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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342700930
Report Date: 06/21/2023
Date Signed: 06/21/2023 12:12:43 PM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/14/2023 and conducted by Evaluator Kevin Mknelly
PUBLIC
COMPLAINT CONTROL NUMBER: 59-AS-20230414143417
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:
06/21/2023
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:CaregiverTIME COMPLETED:
12:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff caused injury to resident.
Staff does not allow resident phone use.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
 On 6/21/23 , Licensing Program Analyst (LPA) Kevin Mknelly LPA Mknelly arrived and met with Administrator to deliver investigation findings. The Administrator was notified and arrived to assist.
LPA reviewed staff records, facility records, and conducted interviews.
LPA finds that facility met Tittle 22 requirements.
Observations, interviews and records found that R1's family had discontunued R1's cell phone use. The staff made the house phone available to R1 if R1 requested. R1 is diagnosed with dementia and related episodic hallucinations. LPA observations and interview with R1 found that R1's reports of abuse, disfigurement and building damage were not credible. R1 is receiving appropriate care as identified by their physician and R1's personal rights are not observed to have been violated. Some modifications have been made to R1's care plan and room set-up and the hallucinations have decreased.
This agency has investigated the above complaint allegations. We have found that the complaint is UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.
Exit interview conducted and report provided.
Unfounded
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Kevin MknellyTELEPHONE: (209) 814-1925
LICENSING EVALUATOR SIGNATURE:

DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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