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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 334842686
Report Date: 10/11/2024
Date Signed: 10/11/2024 12:25:17 PM

Document Has Been Signed on 10/11/2024 12:25 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 CC RO, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501
FACILITY NAME:HELPING HANDS CHILD DEVELOPMENT CENTERFACILITY NUMBER:
334842686
ADMINISTRATOR/
DIRECTOR:		THERESA GOMEZFACILITY TYPE:
850
ADDRESS:8201 ARLINGTON AVENUE, SUITE GTELEPHONE:
(951) 687-5437
CITY:RIVERSIDESTATE: CAZIP CODE:
92503
CAPACITY: 80TOTAL ENROLLED CHILDREN: 80CENSUS: 9DATE:
10/11/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Theresa GomezTIME VISIT/
INSPECTION COMPLETED:
12:30 PM
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On the date and time listed above a case management visit was completed by Licensing Program Analyst (LPA) Giselle Carbullido due to deficiencies found during the course of another inspection.
Reporting Requirements: Facility did not report to Community Care Licensing an unusual incident that occurred on 09/04/24 by telephone or fax to the department by the next business day (24 hours). SEE LIC 809D for the deficiency cited.
The facility representative was provided a copy of their appeal rights and their signature on this form acknowledges receipt of these rights.
An exit interview was conducted, a copy of this report and Notice of Site Visit were provided to the Facility representative , Theresa Gomez. LPA observed the Notice of Site Visit form was posted by staff. THIS REPORT MUST BE AVAILABLE TO THE PUBLIC UPON REQUEST FOR THREE YEARS.
SUPERVISORS NAME: Gilbert Sena
LICENSING EVALUATOR NAME: Giselle Carbullido
LICENSING EVALUATOR SIGNATURE: DATE: 10/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/11/2024
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 10/11/2024 12:25 PM - It Cannot Be Edited


Created By: Giselle Carbullido On 10/11/2024 at 11:45 AM
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
, 3737 MAIN ST., SUITE 700
RIVERSIDE, CA 92501

FACILITY NAME: HELPING HANDS CHILD DEVELOPMENT CENTER
FACILITY NUMBER: 334842686

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/14/2024
Section Cited
CCR
101212(d)((1)(C)-

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Reporting Requirements:101212(d)((1)(C)-Any unusual incident or child absence that threatens the physical or emotional health or safety of any child. This requirement is not met as evidenced by:
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Director will submit an unusual incident report (LIC624) for incident on 9/04/24 by POC due date 10/14/24 to the department.
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iBased upon LPA record review and interviews conducted the facility did not report to the department an incident for child injury occurring on 09/04/24 that resulted in follow up medical care. This is a potential health and safety risk to children 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:Gilbert Sena
LICENSING EVALUATOR NAME:Giselle Carbullido
LICENSING EVALUATOR SIGNATURE:
DATE: 10/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/11/2024


LIC809 (FAS) - (06/04)
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