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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604031
Report Date: 08/04/2022
Date Signed: 08/04/2022 02:08:55 PM


Document Has Been Signed on 08/04/2022 02:08 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:HELIX EMMANUELFACILITY NUMBER:
374604031
ADMINISTRATOR:FLECK, JASONFACILITY TYPE:
735
ADDRESS:8965 JOHNSON DRIVETELEPHONE:
(619) 741-7603
CITY:LA MESASTATE: CAZIP CODE:
91941
CAPACITY:6CENSUS: 5DATE:
08/04/2022
TYPE OF VISIT:Case Management - COVID-19UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Jonathan Sparhawk, DirectorTIME COMPLETED:
02:15 PM
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Licensing Program Analyst (LPA) Vicky Williamson, and County of San Diego Nurse Sandra Brackman, conducted an on-site visit. LPA and Nurse identified themselves and discussed the purpose of the visit with Jonathan Sparhawk, Administrator.

The Department conducted the on-site visit to provide technical assistance and to evaluate the facility's disinfection, screening protocols as well as the use of personal protective equipment. During today's visit, Jonathan Sparhawk was interviewed and a walk-though of the facility was conducted. A debriefing was conducted with the Jonathan Sparhawk at the conclusion of the visit. No deficiencies were issued today.

An exit interview was conducted with the Administrator and a copy of this report, along with Licensee Appeal Rights (LIC 9058 01/16), were provided to the Administrator.

SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Vicky WilliamsonTELEPHONE: (619) 767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/04/2022
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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