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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701323
Report Date: 07/30/2025
Date Signed: 07/30/2025 07:00:34 PM

Document Has Been Signed on 07/30/2025 07:00 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 HOMEFACILITY NUMBER:
342701323
ADMINISTRATOR/
DIRECTOR:		OKORO, SYLVESTER O.FACILITY TYPE:
740
ADDRESS:8685 ELK WAYTELEPHONE:
(614) 747-3443
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 6CENSUS: 6DATE:
07/30/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Valesia ColeTIME VISIT/
INSPECTION COMPLETED:
05:00 PM
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On 07/30/25, an unannounced annual inspection was made to this facility by Licensing Program Analyst (LPA) Sommer Hayes. The LPA identified themselves and the purpose of the visit and asked to speak to the Designated Facility Administrator (DFA). LPA was met by DFA Valesia Cole and a brief interview followed.

LPA was allowed entry into the facility that is licensed to serve a total capacity of 6 residents. The current census is 6. This facility is licensed for 6-non ambulatory residents and a hospice waiver granted for 2. LPA Hayes observed the refrigerator to be locked with a black bike lock.

A fire drill was held on 05/26/25 at 2pm for 1 hour. The drill included 3 staff and 6 residents.


LPA toured the facility with the DFA, Valesia Cole. The kitchen was accessible to residents and clean and sanitary. The LPA observed 7 days of non-perishable food supplies and did not observe 2 days of perishable food supplies. There were enough clean plates, cups and bowls and cutlery to meet capacity. LPA observed opened packages and storage containers with food items in the refrigerator were not dated appropriately. LPA observed a glass top stove in the kitchen. The bottom left “eye” was shattered. DFA stated the homeowner will be replacing the range.

The garage was not accessible to residents. LPA observed non-perishable food items, a freezer with frozen food and other storage items. The garage was clean and sanitary.

Continued on an 809-C

NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Sommer Hayes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/30/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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: 07/30/2025
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LPA observed a malodorous odor in R2’s room. The facility living room was clean and free of obstruction. The temperature reading was 75 degrees Fahrenheit per Title 22 regulations. The seating is efficient for the number of residents in this facility.

There was a fire extinguisher, smoke and carbon monoxide detectors, and central heating and air in the facility.

LPA observed the centrally stored medications area to be locked and inaccessible to residents. The Medication Administration Record (MAR) was reviewed. LPA Hayes observed that R4’s melatonin medication did not have a prescription. Through staff interview this medication has been given to the resident. In addition, R3’s melatonin prescribed to be given at 3mg and through an interview with staff LPA learned that 5mg was being cut in half by staff and given to the resident.

LPA reviewed 6 resident records and 2 staff records. LPA Hayes found the review of staff records to be missing required documents and incomplete. During the review of the resident records there was no documentation that the facility reported an AWOL, and a fall to the Department based on an interview with staff.

LPA observed the residents’ bedrooms. There were three double occupancy rooms. LPA Hayes observed R5 and R3’s room did not have sufficient lighting. LPA Hayes observed each resident room to be without a chair, an individual night stand for each resident and a chest of drawers for each resident.

LPA observed the backyard of the facility. There was a shaded area with an awning for residents to enjoy. Fencing was in good repair. The fence on the left side of the house was locked with a key lock. There were no bodies of water. LPA observed a hose that was left out in the walkway leading to the garden boxes. This could pose a tripping hazard to residents in care. Facility corrected this at the time of the visit.

Based on today’s visit this Annual needs continuation.
Exit interview completed with DFA and a copy of this report was provided to the DFA, Valesia Cole.

NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Sommer Hayes
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2025
LIC809 (FAS) - (06/04)
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