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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 297004181
Report Date: 09/23/2024
Date Signed: 09/23/2024 02:06:28 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 09/23/2024 02:06 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
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:HELPING HANDS CAREGIVER RESOURCEFACILITY NUMBER:
297004181
ADMINISTRATOR/
DIRECTOR:		COLEEN BONDFACILITY TYPE:
775
ADDRESS:17645 PENN VALLEY DRIVETELEPHONE:
(530) 432-2540
CITY:PENN VALLEYSTATE: CAZIP CODE:
95946
CAPACITY: 30CENSUS: 30DATE:
09/23/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:00 AM
MET WITH:Stephanie Murphy, Social WorkerTIME VISIT/
INSPECTION COMPLETED:
02:30 PM
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On 9/23/2024 LPA Tryon returned to the program to complete the annual visit. LPA had visited on 8/23/2024 but did not have sufficient time to complete the annual.
LPA met with Stephanie Murphy.
LPA reviewed the CARE Tool with Ms. Murphy.
LPA also reviewed 4 staff files and 6 participant files. Files include appropriate information and forms.
LPA interviewed 2 participants.


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: 09/23/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/23/2024
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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