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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881274
Report Date: 03/23/2022
Date Signed: 03/23/2022 11:26:01 AM

Document Has Been Signed on 03/23/2022 11:26 AM - 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 - VANGUARD, THEFACILITY NUMBER:
331881274
ADMINISTRATOR:DAVIS, SHAWNIQUAFACILITY TYPE:
735
ADDRESS:1326 VANGUARD CTTELEPHONE:
(619) 723-9899
CITY:SAN JACINTOSTATE: CAZIP CODE:
92582
CAPACITY: 4CENSUS: 0DATE:
03/23/2022
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Licensee, Shawniqua DavisTIME COMPLETED:
11:35 AM
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On 03/23/2022 Licensing Program Analyst (LPA)’s Janira Arreola and David Cuevas conducted an announced visit for the purpose of a pre-licensing inspection. LPA’s met with Administrator/ Licensee, Shawniqua Davis and were granted entry. LPA’s took a tour of the interior and exterior of home. The home will be licensed for a total capacity of (4) non-ambulatory residents, ages 18 through 59. Delay egress and locked permitted not permitted.

LPA’s were informed that no firearms or ammunition will be kept at facility. The Licensee/Administrator, Shawniqua Davis has a current Administrator's Certificate (expires 05/05/2022).

LPA’s observed the home as follows: The home is single story 4 bedroom and 2 -bathroom home with an attached garage next to laundry room. There is dining area next to kitchen with a family room adjacent to the living room.LPA's observed a working phone for residents use.

LPA’s observed the bedrooms to be furnished with a bed, dresser, nightstand, and appropriate lighting. The bathrooms have grab bars for resident’s safety and non- skid mats or strips in tubs and showers. LPA’s observed the home to have ample supply of extra towels and linens for resident’s use. Medications will be locked and stored in kitchen area within a closet inaccessible to residents. LPA’s observed a complete first aid kit and manual within medication cabinet. The kitchen was stocked with pots, pans, cook ware, dishes, and silverware. Knives and other sharp items will be locked and stored in kitchen cabinet under magnetic lock.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: David Cuevas
LICENSING EVALUATOR SIGNATURE: DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/23/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 - VANGUARD, THE
FACILITY NUMBER: 331881274
VISIT DATE: 03/23/2022
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Cleaning supplies and disinfectants where observed to be kept in kitchen cabinet under the sink, inaccessible to residents under locked key. The hot water was measured and it was 117 degrees Fahrenheit. The smoke detectors were tested and showed to be operable condition. Carbon monoxide detector were tested and shown to be in working order. LPA’s observed the Ombudsman poster, personal rights, and Community Care Licensing complaint poster to be posted. Additionally, LPA’s observed facility to have required single entry point for COVID screening, upon entering facility. LPA’s observed required COVID posting through the facility, and soap and disposable towels in bathrooms for washing hands. Backyard is fenced and has a shaded area with table and chairs for resident’s use. Backyard passageways were free of obstructions and gate exits to be unlocked. At this time facility has shown to have met pre-licensing requirements.

No deficiencies or citations were given during this visit.

COMP lll was completed by Administrator/ Licensee, Shawniqua Davis during this visit. Photo ID was presented to verified ID.

An exit interview was conducted, and a copy of this report was reviewed with and provided to, Administrator/ Licensee, Shawniqua Davis.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: David Cuevas
LICENSING EVALUATOR SIGNATURE:

DATE: 03/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/23/2022
LIC809 (FAS) - (06/04)
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