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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603525
Report Date: 10/27/2022
Date Signed: 10/27/2022 03:26:30 PM

Document Has Been Signed on 10/27/2022 03:26 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: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:
10/27/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:03 AM
MET WITH:Sara Verstegui, CaretakerTIME COMPLETED:
11:35 AM
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Licensing Program Analyst (LPA) Tammer De Los Santos and Licensing Program Manger (LPM) Denise Powell visited the facility to conduct an annual required licensing inspection. LPA and LPM were granted entry into the facility by Sara Verastegui, Caregiver, to whom thye disclosed the purpose of the visit. Administrator Ruth Lopez arrived later during visit.

During today's visit, LPA and LPM toured the facility and verified compliance with infection control practices. LPA and LPM observed one central entry point for universal entry screening; signs in the facility to promote hand hygiene; hand sanitizer readily available; available visitation area; emergency agencies’ contact information visible; and a supply of cleaning products and personal protective equipment. LPA and LPM provided additional guidance on maintaining physical plant in outdoor areas and gave copies of Provider Information Notice PIN 22-13-ASC.

The licensee was granted a waiver under the Authority of Governor Newsom’s Executive Order N-11-22 issued on June 17, 2022, and the licensee agreed to submit the Infection Control Plan by December 26, 2022.

No deficiencies were cited during today’s visit. An exit interview was conducted with Sara Verastegui, Caregiver, and administrator Ruth Lopez and copies of this report and Licensee Rights (LIC 9058) were provided via email to the administrator.
SUPERVISORS NAME: Icela Estrada
LICENSING EVALUATOR NAME: Denise Powell
LICENSING EVALUATOR SIGNATURE: DATE: 10/27/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2022
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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