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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880590
Report Date: 04/01/2022
Date Signed: 04/01/2022 12:15:48 PM

Document Has Been Signed on 04/01/2022 12:15 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:HANDS THAT HELP LLC, THEFACILITY NUMBER:
331880590
ADMINISTRATOR:DAVIS, SHAWNIQUAFACILITY TYPE:
735
ADDRESS:4378 CHARLTON AVETELEPHONE:
(619) 723-9899
CITY:HEMETSTATE: CAZIP CODE:
92544
CAPACITY: 6CENSUS: 4DATE:
04/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:07 AM
MET WITH:Shawniqua Davis, AdministratorTIME COMPLETED:
12:25 PM
NARRATIVE
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Licensing Program Analyst (LPA) Jesse Gardner made an unannounced visit to conduct an annual inspection with an emphasis on infection control.

LPA met with Caretaker Isabel Carter. Present in the facility during time of visit were 3 clients, with 1 being at their day program. There are currently no cases of COVID-19 within the facility. Administrator Shawniqua Davis later arrived to the facility.

During today's visit, LPA toured the facility and made observations pertaining to the facility's infection control measures. LPA observed sufficient hand hygiene supplies, sufficient cleaning and disinfecting provisions as well as proper use of face coverings.

The facility has a designated infection control lead person who has been tasked with tracking all COVID-19 cases and/or suspected cases, ensuring PPE supplies are maintained, cleaning and disinfection provisions are in adequate quantities. LPA later discussed infection control practices and procedures with Ms. Davis.

Type B deficiencies was noted at the time of visit as follows:
  1. Prescription medication was not stored in its original prescribed container.
  2. Cleaners not locked.

An exit interview was conducted, and a copy of this report along with a copy of the LIC809-D, was discussed with and provided to Ms. Davis.
SUPERVISORS NAME: Deborah Mullen
LICENSING EVALUATOR NAME: Jesse Gardner
LICENSING EVALUATOR SIGNATURE: DATE: 04/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/01/2022
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
Document Has Been Signed on 04/01/2022 12:15 PM - It Cannot Be Edited


Created By: Jesse Gardner On 04/01/2022 at 11:25 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
, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: HANDS THAT HELP LLC, THE
FACILITY NUMBER: 331880590

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/01/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(g)

80087 Buildings and Grounds (g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation of cleaners unlocked under the sink as well as accessible to the laundry room where cleaners are unlocked, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/15/2022
Plan of Correction
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Licensee agrees to keep cleaners locked. Licensee further agrees to provide LPA proof of review of the regulation by submitting a memorandum of understanding via email by POC date. The cleaners were left locked at the conclusion of the visit.
Type B
Section Cited
CCR
80075(k)(5)

80075 Health Related Services (k) The following requirements shall apply to medications which are centrally stored: (5) Each client's medication shall be stored in its originally received container.
This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA's observation of medication being pre-packaged into one-time use cups, the licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/15/2022
Plan of Correction
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Licensee agrees to provide a memorandum of understanding via email that all staff are trained in the proper storage of medications, and submit that understanding to LPA by POC date via email.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Deborah Mullen
LICENSING EVALUATOR NAME:Jesse Gardner
LICENSING EVALUATOR SIGNATURE:
DATE: 04/01/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/01/2022


LIC809 (FAS) - (06/04)
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