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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880898
Report Date: 07/02/2025
Date Signed: 07/02/2025 04:32:25 PM

Document Has Been Signed on 07/02/2025 04:32 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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME:HELPING HANDS CARE HOMESFACILITY NUMBER:
331880898
ADMINISTRATOR/
DIRECTOR:		KINCHERLOW, TYLAFACILITY TYPE:
740
ADDRESS:33999 TUSCAN CREEK WAYTELEPHONE:
(951) 365-0443
CITY:TEMECULASTATE: CAZIP CODE:
92592
CAPACITY: 5CENSUS: 1DATE:
07/02/2025
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:15 PM
MET WITH:Tyla Kincherlow, Lead CaregiverTIME VISIT/
INSPECTION COMPLETED:
04:45 PM
NARRATIVE
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On 07/02/25 Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility to conduct a case management other visit. LPA met with Lead Caregiver Tyla Kincherlow and explained the purpose of the visit. At the time of the visit there was (1) staff and (1) resident present.

Upon arrival LPA observed for there to be a Volunteer #1 (V1) whom has fingerprint clearance but, is not associated to the facility and was left alone with the resident in care, a deficiency is being cited , and $300 civil penalties are being assessed, as V1 has been a volunteer since 06/30/25. Lead Caregiver Tyla Kincherlow arrived 5 minutes after LPA. LPA conducted a review of the following outstanding items:

-Status of administrator certification for Caregiver Tyla Kincherlow, proof of completion of CEUs as well as a money order for the fees was observed and obtained. The deficiency was cleared.

-On 04/14/25, there was no proof of an emergency disaster drills that were conducted and a citation was issued during the annual inspection conducted. During today's visit there was no proof of an emergency disaster drill being completed therefore the citation is being reissued.

-On 04/14/25 a citation was issued for the facility not having valid liability insurance and a citation was issued. During today's visit the status is the same, as the facility does not possess a valid liability insurance policy, therefore the citation is being reissued.

-On 04/14/25 a citation was issued due to there not being a staff that possessed valid CPR certification. During today's visit proof was provided and the deficiency was cleared.
NAME OF LICENSING PROGRAM MANAGER: Anthony Perez
NAME OF LICENSING PROGRAM ANALYST: Javina George
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/02/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: HELPING HANDS CARE HOMES
FACILITY NUMBER: 331880898
VISIT DATE: 07/02/2025
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LPA conducted a review and found for the facility Licensee Helping Hands Care Homes LLC governing body/ FTB, to not be in good standing, as there is a balance due of around $4,000 per Lead Caregiver Tyla, it will be paid by the second week of July. A deficiency is being cited.

Please note that LPA was provided the LIC9182 as well as a copy valid of V1, identification was obtained during today's visit. V1 will be associated via Guardian at the RO.

An exit interview was conducted and a copy of this report, 809C, 809D, appeal rights, LIC42BG, was reviewed and provided to Lead Caregiver Tyla Kincherlow.
NAME OF LICENSING PROGRAM MANAGER: Anthony Perez
NAME OF LICENSING PROGRAM ANALYST: Javina George
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025
LIC809 (FAS) - (06/04)
Page: 3 of 5
Document Has Been Signed on 07/02/2025 04:32 PM - It Cannot Be Edited


Created By: Javina George On 07/02/2025 at 03:19 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
, 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: 07/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/03/2025
Section Cited
CCR
87355(1)(A)(D)

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87355 Criminal Record Clearance (1) (A) Adults responsible for administration or direct supervision of staff. (D) Any staff person, volunteer, or employee who has contact with the clients. This requirement is not met as evidenced by V1 not being associated to the facility which poses an
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The licensee agrees to associate V1 to the facility, and to review the regulation, 87335 Criminal Record Clearance. Proof of POC is to be submitted to the department by 5pm on the due date indicated.
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immediate health, safety and personal rights risk to persons in care.
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Type A
07/03/2025
Section Cited
HSC1569.695(c)

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(c) A facility shall conduct a drill at least quarterly for each shift. The type of emergency covered in a drill shall vary from quarter to quarter, taking into account different emergency scenarios. An actual evacuation of residents is not required during a drill... Documentation of the drills shall
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The Licensee agrees to conduct an emregency disaster drill, and document it. Proof of POC is due to the department by 5pm on the due date indicated.
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 include the date, the type of emergency covered by the drill, and the names of staff participating in the drill. This requirement is not met as evidenced by: The facility has no record of drills of being conducted, which posed an immediate health safety and personal rights risk to persons 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.
Anthony Perez
NAME OF LICENSING PROGRAM MANAGER:
Javina George
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2025


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 07/02/2025 04:32 PM - It Cannot Be Edited


Created By: Javina George On 07/02/2025 at 03:32 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
, 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: 07/02/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/03/2025
Section Cited
HSC
1569.605

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On and after July 1, 2015, all residential care facilities for the elderly, except those facilities that are an integral part of a continuing care retirement community, shall maintain liability insurance covering injury to residents and guests in the amount of at least one million dollars ($1,000,000) per occurrence and
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The Licensee agrees to obtain valid liability insurance. Proof of POC is due to the department by 5pm on the due date indicated.
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three million dollars ($3,000,000) in the total annual aggregate... This requirement is not met as evidenced by: the licensee did not comply with the section cited above in 1 out of 1 times which poses/posed a potential health, safety or personal rights risk to persons in care.
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Type B
07/16/2025
Section Cited
CCR87205(a)

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87205 Accountability of Licensee Governing Body (a) The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations
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The Licensee agrees to pay the outstanding taxes and reinstate the Proof of POC is due to the department by 5pm on the due date indicated.
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and the welfare of the individuals it serves. This requirement is not met as evidenced by the FTB is not in good standing. This poses a potental health, safety and personal rights risk to persons 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.
Anthony Perez
NAME OF LICENSING PROGRAM MANAGER:
Javina George
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/02/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/02/2025


LIC809 (FAS) - (06/04)
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