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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 019201132
Report Date: 03/24/2022
Date Signed: 03/24/2022 03:43:22 PM

Document Has Been Signed on 03/24/2022 03:43 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
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:HELPING HANDSFACILITY NUMBER:
019201132
ADMINISTRATOR:MIHALE, ELENAFACILITY TYPE:
740
ADDRESS:8552 BRIARWOOD LANETELEPHONE:
(408) 509-0614
CITY:DUBLINSTATE: CAZIP CODE:
94568
CAPACITY: 6CENSUS: 0DATE:
03/24/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:20 PM
MET WITH:Elena Mihale, Applicant/ Administrator,
Antonia Arellano, Licensee		TIME COMPLETED:
04:00 PM
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On 3/24/2022, LPA’s (Licensing Program Analysts) L. Ibo and K. Nguyen arrived unannounced to conduct continuation pre-licensing inspection due to a change of ownership. LPAs met with applicant Elena Mihale. NO resident observed during the visit.


LPA's conducted component III with applicant Elena Mihale and Antonia Arellano. LPAs discussed covid19 guidelines.

No issues noted during inspection. LPA observed that facility is ready to be licensed. This report will be submitted to the Central Applications Unit (CAU) and a final review of the application will be conducted. This facility is not yet licensed and is subject to final approval by CAU. Additional requirements may still be required.

Exit interview conducted with Applicant and a copy of report provided.

SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Leslie Ibo
LICENSING EVALUATOR SIGNATURE: DATE: 03/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/24/2022
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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