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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342700930
Report Date: 02/07/2022
Date Signed: 02/07/2022 01:08:55 PM

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 CARE HOMEFACILITY NUMBER:
342700930
ADMINISTRATOR:KAUR, NAVGEETFACILITY TYPE:
740
ADDRESS:5324 NYODA WAYTELEPHONE:
(951) 775-4933
CITY:CARMICHAELSTATE: CAZIP CODE:
95608
CAPACITY:6CENSUS: 5DATE:
02/07/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:10 AM
MET WITH:Navgeet Kaur, Administrator TIME COMPLETED:
01:10 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a required annual inspection. LPA spoke with caregiver, Nadine Waite Golding, and observed her to be wearing a mask. LPA contacted Navgeet Kaur, Administrator, by phone, who arrived shortly to the facility. Prior to initiating today's inspection, LPA completed required COVID-19 testing protocols, and completed a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms Additionally, LPA was screened per Covid-19 precautionary measures upon entering the facility. LPA ensured she applied hand sanitizer before entering. The following Personal Protective Equipment (PPE) was worn: N95 Mask. LPA observed (1) resident watching television in the common area and (4) residents resting in their rooms. (2) residents are currently receiving hospice services.

LPA and Administrator toured and observed the facility to ensure the health and safety of residents in care. Areas toured include: common areas, (4) private bedrooms, (1) shared bedroom with private bath, (2) resident bathrooms, (1) vacant resident room, (1) staff/break room, dining room, laundry area and kitchen. LPA observed 2+day perishable and 7+day non-perishable food supply and PPE supplies for 30+days on hand. LPA observed locked toxins, medications and sharps. In the areas toured, there were no immediate health, safety, or personal rights violations observed. LPA and Administrator completed the infection control domain and facility was found to be in compliance at this time. Inside temperature was observed to be 73* F. LPA observed several Covid posters posted at/near the front entrance and in the bathrooms-LPA to provide additional posters to post throughout. LPA observed other required postings in place. Administrator Certificate #6057120740 posted (exp 9/13/2022). All staff are cleared/associated to facility. Discussed staff vaccination requirements.Discussed PIN 22-04 issued 1/18/2022 regarding current testing and visitation requirements and subsequent PIN to be issued. LPA requested copy of current liability insurance and completed LIC308 be emailed to the Department by 2/10/22.

There are no deficiencies cited during today's inspection. Exit interview. Copy of report left at facility.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:

DATE: 02/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2022
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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