247209260-8-18-2022-24-AS-KBRN-CHEQUZ-20220818122934

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 247209260
Report Date: 08/18/2022
Date Signed: 08/18/2022 12:29:41 PM

Document Has Been Signed on 08/18/2022 12:29 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME:	HELPING HANDS CARE HOME		FACILITY NUMBER:	247209260
ADMINISTRATOR:	IBANEZ, KRYSTYL SHEEN		FACILITY TYPE:	740
ADDRESS:	658 LIM STREET		TELEPHONE:	(209) 777-0192
CITY:	MERCED	STATE: CA	ZIP CODE:	95341
CAPACITY:	6	CENSUS: 4	DATE:	08/18/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Sheen Ibanez		TIME COMPLETED:	01:17 PM

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	Licensing Program Analyst (LPA) Katie Brown arrived at the facility to conduct the Pre-Licensing Inspection. LPA met with Administrator Sheen Ibanez. LPA began the tour by entering through the front door of the home. All required documents are displayed and observed upon entry. LPA observed Covid-19 Health Screening area and visitor sign in. Furniture and flooring in common rooms observed to be in good repair with adequate lighting throughout. Resident bedrooms have the required furnishings, lighting and bed linens. Smoke and Carbon Monoxide detectors present and in working order. LPA observed supply of extra bed linens, towels, and personal hygiene/grooming products. Hot water temperature in resident bathroom measured at 107 degrees F. LPA observed hand soap, paper towels, garbage cans and grab bars in resident bathrooms. Kitchen observed to have supply of dishes, cups, plates, utensils, pots and pans and cooking utensils in good repair. LPA observed a 7 day of non-perishable and 2 day perishable food supply. Counter tops and cabinets are clear and appropriate for food preparation. Knives are kept in a locked drawer in the kitchen. Cleaning supplies and chemicals are stored in a locked cabinet separate from any food items. A Washer and Dryer were observed with additional shelving for storage. Appliances observed to be in working order and at maintained at proper temperature. Medications are stored in a locked cabinet along with First Aid Kits. The First aid kits contained all required items. A fire extinguisher is present in the kitchen dated 10/12/2021. Doors and passageways are unobstructed throughout the home. See LIC809-C for continuation of this erport

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.

LIC809 (FAS) - (06/04)

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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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: HELPING HANDS CARE HOME	FACILITY NUMBER: 247209260
	VISIT DATE: 08/18/2022

NARRATIVE

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Outside of the facility toured. The home does not have a pool, bodies of water or other hazards. Outdoor activity space with shaded area and seating were located on the backyard patio. LPA observed a self-releasing gate and windows have screens in good repair. e.

Component III was conducted during the visit with the Licensee and Administrator.

LPA called the designated facility phone (209) 233-9334 to verify the phone is set up and in working order.

The applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.

A copy of this report was provided, and an exit interview was conducted with Sheen Ibanez

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

LIC809 (FAS) - (06/04)

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