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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701007
Report Date: 05/13/2021
Date Signed: 05/13/2021 01:06:52 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:CARING HANDS A RESIDENTIAL FACILITYFACILITY NUMBER:
502701007
ADMINISTRATOR:ACEDO, MARIA CRISTINAFACILITY TYPE:
740
ADDRESS:2912 WESTPORT CIRCLETELEPHONE:
(209) 549-6945
CITY:OAKDALESTATE: CAZIP CODE:
95361
CAPACITY:6CENSUS: 0DATE:
05/13/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Maria VercelesTIME COMPLETED:
01:00 PM
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LPA Garcia and LPA Johnson, conducted this announced prelicensing visit. LPA toured with Maria Verceles. This facility has a fire clearance for six non-ambulatory and six total.

This facility has four private and two shared resident rooms. There is staff room for sleeping so this facility is required to have awake night staff. There are two private residents room and one shared room to the left of the main entrance. All three resident rooms have an exit to the outside. There is a common bathroom accessible to all three rooms. From the main entrance is a long hallway, to the right of the main entrance is the first door that is the entrance to the garage with a storage are and laundry area. The second door is the staff room. At the end of the hallway leads to the open floor plan with the common sitting area, kitchen, and dining area. There is one shared room from the open area that has with a bathroom and an exit to the outside.

Staff and client files will be in locked cabinets in open common area. All cabinets have magnet locks. Locked cabinets with separate fridge is in the common open area. The backyard was inspected and there are gates on both sides of the facility. The kitchen was inspected. There is a locked cabinet under the sink that stores the cleaning chemicals. The knobs for the stove range will be covered/or removed when not in use. There is a locked cabinet next to the kitchen that stores the medications. Both front and backyards are well maintained. There are audio alerts on all exits.

Component III orientation was waived, the Administrator has 3 years of licensing experience . LPA is going to submit this report to the applications specialist for review.
SUPERVISOR'S NAME: Stephenie DoubTELEPHONE: (916) 263-2131
LICENSING EVALUATOR NAME: Arlene D GarciaTELEPHONE: 916-862-5907
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2021
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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