247209018-2-2-2021-24-AS-AXIG-BYBN72-20210217091157

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 247209018
Report Date: 02/02/2021
Date Signed: 02/02/2021 06:05:58 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/15/2020 and conducted by Evaluator See Moua

COMPLAINT CONTROL NUMBER: 24-AS-20200615090701

FACILITY NAME:	HELPING HANDS CARE HOME		FACILITY NUMBER:	247209018
ADMINISTRATOR:	IBANEZ, KRYSTYL SHEEN		FACILITY TYPE:	740
ADDRESS:	658 LIM STREET		TELEPHONE:	(209) 239-9334
CITY:	MERCED	STATE: CA	ZIP CODE:	95341
CAPACITY:	6	CENSUS: 5	DATE:	02/02/2021
		UNANNOUNCED	TIME BEGAN:	11:46 AM
MET WITH:	Krystyl Sheen Ibanez, Administrator		TIME COMPLETED:	11:47 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff hit resident.
Staff verbally abused resident's.
Resident does not have access to medical device.
Staff neglected resident.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) S. Moua conducted a subsequent complaint inspection via telephone due to COVID-19 precautionary measures. LPA spoke with Administrator Sheen. Findings were delivered.

The Department conducted interviews with residents and staff during the course of the investigation. Residents #1 and #2 referenced in the complaints are no longer at the facility. Residents were interviewed by Ombudsman and did not confirm any issues of staff hitting, neglecting, or verbally abusing residents. LPA also interviewed residents at the facility and they denied the allegations. Staff interviewed denied all the allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did occur, therefore the allegation is Unsubstantiated. No deficiencies cited. Exit Interview conducted.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Andy Xiong	TELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: See Moua	TELEPHONE: (559) 650-7904
LICENSING EVALUATOR SIGNATURE:	DATE: 02/02/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/02/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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