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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004182
Report Date: 05/10/2023
Date Signed: 05/10/2023 03:47:14 PM


Document Has Been Signed on 05/10/2023 03:47 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, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833



FACILITY NAME:HELPING HANDSFACILITY NUMBER:
347004182
ADMINISTRATOR:ROSANA G. MEADFACILITY TYPE:
740
ADDRESS:7655 PRINCE STREETTELEPHONE:
(916) 723-2985
CITY:CITRUS HEIGHTSSTATE: CAZIP CODE:
95610
CAPACITY:6CENSUS: 4DATE:
05/10/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:10 PM
MET WITH:Rosanna Mead, Administrator TIME COMPLETED:
03:45 PM
NARRATIVE
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a case management inspection related to the fire clearance for non-ambulatory residents. LPA met with Rowena Tirasol, caregiver, and Rosanna Mead, Administrator, and explained purpose of the inspection.

LPA recently received an exception request for a non-ambulatory resident (R1) to be allowed to reside in a room approved for an ambulatory resident.

During today's inspection, LPA reviewed the prior physician's report (LIC602) dated 8/24/21 which notes R1 is wheelchair bound and non-ambulatory. LPA also reviewed the updated LIC602, dated 3/7/23 where it also denotes R1 as wheelchair bound and non-ambulatory. LPA observed R1 to be awake and ambulating on her own in a wheelchair.

Administrator and LPA contacted Sac Metro Fire Department to inquire when they could visit the facility and evaluate if the room R1 currently resides in can be approved for a non-ambulatory resident. Administrator stated to LPA that in years past, the room where R1 is staying was approved for a non-ambulatory resident and then later approved for staff use in March 2009. LPA reviewed documentation supporting this. The Department will follow up and send an STD850 to Sac Metro requesting R1's room be inspected for possible approval for non-ambulatory, as it is near an exit door.

R1 moved to the facility on/around August 2021, moved out in March 2023 and returned in May 2023, and has resided in the same room the entire time.

Per California Code of Regulations, Title 22, Division 6, Chapter 8, the following deficiency is issued on the 809D page.
Exit interview. Copy of report and appeal rights provided to Administrator.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2023
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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Document Has Been Signed on 05/10/2023 03:47 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833


FACILITY NAME: HELPING HANDS
FACILITY NUMBER: 347004182

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/12/2023
Section Cited

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87202 Fire Clearance
(a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal.(1) Nonambulatory persons. This requirement is not met as evidenced by:
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Licensee/Administrator agree to move R1 to another room that is approved for a non-ambulatory resident and place a resident who is ambulatory in R1's room.
Licensee/Administrator to send a photo that resident's belongings have moved to another room by 5/12/23.

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Based on documentation reviewed, the Licensee did not ensure that resident (R1) who has a non-ambulatory status was placed in a resident room that was approved for a non-ambulatory resident, which poses a potential health and safety risk to residents in care.
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Licensee reached out to Fire Dept today regarding an inspection. The Department will follow up and send an inspection request by email.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Maribeth SentyTELEPHONE: (916) 263-4813
LICENSING EVALUATOR NAME: Sabrina CalzadaTELEPHONE: (510) 829-2133
LICENSING EVALUATOR SIGNATURE:
DATE: 05/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/10/2023
LIC809 (FAS) - (06/04)
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