342700930-2-22-2021-27-AS-SCAA-BYGVW8-20210222154730

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342700930
Report Date: 02/22/2021
Date Signed: 02/22/2021 03:48:07 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME:	HELPING HANDS CARE HOME		FACILITY NUMBER:	342700930
ADMINISTRATOR:	KAUR, NAVGEET		FACILITY TYPE:	740
ADDRESS:	5324 NYODA WAY		TELEPHONE:	(951) 775-4933
CITY:	CARMICHAEL	STATE: CA	ZIP CODE:	95608
CAPACITY:	6	CENSUS: 0	DATE:	02/22/2021
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	12:45 PM
MET WITH:	Navgeet Kaur, Administrator		TIME COMPLETED:	02:30 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst (LPA) Sabrina Calzada conducted a Pre-licensing inspection via tele-visit on 02/22/2021 due to COVID-19 and precautionary measures. LPA met with Administrator, Navgeet Kaur. This is not a change of ownership. The facility has a fire clearance for four (4) non-ambulatory. The facility currently has no residents in care. LPA and Administrators toured the interior and exterior of the facility including the common areas, resident bedrooms (4), bathrooms kitchen, medication area, and laundry area. LPA observed the facility to be clean, in good repair and to have sufficient furniture in the common areas and lighting throughout, including night-lights in the hallways. LPA observed sufficient 7+day non-perishable supply of food on hand and sufficient dishes, flatware and cooking pans. LPA observed the smoke/monoxide alarms to be in working order, and the fire extinguisher to have been serviced 1/22/2021. LPA observed the necessary grab bars in the shower and non-skid flooring in the bathrooms. LPA observed some towels on hand and was advised blankets/linens for twin beds were still packed. There was not a first aid kit on site, and the hot water was not able to be measured due to no thermometer available. LPA observed (1) unlocked exit gate and ramps on the side and front of the facility. There and no pools/bodies of water present. LPA observed that exit doors do not have alarms on them. Resident/Staff binders to be put together with required paperwork. LPA observed there were not any games and activities on site. LPA observed the following posters at facility but not posted yet. Facility to post: Resident Personal Rights, See Something Say Something, Facility sketch with evacuation route, Theft and Loss Policy, and Rights of Resident/Family Councils. Ombudsman and Non-Discrimination notice. cont on 809C...

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2021

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: HELPING HANDS CARE HOME	FACILITY NUMBER: 342700930
	VISIT DATE: 02/22/2021

NARRATIVE

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The following areas were noted to not be in compliance during today's tele-visit. Administrator agrees to ensure the following areas are in compliance per Title 22, Division 6, Chapter 8, by Friday, 2/26/2021.

LPA observed that the drawer/area to be used for sharps and medications in the kitchen, and the area to be used for toxins in the laundry room does not have a locking mechanism installed yet.

LPA did not observe one resident room to be complete with required furniture- Administrator stated that furniture (twin beds and night stands) is on order and should be received by Friday, 2/26/2021.

LPA observed that a grab bar needs to be installed by the toilet in two bathrooms.

There was not a first aid kit on site

Hot water was not able to be measured due to no thermometer available.

LPA observed that exit doors do not have alarms on them.

A sample resident and staff binders is to be put together with required paperwork.

LPA observed there were not any games and activities on site.

Comp III was conducted during today's tele-visit.

LPA to notify analyst in application unit that a follow-up tele-visit will be conducted on 2/26/2021 to observe that deficient areas are in compliance .

An exit interview was conducted with Administrator during today's tele-visit, and a copy of this report will be provided to the facility via e-mail at approximately 3:45 pm. Administrators agree to sign and return a copy to CCL promptly following receipt of the report and to keep a copy for the facility records.

SUPERVISOR'S NAME: Maribeth Senty	TELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina Calzada	TELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2021

LIC809 (FAS) - (06/04)

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