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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602424
Report Date: 11/01/2023
Date Signed: 11/01/2023 10:48:12 AM

Document Has Been Signed on 11/01/2023 10:48 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, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:HOME OF GUIDING HANDS-PROSPECT HOUSEFACILITY NUMBER:
374602424
ADMINISTRATOR:RENE M. DOEHRERFACILITY TYPE:
735
ADDRESS:9643 PROSPECT AVETELEPHONE:
(619) 328-6248
CITY:LAKESIDESTATE: CAZIP CODE:
92040
CAPACITY: 6CENSUS: 4DATE:
11/01/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:25 AM
MET WITH:Residential Service Technician Larry BennettTIME COMPLETED:
11:00 AM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management Visit to observe the physical plant. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Residential Service Technician Larry Bennett. LPA also spoke with Administrator Rene Doehrer via phone during the visit.

During today's visit, LPA provided technical assistance / education to the licensee regarding their floor plan and facility sketch. No deficiencies were cited during today's visit.

An exit interview was conducted with Bennett. A copy of this report and the Licensee/Appeal Rights (LIC9058 03/22) were provided to the licensee during the visit.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 11/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/01/2023
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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