342701323-8-20-2024-27-AS-AVIA-D8BQCF-20240820120303

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 342701323
Report Date: 08/20/2024
Date Signed: 08/20/2024 12:03:24 PM

Document Has Been Signed on 08/20/2024 12:03 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 SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME:	HELPING HANDS CARE HOME		FACILITY NUMBER:	342701323
ADMINISTRATOR:	OKORO, SYLVESTER O.		FACILITY TYPE:	740
ADDRESS:	8685 ELK WAY		TELEPHONE:	(614) 747-3443
CITY:	ELK GROVE	STATE: CA	ZIP CODE:	95624
CAPACITY:	6	CENSUS: 0	DATE:	08/20/2024
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	10:05 AM
MET WITH:	Sylvester Okoro		TIME COMPLETED:	12:15 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	On 8/20/24, at 10am, Licensing Program Analyst (LPA), Arvin Villanueva conducted an announced inspection to the above facility for purpose of a pre-licensing evaluation. An application was submitted to Community Care Licensing Department (CCLD) on 7/18/23, for an Initial license for a Residential Care for the Elderly. The requested capacity is for 6 residents (ambulatory/non-ambulatory). LPA was greeted and accompanied on inspection by the Administrator, Sylvester Okoro. At 10:25am, LPA and Administrator inspected the physical plant. Facility is a single-story house located in a residential neighborhood. Facility has 4 resident bedrooms, 2 resident bathrooms, living room/dining room kitchen, garage, and outdoor living space equipped with automatic awning. Additionally, fence and gates were observed to be in good repair. Outdoor passageways, walkways, driveways, and steps are free from obstructions. LPA did not observe hazards, such as ladders, gardening tools and/or motorized equipment in the front, back and/or side areas of the facility. LPA observed a fire door leading to the hallway to the resident bedrooms and bathrooms. Resident's Personal Rights, Resident Counsel, and Let Us Know posting in main area accessible to all residents, family, visitors, and staff. Residents' Bedrooms: LPA observed 4 resident bedrooms. The resident bedrooms are spacious and will easily accommodate the resident's furnishings. Bedrooms were observed to be equipped with a night stand, overhead lighting/fan, closet or wardrobe and a dresser with several drawers. All drawers comply with the requirement of 8 cubic feet of space and there was ample closet space. Bathroom: Facility has 2 resident bathrooms. One of the bathrooms is located in master bedroom. All bathrooms have working toilets, wash basins and full baths and showers. Both bathrooms are equipped with grab bars, non-skid mats and close-lid garbage cans. LPA observed adequate lighting in hallway leading to bathrooms via nigh lights. {Con't on LIC809-C}

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Arvin Villanueva	TELEPHONE: 916-208-0023
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HELPING HANDS CARE HOME	FACILITY NUMBER: 342701323
	VISIT DATE: 08/20/2024

NARRATIVE

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Linens & Hygiene Supplies: Beds have the required linen/supplies which include, pillowcases, mattress pads, fitted sheet, blanket and bedspreads. Adequate supply of linen and hygiene supplies stored in linen closet, which is at end of the hall between the bedrooms.

Emergency Phone Numbers, Exit Plan & Menu: The facility will have a landline be installed as per Administrator. One fully charged fire extinguisher were found in hallway located in the kitchen by the door to the garage. Fire extinguisher was last serviced on 8/29/23.

Toxins: Toxins locked/stored under kitchen sink and are inaccessible to residents.

Water temperature: Water temperature in both bathrooms measured between 110* F and 114* F. Hot water in the kitchen faucet was measured at 121*F. Administrator printed a warning sign to be placed at the kitchen area.

Food Service: Dishes, cups and flat ware are stored in the kitchen cupboards, inspected and in good repair. Knives, cutlery and other sharp kitchen utensils are in locked. Food supply was adequate and stored in kitchen refrigerator and cabinets.

Smoke Detectors and carbon monoxide: LPA observed smoke/carbon monoxide combo detectors in all resident bedrooms, hallway and kitchen area. They were tested and found to be operable during this visit.

Appliances: Stove burners and oven are in good working condition. Refrigerator/freezer in the kitchen was inspected and within regulatory temperatures measure at 35*F/0*F. Washer and dryer are located in the garage.

Medications, First-Aid Kit & Book: First aid kit has been inspected. Technical assistance was provided for Administrator to purchase current edition of the first aid manual and thermometer. First Aid kit was observed to be stored in the kitchen area, available for staff use.

{Con't to LIC809-C}

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Arvin Villanueva	TELEPHONE: 916-208-0023
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HELPING HANDS CARE HOME	FACILITY NUMBER: 342701323
	VISIT DATE: 08/20/2024

NARRATIVE

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Residents & Staff Files: Licensee will not be handling cash resources of residents at this time. Records of staff and residents shall be stored in a locked kitchen cabinet accessible to staff.

Reading Material, Games, Equipment & Materials: The facility has games and reading materials at this time but will be purchasing more activity materials in the future. Outside activity area is properly enclosed.

Pool/Jacuzzi & Pets: LPA did not observe any pets or bodies of water at the facility.

Component III: Conducted at the Pre-Licensing visit, on 8/20/24 at Helping Hands Care Home, information provided about how to operate the facility within substantial compliance.

Pre-Licensing is complete, and this facility has no deficiencies. Accordingly, LPA Villanueva will submit a copy of this facility evaluation report to the Central Applications Bureau (CAB) for review. If the applicant has questions regarding the status of the application, they have been instructed to communicate with the CAB Analyst assigned to their application.

An exit interview was conducted with Sylvester Okoro, and a copy of this report was provided.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR NAME: Arvin Villanueva	TELEPHONE: 916-208-0023
LICENSING EVALUATOR SIGNATURE:	DATE: 08/20/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/20/2024

LIC809 (FAS) - (06/04)

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