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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880898
Report Date: 01/31/2022
Date Signed: 01/31/2022 11:34:04 AM


Document Has Been Signed on 01/31/2022 11:34 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, 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: 2DATE:
01/31/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Tyla Kincherlow - LicenseeTIME COMPLETED:
11:45 AM
NARRATIVE
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Licensing Program Analyst (LPA) Crystal Colvin arrived at the facility unannounced for the purpose of initialing a complaint investigation (#18-AS-20220127103222), and met with Licensee Tyla Kincherlow. During today's inspection, LPA Colvin observed the following deficiency:

LPA Colvin learned from the Licensee that she and her mother (S1) are the only current employees at the facility, and both were present during today's inspection. S1 is additionally the acting Administrator while the Licensee is working on getting their Administrator Certificate renewed. LPA Colvin checked the Licensing Information System (LIS) on her computer and observed that S1 is not associated to the facility. LPA Colvin looked up S1 in LIS and further observed that S1 requires an Exemption Transfer in order to be associated to the facility. Deficiency cited.

Having someone working at the facility without proper background clearance (or completion of transferring clearance) results in civil penalties in the amount of $100 per day, per individual. Since this is the facility's first citation for this in the last 12 months, the maximum amount of days they can be cited is 5. LPA Colvin will be issuing civil penalties in the maximum amount of $500 ($100 per day x 5 days) during today's inspection.

LPA Colvin conducted an exit interview with Licensee Tyla Kincherlow, and a copy of this report, LIC809D, LIC421BG, and appeal rights were provided.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
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)
Page: 1 of 2


Document Has Been Signed on 01/31/2022 11:34 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 HOMES
FACILITY NUMBER: 331880898

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/31/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
02/01/2022
Section Cited

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Criminal Record Clearance: (e) All individuals...shall prior to working, residing or volunteering in a licensed facility: (3) Request and be approved for a transfer of a criminal record exemption... This requirement was not met as evidenced by:
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Licensee agrees to submit an Exemption Transfer Request by 2/1/22 in order to continue to have S1 work or reside at the facility. Licensee to provide LPA Colvin with proof of submitted request by 2/1/22.
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Based on observation and interview, the Licensee did not comply with the above regulation with at least one staff (S1). LPA Colvin learned that S1 is the acting Administrator for the facility, and requires an Exemption Transfer to this facility. This is an immediate safety risk to all residents in care.
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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: Joel EsquivelTELEPHONE: (951) 248-0312
LICENSING EVALUATOR NAME: Crystal ColvinTELEPHONE: (951) 204-0848
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2022
LIC809 (FAS) - (06/04)
Page: 2 of 2