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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603525
Report Date: 01/31/2022
Date Signed: 01/31/2022 11:29:19 AM

Document Has Been Signed on 01/31/2022 11:29 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:HEALING HANDS ADULT CARE HOMEFACILITY NUMBER:
374603525
ADMINISTRATOR:RUTH LOPEZFACILITY TYPE:
735
ADDRESS:211 E. OXFORD STREETTELEPHONE:
(619) 737-9799
CITY:CHULA VISTASTATE: CAZIP CODE:
91911
CAPACITY: 4CENSUS: 4DATE:
01/31/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator, Ruth LopezTIME COMPLETED:
10:50 AM
NARRATIVE
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Licensing Program Analyst (LPA) Marisela Garcia-Centeno, and County of San Diego Senior Public Health Nurse, Elizar Perez, conducted an in-person visit.

LPA and Nurse Perez identified themselves and discussed the purpose of the visit with Administrator, Ruth Lopez.

The Department conducted an on-site visit to provide technical assistance and to evaluate the facility's disinfection and screening protocols. During today's visit, the team interviewed the Administrator and provided consultation and conducted a walk-though of the facility. A debriefing was conducted with the Administrator.

During today's visit, no deficiencies were issued. An exit interview was conducted with Administrator, Lopez, and a copy of this report, along with Licensee Rights (LIC 9058 01/16), were provided to the Administrator via electronic mail. An electronic receipt of confirmation was requested to be sent by the Administrator upon receipt of the documents.
SUPERVISORS NAME: John Rante
LICENSING EVALUATOR NAME: Marisela Garcia-Centeno
LICENSING EVALUATOR SIGNATURE: DATE: 01/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/31/2022
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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