<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 392701311
Report Date: 05/01/2024
Date Signed: 05/01/2024 12:09:30 PM

Document Has Been Signed on 05/01/2024 12:09 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:ELITE HELPING HANDS CARE HOME LLCFACILITY NUMBER:
392701311
ADMINISTRATOR/
DIRECTOR:
MOODY, CAMISHAFACILITY TYPE:
735
ADDRESS:1620 MIGHTY OAK DR.TELEPHONE:
(510) 501-9683
CITY:STOCKTONSTATE: CAZIP CODE:
95205
CAPACITY: 2CENSUS: 0DATE:
05/01/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:16 AM
MET WITH:Camisha MoodyTIME VISIT/
INSPECTION COMPLETED:
12:15 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
On 5-1-2024 at 10:15am, Licensing Program Analyst (LPA) Michael Bilger arrived at this facility unannounced to conduct a post licensing visit. LPA met with the administrator Camisha Moody and explained the purpose of the visit.

LPA inspected the physical plant including but not limited to the kitchen, dining room, resident bedrooms; resident bathrooms, laundry room, living area, common TV area, and outside of the facility to ensure compliance with Title 22 regulations. Facility is an adult residential facility with a current census of 0 Facility is currently awaiting regional center approval to accept clients.. Facility currently has 2 bedrooms and 2 bathrooms for resident use. Facility has an additional bedroom not in use and a staff office.. Facility has a dining area off the kitchen and a formal living room. LPA also conducted the inspection using the CARE tool. The facility has an approved infection control plan in place.

Water temperature reads 105*F to 120*F in the bathroom and room temperature reads 69*F. Resident rooms were sanitary and had the required furniture and furnishings. The facility common areas were clean and furnished. Smoke and carbon detectors were in good repair. Fire extinguisher was checked 8-1-23. Facility has an emergency food and water kit. All toxins and other dangerous items including sharp objects were locked and secured.

All staff noted on LIC 500 contained criminal background clearances. Facility’s surety bond is current and update to date per regulatory requirements. Facility does not contain any bodies of water. LPA observed personal rights posted. Facility has appropriate internet access available for resident use. LPA reviewed facility’s disaster plan to ensure regulatory compliance.
Per California Code of Regulations, Title 22, no deficiencies were observed during this visit. Exit interview was held and a report was given to Administrator Camisha Moody.
SUPERVISORS NAME: Liza King
LICENSING EVALUATOR NAME: Michael Bilger
LICENSING EVALUATOR SIGNATURE: DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/01/2024
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