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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247209018
Report Date: 12/15/2021
Date Signed: 12/15/2021 02:57:04 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:HELPING HANDS CARE HOMEFACILITY NUMBER:
247209018
ADMINISTRATOR:IBANEZ, KRYSTYL SHEENFACILITY TYPE:
740
ADDRESS:658 LIM STREETTELEPHONE:
(209) 233-9334
CITY:MERCEDSTATE: CAZIP CODE:
95341
CAPACITY:6CENSUS: 6DATE:
12/15/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Krystal Sheen IbanezTIME COMPLETED:
03:47 PM
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Licensing Program Analyst (LPA) Katie Brown arrived at the facility unannounced to conduct the Infection Control Inspection. LPA met with Administrator Krystyl Sheen Ibanez. LPA entered through the central entry point where health screening was conducted. Visitor policy, PPE and sanitizer was observed in the entryway.

Infection control procedures which were observed or reviewed by LPA include: Daily symptoms screenings (for staff, residents and visitors), testing, visitation, quarantine/isolation procedures, staffing, PPE and daily infection control procedures.

LPA toured the facility inside and out. All required postings including to encourage face coverings and hand washing were observed. Furniture in common and dining areas are spaced to promote distancing. Facility has a designated visitation area available. LPA observed 30-day resident medication as well as PPE supply. Common and resident bathroom sinks are stocked with liquid soap and towels washing.


A copy of this report was provided and an exit interview was conducted with Administrator.




The following forms requested to be updated and submitted to LPA by 12/27/2021: LIC 308, 309 610, 500, 9020A, copy of current Liability Insurance. Administrator Certification verified by LPA.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 12/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/15/2021
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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