247209018-8-18-2022-24-AS-SPIY-CHKLN3-20220823085338

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 247209018
Report Date: 08/18/2022
Date Signed: 08/18/2022 12:38:17 PM

Unfounded

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
07/06/2022 and conducted by Evaluator Katie Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20220706162041

FACILITY NAME:	HELPING HANDS CARE HOME		FACILITY NUMBER:	247209018
ADMINISTRATOR:	IBANEZ, KRYSTYL SHEEN		FACILITY TYPE:	740
ADDRESS:	658 LIM STREET		TELEPHONE:	(209) 233-9334
CITY:	MERCED	STATE: CA	ZIP CODE:	95341
CAPACITY:	6	CENSUS: 4	DATE:	08/18/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Sheen Ibanez		TIME COMPLETED:	10:04 AM

ALLEGATION(S):

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Unexplained death

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Katie Brown arrived unannounced at the facility to deliver investigation findings. LPA met with and explained the purpose of the visit to Administrator Sheen Ibanez.

A record review of Resident (R1’s) file was conducted and revealed that medications were given as ordered. The facility sought medical attention as required and as requested by family. R1’s Death Certificate was obtained and states R1’s cause of death was not related to the care provided by the facility. R1 was discharged from the hospital and passed away in the family home, not at the facility. This agency has investigated the complaint alleging unexplained death. We have found that the complaint was UNFOUNDED, therefore we have dismissed the complaint.

There were no citations issued during this visit. An exit interview was conducted, and a copy of this report was provided to Administrator Sheen Ibanez.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Katie Brown	TELEPHONE: (559) 498-9964
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2022

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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