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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247209260
Report Date: 09/04/2024
Date Signed: 09/04/2024 06:57:30 PM


Document Has Been Signed on 09/04/2024 06:57 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:HELPING HANDS CARE HOMEFACILITY NUMBER:
247209260
ADMINISTRATOR:IBANEZ, KRYSTYL SHEENFACILITY TYPE:
740
ADDRESS:658 LIM STREETTELEPHONE:
(209) 777-0192
CITY:MERCEDSTATE: CAZIP CODE:
95341
CAPACITY:6CENSUS: 3DATE:
09/04/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:Administrator Krystyl SheenTIME COMPLETED:
12:05 PM
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On 09/04/2024, Licensing Program Analyst (LPA) V. Gorban arrived unannounced at the facility to conduct a Required Annual Inspection. LPA met with staff Sabrina Deniels and announced the purpose of the inspection. Administrator Krystyl Ibanez was notified of Licensing visit and was able to attend it. Administrators certificate number 6053811740 and renewal date 10/1/2025.

LPA toured the facility inside and outside. Passageways and exits were clear and free from obstruction. Smoke detectors and carbon monoxide detectors were present and operational. Facility was clean and odor free. LPA observed sufficient amount of perishable and non-perishable foodstuffs. Common areas were clean, adequately furnished, and adequately lit. Resident bedrooms were clean and had required minimum furnishings. Resident bathrooms were clean, odor free, and water temperature was within required temperature range. The rooms temperature observed at 77 degrees F. A locked cabinet was observed to store resident medications, and medications appeared to be administered properly. LPA reviewed facility plan of operations and emergency disaster plan. LPA reviewed a sample of resident and staff files.

CCLD requested the following documents to update the facility file: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan, LIC 9020 Register of Facility Residents, Alternative contact information to be provided by 9/10/2024

No deficiencies were cited during the inspection. Exit interview conducted and a copy of the report was provided.
SUPERVISOR'S NAME: Brenda ChanTELEPHONE: (650) 266-8889
LICENSING EVALUATOR NAME: Vadim GorbanTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 09/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/04/2024
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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