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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 297004181
Report Date: 09/08/2023
Date Signed: 09/12/2023 10:27:10 AM

Document Has Been Signed on 09/12/2023 10:27 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
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: 21DATE:
09/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME 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 to complete the annual review using the CARE Cool 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 CARES Tool with Ms. Murphy.

The facility keeps appropriate records for clients and staff.

Fire extinguishers are present and charged, fire alarm system is installed and functional.

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: 09/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/08/2023
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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