was observed that R1 is bedridden and facility does not have bedridden clearance. First aid kit contains all the required items. A fire extinguisher is mounted on the wall of each home with a service date of 3/27/2025. All homes have smoke detectors, carbon monoxide and sprinkler systems.

Medications observed to be locked and secured in a medication cart that is stored in building 4. Medications reviewed.

Staff files reviewed, LPAs observed S1 is not fingerprinted and cleared and S2 has a exemption that has not been transferred to facility. Both S1 and S2 have worked 5 days or more between 9/29/2025 and 10/12/2025.

Perimeter of the grounds is surrounded by a gate which is locked from the exterior. Exit gates observed to be self latching upon exit. There are benches around the property under covered patios for resident seating.
Due to time constraint, resident and staff files will be reviewed at a later date.

Based on today's visit, and per CCR Title 22, deficiencies are being cited on the attached 809-D. Immediate civil penalties are being assessed in the amount of $500 for Caregiver Background clearance, $500 for Caregiver exemption transfer request, and $500 for Bedridden fire clearance totalling $1500. If not corrected, the violations will have a direct and immediate risk to the health, safety, or personal rights of clients in care.

An exit interview was conducted with Administrative Assistant. A copy of this report and appeals rights were discussed and provided at the time of visit. A plan of correction was developed by Administrator Assistant and reviewed with LPAs.
NAME OF LICENSING PROGRAM MANAGER: Sergiy Pidgirny
NAME OF LICENSING PROGRAM ANALYST: Melinda Medina
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 10/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/14/2025
LIC809 (FAS) - (06/04)
Page: 5 of 5
Document Has Been Signed on 10/14/2025 06:48 PM - It Cannot Be Edited


Created By: Melinda Medina On 10/14/2025 at 06:16 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: HELPING HANDS SENIOR CARE
FACILITY NUMBER: 107209444

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87202(a)
Fire Clearance
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department or district providing fire protection services, or the State Fire Marshal:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above in 1 out of 9 out of persons which poses an immediate health, safety or personal rights risk to persons in care. Resident 1 is bedridden and facility is not cleared for bedridden.
POC Due Date: 10/15/2025
Plan of Correction
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Facility to submit an LIC 200, LIC 9054, LIC 9099 to Fresno CCL office no later than plan of correction due date.
Type A
Section Cited
HSC
1569.17(c)(1)(A)
Licensing
(c)(1)(A) Subsequent to initial licensure, a person specified in subdivision (b) who is not exempted from fingerprinting shall obtain either a criminal record clearance or an exemption, pursuant to subdivision (f) of this section or Section 1522.7, from the State Department of Social Services prior to employment, residence, or initial presence in a facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Staff 1 is not fingerprinted and cleared and has worked 5 days or more from 9/29/25 through 10/12/25.
POC Due Date: 10/15/2025
Plan of Correction
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Staff 1 was removed from schedule and told they would not be able to return to work until fingerprinted and cleared.

DEFICIENCY CLEARED AT TIME OF INSPECTION
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Sergiy Pidgirny
NAME OF LICENSING PROGRAM MANAGER:
Melinda Medina
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2025


LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 10/14/2025 06:48 PM - It Cannot Be Edited


Created By: Melinda Medina On 10/14/2025 at 06:16 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: HELPING HANDS SENIOR CARE
FACILITY NUMBER: 107209444

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/14/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87355(e)(4)
Criminal Record Clearance
(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: (4) Request and be approved for a transfer of a criminal record exemption, as specified in Section 87356(r), unless, upon request for a transfer, the Department permits the individual to be employed, reside or be present at the facility.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above which poses an immediate health, safety or personal rights risk to persons in care. Staff 2 has a fingerprint exemption that has not be transfered to facility. Staff 2 has worked 5 days or more between 9/29/25 - 10/12/25.
POC Due Date: 10/15/2025
Plan of Correction
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Administrator to submit LIC 9188 Fingerprint Transfer Exemption to Department for Staff 2. Staff 2 may return to work when exemption is transfered and Staff 2 is associated to facility.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Sergiy Pidgirny
NAME OF LICENSING PROGRAM MANAGER:
Melinda Medina
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 10/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/14/2025


LIC809 (FAS) - (06/04)
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