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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 297004181
Report Date: 10/04/2021
Date Signed: 10/04/2021 02:17:20 PM

Document Has Been Signed on 10/04/2021 02:17 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, 520 COHASSET RD., STE. 170
CHICO, CA 95926
FACILITY NAME:HELPING HANDS CAREGIVER RESOURCEFACILITY NUMBER:
297004181
ADMINISTRATOR:COLEEN BONDFACILITY TYPE:
775
ADDRESS:17645 PENN VALLEY DRIVETELEPHONE:
(530) 432-2540
CITY:PENN VALLEYSTATE: CAZIP CODE:
95946
CAPACITY: 30CENSUS: 13DATE:
10/04/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Coleen BondTIME COMPLETED:
03:00 PM
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LPA Lusby arrived on Monday October 4, 2021 to conduct the annual inspection. Prior to the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms; LPA ensured she applied hand sanitizer before entering the facility and the following Personal Protective Equipment (PPE) was worn: N-95 mask.

LPA and Coleen completed the infection control domain together and facility was found to be in compliance at this time. Facility to resume daily screening of clients and staff. All clients and staff are fully vaccinated. LPA to drop off additional PPE to the facility next week.

LPA and Coleen toured facility together to ensure health and safety of residents in care. Areas toured include but are not limited to kitchen, common area, and office/medication room. In the areas toured no immediate health, safety, or personal rights violations were observed.

No deficiencies are being cited as a result of todays inspection. Exit interview conducted. A copy of this report was left at the facility.
SUPERVISORS NAME: Anthony Perez
LICENSING EVALUATOR NAME: Melissa Lusby
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2021
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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