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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 347004182
Report Date: 06/01/2023
Date Signed: 06/01/2023 12:32:02 PM


Document Has Been Signed on 06/01/2023 12:32 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: 5DATE:
06/01/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Rosana Mead, Administrator TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Sabrina Calzada arrived unannounced to conduct a follow up case management inspection related to the fire clearance for non-ambulatory residents. LPA met with Rowena Tirasol, caregiver, and Rosana Mead, Administrator, and explained purpose of the inspection. LPA observed (1) resident to be enjoying television in the common area and a second resident to be sitting on the front porch. LPA observed (5) residents present and a hospice nurse also present with one resident.

LPA stated she spoke with local fire inspector today who confirmed an inspection was made on 5/30/23 and room #1, in front, can only be approved for a non-ambulatory resident if an exit door is installed in the room as a primary exit. Fire inspector explained that the front door cannot be considered a primary exit.

LPA and Administrator toured the facility and observed a glass sliding exit door in rooms #4, 5 and 6 and an exit door from Room #3. License is currently approved for (5) non-ambulatory residents, (1) of whom can be bedridden. LPA reached out to fire inspector during today's inspection to confirm if room #3 is approved for (2) non-ambulatory residents.

The facility was issued a citation on 5/10/23 for a violation of the fire clearance due to resident (R1) who is non-ambulatory residing in room #1. Resident did not agree to move to another room by the POC date of 5/12/23, so a second citation is issued today. Resident agrees now that she cannot stay in a room that is not approved for a non-ambulatory resident and agrees to move to another room if approved for a second resident. Administrator to issue a 30-day eviction today should another room not be available for R1 to move into.

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: 06/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2023
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 2


Document Has Been Signed on 06/01/2023 12:32 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: 06/01/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/02/2023
Section Cited
CCR
87202(a)(1)

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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 issue an immediate 30-day eviction notice to R1 in the event there is not an open vacancy at the facility in a room approved for non-ambualtory status. R1 also agreed to temporarily stay in room #3, pending confirmation from fire it is approved for (2) non-ambulatory residents.
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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. R1 did not agree to move to another room by 5/12/23, following the first citation.
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Licensee/Administrator agrees to provide a copy of the eviction notice issued to R1 to the Department by tomorrow, 6/2/23, and also provide an update if R1 moves to another room or moves from the facility.
CCR

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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: 06/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/01/2023
LIC809 (FAS) - (06/04)
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