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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331881274
Report Date: 04/26/2023
Date Signed: 04/26/2023 02:22:27 PM

Document Has Been Signed on 04/26/2023 02:22 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 - 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:
04/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:ADMINISTRATOR, SHAWNIQUA DAVISTIME COMPLETED:
02:40 PM
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On April 26, 2023, Licensing Program Analyst (LPA), Venus Mixson arrived to the facility unannounced in order to conduct the required annual inspection. LPA Mixson met with Administrator, introduced self, and stated the purpose of the visit. LPA Mixson toured the facility, along with the Administrator, and inspected the inside and outside of the facility. The facility is a single story home, and currently there are no residents residing in the home. There are two staff associated to the facility. Currently only the Administrator is present, and was interviewed. The facility has four bedrooms and two full baths. There is a kitchen, dining room, and living room. Additionally, the facility has a three car garage and a back yard.
Physical Plant: The physical plant, is in good condition, neat, and orderly. The lawns and shrubbery are well maintained. Outdoor and indoor passageways are free of obstruction at the time of this visit. Residents bedrooms have the required bedding and furniture; such as clean mattresses, night stands, storage space, and sufficient lighting. The bedroom temperatures were comfortable although there were no residents residing in the home. All resident bedrooms were equipped with the required items. The Administrator tested the hot water temperature in the kitchen, in which the kitchen sink faucet tested within the required regulation. The restrooms were equipped with non-skid surfaces. LPA Mixson toured the kitchen and dining area. The facility had a menu posted and available for review. Kitchenware was in good condition and stored safely. Emergency food and water were observed. LPA Mixson inspected the common areas. Smoke detectors are hard wired and were tested. The fire extinguisher was in the green and was last check 04/06/, by Desert Fire Ext. Company. Carbon monoxide alarms, along with smoke detectors were observed, and showed a green light. Fireplace has screen, is covered, and is clean. There was a locked and centralized storage area for medications. Medications will be ordered through a pharmacy that utilizes bubble packs. The facility had a designated area for resident and staff files, and it was lockable. Emergency disaster plans, personal rights, and complaint procedures were posted in a prominent area. There was adequate seating in the common areas and sufficient space for activities. LPA Mixson observed a monthly activity calendar. LPA Mixson reviewed two staff files, zero resident files, and conducted one interview with the Administrator. There were no regulation violations observed during todays visit.
An exit interview was conducted and a copy of this report, along with the LIC 811, was provided to Administrator.
SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Venus Mixson
LICENSING EVALUATOR SIGNATURE: DATE: 04/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/26/2023
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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