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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502700113
Report Date: 02/22/2024
Date Signed: 02/22/2024 03:11:11 PM


Document Has Been Signed on 02/22/2024 03:11 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:CARING HANDS FOR THE ELDERLYFACILITY NUMBER:
502700113
ADMINISTRATOR:GUERRERO, ANAFACILITY TYPE:
740
ADDRESS:4229 GABRIEL WAYTELEPHONE:
(209) 360-2973
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY:6CENSUS: 5DATE:
02/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ana GuerreroTIME COMPLETED:
03:20 PM
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On 2/22/24 Licensing Program Analyst (LP) Maja Jensen arrived at facility unannounced to conduct a required one year annual visit. LPA Jensen met with Administrator Ana Guerrero and explained the purpose of today's visit.

LPA Jensen toured the grounds and observed them to be well maintained. All paths were free of obstruction. There are no bodies of water on the premises. There is outdoor furniture for resident activities with shade available. LPA Jensen toured the physical plant. The facility is a single story building with 4 bedrooms. There are 2 double occupancy rooms and 2 single occupancy rooms. The facility was observed to be sanitary and free of odor. There was adequate furnishings and lighting throughout. The facility maintains an adequate supply of linens. All furniture was observed to be in good repair.

LPA Jensen inspected the kitchen and observed all knives to be locked and inaccessible to residents in care. There was in excess of a 2 day supply of perishable food and a 7 day supply of non-perishable food. Food in the refrigerator was labeled with the date opened. There was no expired food product observed. Lunch service was provided during the course of this inspection and residents received different lunches according to each individual's preference. There was fresh fruit and vegetables available.

LPA Jensen tested the carbon monoxide detector and observed it to be good working order. The smoke detectors were also observed to be in good working order. The fire extinguisher was last serviced in August of 2023 and is in compliance. The first aid kit was observed to be complete. Fire drills are conducted and logged in compliance with regulation. The Emergency disaster plan was posted and in compliance. All required postings were prominently displayed. The facility maintains an emergency supply of water and lighting. The infection control plan has been submitted and is in compliance.

LPA Jensen conducted interviews with 2 residents, both who were satisfied with the care they receive and the accommodations. LPA Jensen interviewed 1 staff member who was able to respond to all questions appropriately.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2024
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 2


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: CARING HANDS FOR THE ELDERLY
FACILITY NUMBER: 502700113
VISIT DATE: 02/22/2024
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LPA Jensen reviewed 5 of 5 resident files. All files were observed to be complete. LPA Jensen reviewed 6 of 6 staff files and all staff files were observed to be complete and in compliance. LPA Jensen reviewed the facility advertising materials which were observed to be in compliance. The facility provides internet service and telephone service for clients in care.

The medications were observed to be locked and inaccessible to residents in care. The facility monitors and logs the effectiveness of PRN's given. The Medication Administration Record was compared to medication on hand and was consistent. The facility does not handle any Personal and Incidental funds.

LPA Jensen requested and received an updated LIC 500, a current copy of the liability insurance and an LIC 308. The inspection tool was used during the course of this visit. LPA Jensen inspected the grounds and interior then left the facility for lunch and returned to conduct file reviews. The facility currently has a hospice waiver for 4. LPA Jensen discussed requesting an increase in the hospice waiver and recommended that an increase be sought should the need arise so the Department can assess the situation on a case by case basis.

The facility is in substantial compliance. No deficiencies were observed. An exit interview was conducted and a copy of this report was provided.
SUPERVISOR'S NAME: Lisa RiosTELEPHONE: (916) 969-9685
LICENSING EVALUATOR NAME: Maja JensenTELEPHONE: (916) 639-5584
LICENSING EVALUATOR SIGNATURE:

DATE: 02/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2024
LIC809 (FAS) - (06/04)
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