<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
345002931
Report Date:
10/16/2023
Date Signed:
10/16/2023 04:02:53 PM
Document Has Been Signed on
10/16/2023 04:02 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 NORTH ASC
,
9835 GOETHE ROAD, SUITE 100
SACRAMENTO
,
CA
95827
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:
6
DATE:
10/16/2023
TYPE OF VISIT:
Required - 1 Year
UNANNOUNCED
TIME BEGAN:
01:50 PM
MET WITH:
Navgeet Kuar
TIME COMPLETED:
04:15 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
LPA Hiratsuka conducted this unannounced annual visit. LPA toured with Administrator Navgeet Kaur.
This facility has five resident rooms. One room is shared and the others are private. The largest room has a full private bathroom and a door leading to the outside. There is a laundry room that leads to the garage. The backyard has a locked shed and a pool that is surrounded by a fence. The pool has two gates that are locked.
Six resident records were reviewed
Three staff records were reviewed
The following was discussed:
-definition of ambulatory and non-ambulatory status
The following shall be updated and submitted to Community Care Licensing by 10/30/2023:
-LIC 500 facility personnel or staff schedule
-LIC 610 emergency disaster plan
-LIC 308 designation of administrative responsibility
no deficiencies cited.
SUPERVISOR'S NAME:
Troy Ordonez
TELEPHONE:
(916) 263-4700
LICENSING EVALUATOR NAME:
Kerry Hiratsuka
TELEPHONE:
(916) 591-0210
LICENSING EVALUATOR SIGNATURE:
DATE:
10/16/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
10/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809
(FAS) - (06/04)
Page:
1
of
1