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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 435202502
Report Date: 01/06/2023
Date Signed: 01/06/2023 10:00:16 AM

Document Has Been Signed on 01/06/2023 10:00 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
CENTRAL COAST CR/RES, 2580 N. FIRST STREET, STE. 350
SAN JOSE, CA 95131
FACILITY NAME:HELPING HANDS RESIDENTIAL CARE HOME 3FACILITY NUMBER:
435202502
ADMINISTRATOR:JANESSA FLORESFACILITY TYPE:
735
ADDRESS:3318 DIAS DRIVETELEPHONE:
(408) 239-0916
CITY:SAN JOSESTATE: CAZIP CODE:
95148
CAPACITY: 6CENSUS: 5DATE:
01/06/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Administrator, Janessa FloresTIME COMPLETED:
10:10 AM
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On 1/6/2023 @ 9:03am, Licensing Program Analyst (LPA) Simi Rai conducted an unannounced annual inspection focusing on infection control. LPA met with Administrator, Janessa Flores. LPA Rai observed 4 client in the living room and family room. Per ADM, 1 client is at day program.

During visit, LPA Rai toured the facility to include the family room, living room, 4 resident rooms, 2 bathrooms, kitchen, laundry area, dining area, garage and exterior. All fire exit routes are free and clear of obstruction. Toxins and sharp objects were secured. Medication stored in a locked closet.

Facility observed to have a designated central entry point to include a sign-in sheet and temperature check. Facility clean and disinfect as often as needed. Bathrooms supplied with hygiene products and hand washing sign. Trash can with lid observed. LPA observed a sufficient amount of Personal Protective Equipment (PPE).

The following posters observed to include wash your hands, symptoms of COVID-19, social distancing and importance of wearing a mask.

LPA Rai observed a no visitor sign posted at the front door. Administrator removed the no visitor sign during visit. LPA Rai advised of the visitation guidelines per PIN 22-28.1-ASC.

No deficiencies were cited per California Code of Regulations, Title 22.

This report was reviewed with Administrator, Janessa Flores and a copy of the report was provided.
SUPERVISORS NAME: Romeo Manzano
LICENSING EVALUATOR NAME: Simranjit Rai
LICENSING EVALUATOR SIGNATURE: DATE: 01/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/06/2023
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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