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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374602984
Report Date: 03/04/2024
Date Signed: 03/04/2024 03:54:06 PM


Document Has Been Signed on 03/04/2024 03:54 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:4CENSUS: 3DATE:
03/04/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator Rene DoehrerTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Debbie Correia conducted an unannounced case management visit regarding a Death Report received by CCL on 02/29/2024. LPA identified herself to Administrator Doehrer, and we discussed the purpose of the visit.

C1 passed away while under hospital care on February 29, 2024. LPA conducted a Health & Safety check, secured pertinent records, and interviewed staff. The facility was observed to be well 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.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Debbie CorreiaTELEPHONE: (619) 407-0894
LICENSING EVALUATOR SIGNATURE:
DATE: 03/04/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/04/2024
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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