345002931-9-22-2022-25-AS-DAWL-CJHNTJ-20220922104450

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 345002931
Report Date: 09/22/2022
Date Signed: 09/22/2022 10:47:24 AM

Document Has Been Signed on 09/22/2022 10:47 AM - It Cannot Be Edited

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 HOME II		FACILITY NUMBER:	345002931
ADMINISTRATOR:	KAUR, NAVGEET		FACILITY TYPE:	740
ADDRESS:	4400 BELMONT PLACE LANE		TELEPHONE:	(951) 775-4933
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95841
CAPACITY:	6	CENSUS: 0	DATE:	09/22/2022
TYPE OF VISIT:	Prelicensing	ANNOUNCED	TIME BEGAN:	08:29 AM
MET WITH:	Navgeet Kaur, Administrator		TIME COMPLETED:	11:00 AM

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On September 22, 2022 at 9am, Licensing Program Analyst (LPA) De Anna Williams-Lyons arrived announced to conducted an Pre-Licensing l Inspection of the facility to ensure compliance with Title 22 regulations. LPA Lyons met with the Navgeet Kauri, Administrator who assisted LPA in today’s inspection.

Prior to initiating the visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms and completed a facility risk assessment. LPA ensured she applied hand sanitizer before entering the facility and a N-95 mask was worn for Personal Protective Equipment.

The Administrator certificate expires September 2024. The current census is 0. The facilities Administrator’s Certificate, Emergency Disaster Plan, Resident’s Rights and Facility Sketch was available for viewing. The room temperature was 75 degrees F which is within the allowed range.

LPA inspected the interior and the exterior of the facility including the common living spaces, the kitchen, resident bedrooms and bathrooms. In the kitchen area, cabinets and drawers were reviewed. Knives and sharp objects were reviewed to make sure that they were locked and made inaccessible to the residents at all times. LPA observed there to be a sufficient amount of 2-day perishable and 7-day non-perishable food. Hot water temperatures were taken and measured at 116 degrees F, which is within the allowed range of 105-120 degrees. There’s appropriate lighting throughout the facility.

To continue see 809-C...

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 HOME II	FACILITY NUMBER: 345002931
	VISIT DATE: 09/22/2022

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The facility is a one story home. Living rooms, dining room, and areas designated for resident use were toured. Furniture and furnishings were observed to be sufficient and in good repair. Resident bedrooms and bathrooms were toured. There are 5 Bedrooms in which 4 are private and 1 shared. All rooms had the required items of furniture. Window screens were on and in good repair. Bathrooms were clean, sanitary and odorless and consisted of grab bars and non-skid mats. Hot water temperature is 116 degrees F. The sink, toilet, bathtub and shower operate properly. The facility has a sufficient supply of linens, towels, bedding, etc. for residents in care. Washer and dryer was present and operating properly. Toxic substances, laundry and cleaning supplies are inaccessible.

There’s a centralized storage area for resident’s medication. Medication cabinet was locked. First aid kit was present and included the required scissors, tweezers, thermometer and guide. Fire alarms, smoke alarms, and carbon monoxide detectors operate properly. Fire extinguisher is maintained and ready for emergency use. The facility was observed to have been annually inspected in June 2022 by Fire Code and in compliance at this time. LPA inspected the exterior grounds of this facility. There are bodies of water on the premises and the pool will be covered when residents are admitted. The perimeter fence, side gates, and latches were in good repair. Passageways are free of obstruction and potential hazards.

The administrator has an updated CPR and First Aid Certificates.

Because the Licensee has another facility, LPA did not conducted Component III.

Licensure pending approval from Central Application Unit

Per California Code of Regulations, Title 22 Division 6, Chapter 8, no deficiencies were observed today.

An exit interview was conducted and a copy of this report was given to Navgeet.

SUPERVISOR'S NAME: Laura Munoz	TELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: DeAnna Williams-Lyons	TELEPHONE: (916) 212-3983
LICENSING EVALUATOR SIGNATURE:	DATE: 09/22/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/22/2022

LIC809 (FAS) - (06/04)

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