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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604222
Report Date: 12/24/2024
Date Signed: 01/01/2025 12:01:11 AM

Document Has Been Signed on 01/01/2025 12:01 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
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:HANDS THAT HELP, LLC - MANZANA, THEFACILITY NUMBER:
374604222
ADMINISTRATOR/
DIRECTOR:
BROOKINS, PAMELAFACILITY TYPE:
735
ADDRESS:1395 MANZANA WAYTELEPHONE:
(619) 389-7386
CITY:SAN DIEGOSTATE: CAZIP CODE:
92139
CAPACITY: 4CENSUS: 4DATE:
12/24/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
12:00 PM
MET WITH:Administrator Shawniqua Davis TIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) Liliana Silveira conducted an unannounced visit to continue a required Annual Inspection. The facility file was reviewed prior to the visit. LPA was welcomed by, identified themselves to, and discussed the purpose of the visit with Administrator Shawniqua Davis.

According to the facility’s license, the facility has a maximum capacity of 4 developmentally disabled clients, age range from 18 to 59, all of whom must be ambulatory. During today’s inspection, there were a total of 0 clients in care- all clients were at Day Program during the visit. This facility does not feature a secured perimeter or delayed egress doors.

LPA, accompanied by Shawniqua, toured the interior and exterior of the facility, and inspected each room. The facility was clean, sanitary, and in good repair. Pathways were free of obstruction and slip hazards. Client bedrooms contained the required furnishings. Doors, windows and screens, toilets, and showers were in working order. Extra linens and hygiene supplies were present, as well as Personal Protective Equipment. The facility had sufficient space and equipment to facilitate dining, laundry, visitation, meetings, and client activities. The facility’s ambient internal temperature was 68 degrees F. Hot water temperature at taps accessible to clients were all compliant: Bathroom #1 sink was 105.3 F, Bathroom #2 sink was 112.7 F and Bathroom #3 sink was 117.1 F.

No pools or bodies of water were observed on the premises. Per Shawniqua Davis, no firearms or ammunition are kept at the facility. Smoke alarms, carbon monoxide detectors, emergency lighting, and facility telephone were all working. Fire extinguisher(s) were serviced within the last 12 months. First aid kit(s) were complete and readily accessible. There were no sharp objects, toxic chemicals/poisons, fireplaces, or open-faced heaters accessible to clients. Medications were labeled, as required, and stored in locked areas. Required licensing postings were observed in visible areas of the facility. [CONTINUED ON LIC 809-C]

SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE: DATE: 12/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/24/2024
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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Document Has Been Signed on 01/01/2025 12:01 AM - It Cannot Be Edited


Created By: Liliana Silveira On 12/24/2024 at 02:24 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108

FACILITY NAME: HANDS THAT HELP, LLC - MANZANA, THE

FACILITY NUMBER: 374604222

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 12/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
HSC
1522(c)(1)
General Provisions
(c)(1) Subsequent to initial licensure, a person specified in subdivision (b) who is not exempted from fingerprinting shall obtain either a criminal record clearance or an exemption from disqualification pursuant to subdivision (g) of this section or Section 1522.7 from the State Department of Social Services prior to employment, residence, or initial presence in the facility. 

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in 1 out of 7 staff, which poses an immediate health, safety or personal rights risk to four (4) persons in care.
POC Due Date: 12/24/2024
Plan of Correction
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LPA observed that S1 immediately left the home. Licensee confirmed that S1 will not return to the home until proof of criminal record clearance has been received.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Robyn Clark
LICENSING EVALUATOR NAME:Liliana Silveira
LICENSING EVALUATOR SIGNATURE:
DATE: 12/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/24/2024


LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME: HANDS THAT HELP, LLC - MANZANA, THE
FACILITY NUMBER: 374604222
VISIT DATE: 12/24/2024
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[CONTINUED FROM LIC 809] There was at least 2 days of perishable food, and at least 7 days non-perishable food present, all safely stored in the kitchen. Cooking/dining equipment and utensils were present. Shawniqua also presented proof of current/active business liability insurance and surety bond.

LPA interviewed staff and clients. LPA reviewed multiple staff and client records/files. The interviews did not raise any significant licensing concerns. Confidential records were stored in locked areas.

Client #1 (C1) file did not contain a negative TB test result. Staff #1 (S1) and Staff #2 (S2) did not contain a negative TB test result or Health Screening records. All other files contained required documents. The Administrator is currently working on obtaining the results for the clients and staff.

Upon LPA’s arrival, it was discovered that the Staff (S1) who was present and working in the facility did not have criminal background clearance. A civil penalty of $700 is being assessed and noted on an LIC421BG.



A Plan of Correction was jointly developed with the licensee. An exit interview was conducted with Shawniqua Davis, to whom a copy of this report, the LIC 809-D, the LIC421BG, LIC 9102TVs, the LIC 811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided at the end of the visit.
SUPERVISORS NAME: Robyn Clark
LICENSING EVALUATOR NAME: Liliana Silveira
LICENSING EVALUATOR SIGNATURE:

DATE: 12/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/24/2024
LIC809 (FAS) - (06/04)
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