<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602984
Report Date: 10/14/2022
Date Signed: 10/14/2022 08:41:44 PM

Document Has Been Signed on 10/14/2022 08:41 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-CALDERAFACILITY NUMBER:
374602984
ADMINISTRATOR:RENE DOEHRERFACILITY TYPE:
735
ADDRESS:9915 VIA RITATELEPHONE:
(619) 596-2067
CITY:SANTEESTATE: CAZIP CODE:
92071
CAPACITY: 6CENSUS: 4DATE:
10/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
04:20 PM
MET WITH:Administrator Rene TIME COMPLETED:
05:07 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced case management visit regarding a Death Report received by CCL on 10/14/2022. LPA identified herself to Administrator Doehrer, and we discussed the purpose of the visit.

C1 passed away while under the facility's care on October 13, 2022. LPA conducted a Health & Safety check, secured pertinent records, and interviewed staff. The facility was observed to be kempt, and no health or safety issues were observed on this date.

No deficiencies were cited or observed at this time.

An exit interview was conducted with the Administrator Doehrer. A copy of this report along with Licensee/Appeal Rights (LIC 9058 01/16) was provided to Administrator Doehrer. Signature on this form confirms receipt of the report.
SUPERVISORS NAME: Simon Jacob
LICENSING EVALUATOR NAME: Debbie Correia
LICENSING EVALUATOR SIGNATURE: DATE: 10/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/14/2022
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 1