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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 297004181
Report Date: 10/31/2022
Date Signed: 10/31/2022 03:12:49 PM

Document Has Been Signed on 10/31/2022 03:12 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
CHICO - RESIDENTIAL, 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: DATE:
10/31/2022
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Stephanie Murphty, Social WorkerTIME COMPLETED:
03:30 PM
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On this date LPA Tryon visited the facility again to complete the annual review using the Infection Contorl Domain of the CARES Tool LPA met with Social Worker Stephanie Murphy.

LPA toured the day program including several areas of the main room the kitchen, bathrooms, storage, office, etc.

LPA reviewed the infection control portion of the CARES Tool with Ms. Murphy.

At this time, the program appears to be in substantial compliance with the regulations. No deficiencies were cited at this visit.

Exit interview conducted.


SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Todd Tryon
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2022
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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