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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602424
Report Date: 01/19/2024
Date Signed: 01/19/2024 01:26:45 PM

Document Has Been Signed on 01/19/2024 01:26 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, 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: 4CENSUS: 3DATE:
01/19/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Case Manager Amanda Gerhart and Administrator Rene DoehrerTIME COMPLETED:
01:30 PM
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Licensing Program Analyst (LPA) Dang Nguyen conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified himself to, and discussed the purpose of the visit with Case Manager Amanda Gerhart. LPA also met with Administrator Rene Doehrer, who arrived later during the visit.

Today's visit was in response to Licensee’s self-reported death of Client #1 (C1), received at the CCLD San Diego Regional Office on 01/15/2024. [See LIC 811 Confidential Names List for a description of C1]. Per the report, C1 passed away on 01/14/2024.

During today’s visit, LPA performed a brief facility tour and welfare check on remaining clients, finding no safety concerns. LPA also collected copies of and reviewed pertinent records and interviewed relevant staff.

Medical records, hospice records, and staff interviews unanimously showed: C1 had been under hospice care since 09/28/2022. C1’s diagnosed reason for being on hospice was lung cancer.

No deficiencies were cited during today’s visit.

An exit interview was conducted with Doehrer, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Lizzette Tellez
LICENSING EVALUATOR NAME: Dang Nguyen
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2024
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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