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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 342701323
Report Date: 09/10/2025
Date Signed: 09/10/2025 05:56:25 PM

Document Has Been Signed on 09/10/2025 05:56 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:HELPING HANDS CARE HOMEFACILITY NUMBER:
342701323
ADMINISTRATOR/
DIRECTOR:		OKORO, SYLVESTER O.FACILITY TYPE:
740
ADDRESS:8685 ELK WAYTELEPHONE:
(614) 747-3443
CITY:ELK GROVESTATE: CAZIP CODE:
95624
CAPACITY: 6CENSUS: 6DATE:
09/10/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:30 AM
MET WITH:Valesia ColeTIME VISIT/
INSPECTION COMPLETED:
06:15 PM
NARRATIVE
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Licensing Program Analysts (LPAs) Sommer Hayes and Arvin Villanueva conducted an unannounced Case Management- Annual Continuation visit today, 9/10/2025, to continue with the Annual visit initiated on 07/30/2025. LPAs met with The Designated Facility Administrator (DFA) Valesia Cole and a brief interview followed and LPAs stated the purpose of this visit.

The LPAs continued with the facility visit to ensure there are no health and safety hazards and facility is in compliance with Title 22 Regulations. LPAs conducted a facility walk-through including the garage, front and backyard.

LPAs observed similar deficiencies during this visit. This facility was cited on 04/20/2025 for Fire Clearance--not being in compliance with the fire clearance as the rooms are being used differently that what is indicated on the sketch provided to the fire inspector. The plan of correction was not received by LPA Hayes by the indicated due date.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, deficiencies are being cited today and advisories were given. In addition civil penalties are being assessed.

Exit interview was conducted and a copy of the report was provided to DFA Valesia Cole upon exit.

NAME OF LICENSING PROGRAM MANAGER: Stephen Richardson
NAME OF LICENSING PROGRAM ANALYST: Sommer Hayes
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 09/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/10/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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Document Has Been Signed on 09/10/2025 05:56 PM - It Cannot Be Edited


Created By: Sommer Hayes On 09/10/2025 at 11:14 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HELPING HANDS CARE HOME
FACILITY NUMBER: 342701323

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87203

Fire Safety: All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation and interviews, the licensee did not comply with the section cited above. During physical observation on 9/10/25, LPAs observed the fire door to be propped open with a door stopper. Interview with staff on duty stated they keep this door open. This which poses/posed a immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/11/2025
Plan of Correction
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Per discussion Administrator agrees to submit a letter of understanding to The Department indicating they understand this regulation being cited for the fire door being opened. This is due no later than tomorrow by 5:00pm PST.
Type A
Section Cited
CCR
87202(a)
Fire Clearance: …licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations, interviews and a review of records, the facility is not in compliance with the fire clearance as the rooms are being used differently that indicated on the sketch provided to the fire inspector. This facility is only cleared for two rooms for a 2 capacity each and two rooms cleared for 1 capacity each. This poses an immediate health, safety and personal rights risk to the residents in care.
POC Due Date: 09/11/2025
Plan of Correction
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Per discussion Administrator agrees to submit a letter of understanding to The Department indicating they understand this regulation being cited for the fire door being opened. This is due no later than tomorrow by 5:00pm PST.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Stephen Richardson
NAME OF LICENSING PROGRAM MANAGER:
Sommer Hayes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/10/2025 05:56 PM - It Cannot Be Edited


Created By: Sommer Hayes On 09/10/2025 at 11:40 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HELPING HANDS CARE HOME
FACILITY NUMBER: 342701323

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87309(a)

Except as specified in subsection (b), the licensee shall ensure that disinfectants, cleaning solutions, poisonous substances, knives, matches, tools, sharp objects, and other similar items which could pose a danger to residents are in locked storage and are not left unattended if outside the locked storage.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. During physical observation on 9/10/25, LPAs observed a fabric softener on a shelf inside the garage; additionally, the bin that staff use to keep laundry supplies is not locked. LPAs observed the door to the garage can be unlocked from the inside by residents in care. This poses/posed an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/11/2025
Plan of Correction
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Per discussion Administrator agrees to send a picture of locked chemicals to LPA Hayes at sommer.hayes@dss.ca.gov by 5pm on 09/11/25.
Type A
Section Cited
CCR
87705(f)
Licensees that lock exterior doors or perimeter fence gates shall meet the following initial and continuing requirements…

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations on 9/10/25 and 7/30/25, LPAs observed the exit gate to be locked with a padlock. This poses/posed an immediate health, safety or personal rights risk to persons in care. The padlock was removed during today's visit.
POC Due Date: 09/11/2025
Plan of Correction
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Per discussion the Administrator agrees to submit a letter of understanding to The Department by 09/11/25 by 5pm by submitting the letter to sommer.hayes@dss.ca.gov.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Stephen Richardson
NAME OF LICENSING PROGRAM MANAGER:
Sommer Hayes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/10/2025 05:56 PM - It Cannot Be Edited


Created By: Sommer Hayes On 09/10/2025 at 11:46 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HELPING HANDS CARE HOME
FACILITY NUMBER: 342701323

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87465(h)(2)
Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. During physical observation on 9/10/25, LPAs observed a resident’s medication in a pill cup on top of a shelf at the medication area. This poses/posed an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/10/2025
Plan of Correction
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Per discussion Administrator agrees to submit the Community Option --training plan for staff handling medications. Once the course have been completed submit certificate(s) of completion to LPA Hayes by 09/11/25 and submit a letter of underdstanding of the regulation mentioned above by submitting all to sommer.hayes@dss.ca.gov.
Type A
Section Cited
CCR
87465(a)(4)
The licensee shall assist residents with self-administered medications as needed.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, licensee did not comply with the regulation cited above.
(For the R3’s melatonin being given the wrong dosage)
Based on record review, licensee did not comply with the regulation cited above. Since the 07/30/25 initial annual visit the Administrator has corrected the dosage of melatonin being dispensed R3.

POC Due Date: 09/11/2025
Plan of Correction
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Per discussion Administrator has changed the dosage to match the doctor's orders. This item has been corrected.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Stephen Richardson
NAME OF LICENSING PROGRAM MANAGER:
Sommer Hayes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/10/2025 05:56 PM - It Cannot Be Edited


Created By: Sommer Hayes On 09/10/2025 at 11:51 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HELPING HANDS CARE HOME
FACILITY NUMBER: 342701323

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87465(a)(5)(A)

…Assistance with self-administered medications shall be limited to the following: (A) Medications usually prescribed for self-administration which have been authorized by the person's physician.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, licensee did not comply with the regulation cited above.
(For R4's lack of prescription for melatonin)
This poses/posed an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 09/11/2025
Plan of Correction
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Per discussion the medications was put on hold until they obtain a prescription from residents' doctor. Administrator agrees to submit a letter of understanding of the regulation cited above by 09/11/25 at 5:00pm.
Type A
Section Cited
CCR
87468.1(a)(3)

Personal Rights of Residents in All Facilities: To be free from…actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination.
This requirement is not met as evidenced by:

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation on 7/30/25, LPA observed the kitchen refrigerator to be locked with a black cable lock and not accessible to residents in care which poses an immediate health, safety or personal rights risk to persons in care. LPAs did not observe a locked refrigerator at the time of visit on 09/10/25.
POC Due Date: 09/11/2025
Plan of Correction
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As discussed Administrator agrees Administrator agrees to submit a letter of understanding of the regulation cited above by 09/11/25 at 5:00pm. Please submit to LPA Hayes at sommer.hayes@dss.ca.gov.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Stephen Richardson
NAME OF LICENSING PROGRAM MANAGER:
Sommer Hayes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2025


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Document Has Been Signed on 09/10/2025 05:56 PM - It Cannot Be Edited


Created By: Sommer Hayes On 09/10/2025 at 12:06 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: HELPING HANDS CARE HOME
FACILITY NUMBER: 342701323

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87211(a)(1)

Reporting Requirement: A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D)…
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, licensee did not comply with the regulation cited above.
LPA Hayes observed during the initial annual visit that a missing person’s report was submitted for R4 during R4’s file review. This incident was not reported to the Department by the Admin/Licensee. This poses/posed an immediate health, safety or personal risk to persons in care.
POC Due Date: 09/17/2025
Plan of Correction
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As discussed Administrator agrees to send an incident report and a copy of the police report detailing this incident. In addition, Administrator will send a letter of understanding via email/fax stating that they understand the above regulation. Special Incident reports and/or requested documents:(916) 263-4744 fax or CCLASCPSacramentoRO@dss.ca.gov
Type B
Section Cited
CCR
87303(a)
The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observations on 7/30/25, LPAs observed the kitchen stove was in disrepair. This poses/posed a potential health, safety or personal rights risk to persons in care. LPAs observed a new stove in place of the old stove during today's visit.
POC Due Date: 09/17/2025
Plan of Correction
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Per observation on today's visit LPA observed the stove has been repaired.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
Stephen Richardson
NAME OF LICENSING PROGRAM MANAGER:
Sommer Hayes
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 09/10/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/10/2025


LIC809 (FAS) - (06/04)
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