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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880898
Report Date: 04/22/2022
Date Signed: 04/22/2022 01:40:37 PM


Document Has Been Signed on 04/22/2022 01:40 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507



FACILITY NAME:HELPING HANDS CARE HOMESFACILITY NUMBER:
331880898
ADMINISTRATOR:KINCHERLOW, TYLAFACILITY TYPE:
740
ADDRESS:33999 TUSCAN CREEK WAYTELEPHONE:
(951) 365-0443
CITY:TEMECULASTATE: CAZIP CODE:
92592
CAPACITY:5CENSUS: 4DATE:
04/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:25 PM
MET WITH:Rachel Gonzalez, CaregiverTIME COMPLETED:
01:50 PM
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On 4/22/22 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct an annual inspection focused on infection control. LPA was greeted and granted entry by Caregiver Rachel Gonzalez. LPA explained the purpose of the visit. Administrator Joyce Kincherlow was unavailable to meet. At the time of visit there was 1 staff and 4 residents present. The facility currently has zero positive or suspected Covid-19 cases.
LPA toured the facility and made observations regarding the infection control measures that the facility has implemented. LPA did not observe Covid-19 postings posted throughout the facility. Per lead caregiver Tyla Kincherolw, whom was available by telephone the facility did not receive the postings. LPA will provide the required postings via email on this date.

Upon entry there is a hand washing station and temperature screening for staff and visitors, as well as a sign reminding to wear a mask and to stay 6 feet apart to promote social distancing.
LPA discussed with Tyla the expectation for the facility to submit their LIC808 mitigation plan to have on file and for review for staff, residents and visitors. It was agreed that the facility's mitigation plan will be submitted no later than Tuesday 4/26/22, by 5:00pm. The facility staff are using EPA approved cleaners to clean and disinfect the facility at minimum of three times a day.

Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and a copy of this report was provided to Caregiver Rachel Gonzalez.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Javina GeorgeTELEPHONE: (951) 204-7107
LICENSING EVALUATOR SIGNATURE:
DATE: 04/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/22/2022
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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