summary: Facility Evaluation

raw_content:
Narrative:
On November 30, 2022 at 10: AM, Licensing Program Analysts (LPA) Val Wilson, made an unannounced post-licensing inspection at Hillside Horizon Group Home- Richard Street. LPA was met at the facility by Behavior Health Specialist (BHS), Bailey Kinsley and Therapist (THR), Erin Bixel, and LPA was provided a work area in the Nursing and Behavioral Health Technician office. LPA provided THR the Entrance Checklist. LPA was greeted by Administrator (ADM), Beau Moore, and Director of Operations/Facility Manager (FM), Marissa Cabrera at 11: AM. LPA began a physical plant inspection at 11: AM assisted by the ADM and FM. LPA toured the facility inside and out. The facility is a single-story home in a residential neighborhood. The home is about 1,664 square feet and serves males only. The physical plant inspection included the following: The entry way of the home is equipped with an entry table with log guest sign in book. Per Administrator there are no guns or weapons on facility grounds. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, activity schedule, and Foster Care Ombudsman poster in main entrance of the facility. The posted evacuation and disaster plan will be updated with staff responsibilities and permission letters from the two sites that would be utilized in case of evacuation. The family room is equipped with a television, sofa's, and furnishings. The dining room table has ample seating for 6 clients. All facility smoke detectors and carbon monoxide detectors are hardwired in and are in appropriate working order. The hot water in the client's bathroom and kitchen was measured and were within 105-120 degrees Fahrenheit. Trash cans for storage of solid waste had tight fitting lids. The laundry room is equipped with washer, dryer and space for folding clothing. Cabinets with extra supplies of linens and hygiene products are next to the laundry area. The kitchen is equipped with operable appliances and cooking utensils and supplies. There is a locked cabinet for knives and cleaning solutions. All hazardous items have been (continued on page 2) (continued from page 1) properly made inaccessible to areas where clients will have access. Licensee maintains an adequate supply of perishable and non-perishable foods and the food menus are posted. There are three client bedrooms. Fire extinguisher is located in the kitchen by the refrigerator. Bedroom 1 and Bedroom 3 have their own restrooms. Bedroom 2 clients utilize the hallway full-bathroom. All Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. All beds contained a mattress, mattress pad, sheets, comforter, and pillows. There are cameras in the home in the common area and outside the home by the pool and patio areas. LPA looked at the all camera views on the FMs phone and there are no views of the bathroom or bedrooms. The video program, EZ View, has the ability to record and review camera footage for up to seven days. Nursing and Behavioral Health Technician office is equipped with a locked cabinet for storage and locked refrigerator for medication. Medications are locked and centrally stored in the nursing/medical office. The first aid kit was also in the medical office with all required items. The nursing office is also equipped with desk and supplies. Client files are maintained using the KIPU application system which is a portal to store client files and keep all information confidential. Administrator stated licensing has access to the KIPU portal upon request of client files for any purpose. The Clinical office is located separately from the home in the backyard. The office also has a restroom which will be used for staff only. This office is used to provide therapy and treatment to clients and there are no cameras. Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space, and all exits were free from obstruction. Sports equipment/toys/games were observed for recreation time. There is a basketball court, garden, extensive backyard, built-in conversation fire pit with bench, and a gazebo on premises. There is a pool on premises with 5 feet tall mesh fencing surrounding the entire pool that meets regulatory standards and does not obscure the pool from view. The mesh fence is self-closing and self-latching. The gate swings open away from the body of water. The licensee understands that regardless of whether clients are present, the fence will remain permanently in place for the duration of the license. LPA observed the pool is clean and well maintained. (continued on page 3) (continued form page 2) There were no deficiencies observed during today's inspection. Due to time constraints, LPA's will return to complete the inspection at a later date. An exit interview was conducted, and a copy of this report and appeal rights were provided and explained to the Administrator and Facility Manager.

met_with: Marissa Cabrera and Beau Moore


state: CA

facility_name: HILLSIDE HORIZON

summary: Facility Evaluation

raw_content:
Narrative:
On February 21, 2023 at 2: PM, Licensing Program Analysts (LPA) Val Wilson, arrived unannounced at Hillside Horizon Group Home (GH)- Richard Street. This is a continuation of a Post-Licensing GH inspection initiated on November 30, 2022. LPA was met at the facility by Facility Manager- Behavior Health Specialist (FM), Bailey Kinsley, and LPA was provided a work area in the medication office. LPA was provided the current LIC Personnel Report and LIC Register of Facility Clients. Bailey had another staff reach out to the Administrator during today's visit. During the inspection continuation, LPA interviewed one staff and one client. There were no deficiencies observed during today's inspection. Due to time constraints, LPA will return to complete the inspection at a later date. An exit interview was conducted, and a copy of this report and appeal rights were provided and explained to the Facility Manager.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Bailey Kinsley


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
facility was reluctant to provide information and pertinent details for Law Enforcement to complete their investigation of the physical altercation in a timely manner. Some interviews indicated that C2-C3 planned to fight C1, while other interviews indicated that they were unaware C2-C3 had any intentions to cause physical harm to C1. LPA was unable to interview all individuals, although multiple attempts were made, thus, confidential interviews could not confirm or deny the allegation. Based on confidential interviews and records reviewed the allegation that the facility did not provide a safe environment for C1 in care, which may have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was reviewed with Dante Patnode. Due to printer difficulties, a copy of this report, LIC 811, and appeal rights were emailed to the Facility Administrator. A copy of this report will be placed in the facility file.

Investigation Findings:
13On December 9, 2024, at 1:20 pm, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced at the facility and met with Dante Padnode, Lead Behavioral Technician, to discuss the investigative finding for the allegation noted above. LPA conducted an inspection of the facility on September 26, 2024, at 1:30 pm and no deficiencies were observed. LPA Linley interviewed one client (C4), three staff (S1-3), and LPA was unable to interview four clients (C1-3, C5), despite multiple attempts to contact them. The following documents were reviewed during the investigation: C1- Admission Agreements, C1- Treatment Plans, Staff Roster, Special Incident Report, Law Enforcement Incident Report, and videos from the facility. On September 17, 2024, Community Care Licensing (CCL) received an allegation that the facility did not provide a safe environment for client in care. It was reported that C2 and C3 physically attacked C1, C1 was taken to get medically evaluated and medical personnel notified Law Enforcement. It was reported that the UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ORANGE COUNTY RO, THE CITY DR., SUITE FACILITY NAME: HILLSIDE HORIZONFACILITY NUMBER: VISIT DATE: 12/09/2024

Allegations:
- UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

report_type: Complaint Investigation

met_with: Dante Patnode

complaint_status: unsubstantiated


raw_content:
Narrative:
Based on confidential interviews, the preponderance of evidence standard has been met and the allegation that facility staff interacted inappropriately with youths is substantiated. The facility is being cited for violations of Interim Licensing Standards (ILS), version 5, section 87072(c)(1) for Personal Rights. An exit interview was conducted, appeal rights were explained, and a copy of this report and LIC 811 was provided to Hillside Horizon Group Home (GH), Sydney Scott, Program Director. Confidential interviews revealed that C1, C2, C3 and C4 were alone inside of the master bedroom playing a spin the bottle game then C1 and C2 proceeded to go inside the closet and touched each other inappropriately. Additionally, confidential interviews revealed that the staff will conduct room checks every 15-30 minutes, however, other confidential interviews revealed that the staff will only periodically do the room checks because they had to. During the investigation, there was no corroborating evidence to support the above allegation. Although the Department received detailed information regarding the allegation, confidential interviews revealed conflicting statements to if the incidents occurred. Based on confidential interviews, the allegation that due to lack of supervision resulted in C1 and C2 engaging in inappropriate behaviors with each other, may have occurred, however, is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report along with appeal rights was given to Hillside Horizon Group Home (GH), Sydney Scott, Program Director.

Investigation Findings:
13On April 1, 2025 at 02:15pm, Licensing Program Analyst (LPA) Sarah Lo met with Sydney Scott, Program Director, to deliver the findings for the above complaint allegation at Hillside Horizon Group Home (GH). On 01/24/2024, LPA inspected the facility's physical plant, and no immediate health and safety hazards were observed. The investigation included interviews with seven staff (S1, S2, S3, S4, S5, S6, S7) and three clients (C1, C3, C4). Three clients (C2, C5, C6) were declined to be interviewed by their authorized representatives. On January 17, 2025, Community Care Licensing received an allegation stating that facility staff (S2) interacted inappropriately with youths. Specifically, it was reported that S2 had all of the clients who identified as LGBTQ+ to line up against a wall according to the size of their genitalia. Confidential interviews confirmed that S2 conducted a group session with only the clients that identified as LGBTQ+ and asked the clients about their level of comfort with the size of their genitalia to determine where the clients stood in line. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Sarah Lo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ORANGE COUNTY RO, THE CITY DR., SUITE FACILITY NAME: HILLSIDE HORIZONFACILITY NUMBER: VISIT DATE: 04/01/2025

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

met_with: Sydney Scott, Program Director


raw_content:
Narrative:
clients running away and the incident reports were sent to S1 or saved on the computer network drive. Records reviewed indicated that Community Care Licensing did not receive Incident Reports for the incidents listed below: Records reviewed indicated that on 09/01/2024, C3 was observed with superficial cuts on their arms and S1 was notified. Records reviewed indicated that on 09/09/2024, C7 climbed out of the window and got onto the roof of the facility and Law Enforcement was contacted and responded and C7 got off the roof of the facility and returned inside of the facility. Records reviewed indicated that on 05/01/2024, S1 sent a twenty-four hour notification to Community Care Licensing that C6, C9, and C10 engaged in self-harm behavior that led to a search of the facility. Records reviewed indicated that on 12/16/2024, Law Enforcement responded to the facility and a client was transported to the hospital. Records reviewed indicated that on 01/24/2025, a twenty-four hour notification was sent to Community Care Licensing that C11 disclosed they had sexual interactions with C12 while in the facility. Based on confidential interviews and record review the allegation that the facility is not meeting reporting requirements is substantiated. The preponderance of evidence standard has been met. The facility is cited for violation of the California Code of Regulations, Title Division Six, regulation 80061(b) Reporting Requirements. Facility was issued a civil penalty of $250.00 for repeat violation of California Code of Regulations, Title 22 80061(b) Reporting Requirements. Refer to LIC809D. An exit interview was conducted, appeal rights explained, and a copy of this report and appeal rights were provided to Victor Hamaker . A copy of this report will be placed in the facility file. confidential interviews confirmed S1 and S2 led group sessions, however, confidential interviews could not confirm what was discussed during the group sessions. Records reviewed indicated S1 and S2 do not have a Bachelor's or Master's degree. It was also reported that S1 took C1 out to lunch by themselves and had private meetings with C1 behind closed doors where cameras were not present. Some confidential interviews indicated that S1 took C1 out to lunch alone and met with C1 in various offices throughout the facility. Some interviews indicated that S1 joked around with C1 and acted as a friend, rather than a staff member. Lastly, it was reported that C6 and another client hid knives in the backyard and used the knives to self-harm and staff was not aware of the knives. It was also reported that C7 stole Benadryl tablets from the store and snuck them back into the facility, took several tablets, and it was difficult to wake up C7 after taking the Benadryl pills. Some confidential interviews indicated that sharps were hidden, however, they could not recall specific details of what was hidden in the backyard. Some confidential interviews indicated that C7 stole Benadryl from the store, took several tablets, and staff had a difficult time waking up C7 and once they woke up, staff found several Benadryl tablets hidden in the facility. LPA was unable to interview all individuals, although multiple attempts were made, thus, confidential interviews could not confirm or deny the allegations. Thus, confidential interviews did not corroborate the allegations with a preponderance of evidence. Based on confidential interviews and records reviewed the allegations that staff is not qualified to lead therapy sessions, staff engaged in an inappropriate relationship with client in care, and lack of supervision resulting in self-harming behaviors, which may have occurred, however, they are not supported or proven by the evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report and appeal rights were provided to Victor Hamaker. A copy of this report will be placed in the facility file.

Investigation Findings:
13On September 2, 2025, at 11:39 am, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced at the facility and met with Victor Hamaker, Facility Manager, to discuss the investigative finding for the allegation noted above. LPA conducted an inspection of the facility on April 14, 2025, at 12:35 pm, and no deficiencies were observed. LPA interviewed four Staff (S5, S7, S10, S12), and LPA was unable to interview eight Clients (C1-8) and eight Staff (S1-S4, S6, S8-S9, S11), despite multiple attempts to contact them. LPA reviewed the facility documents during the investigation and Law Enforcement Incident Reports. On April 4, 2025, Community Care Licensing (CCL) received an allegation that the facility is not meeting reporting requirements. It was reported that S1 was not reporting incidents of clients running away and clients hiding sharps and vapes in the backyard. Some confidential interviews indicated that incident reports were completed for some incidents regarding SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ORANGE COUNTY RO, THE CITY DR., SUITE FACILITY NAME: HILLSIDE HORIZONFACILITY NUMBER: VISIT DATE: 09/02/2025

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

met_with: Victor Hamaker


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Based on confidential interviews and record review the allegation that staff are not meeting reporting requirements is substantiated. The preponderance of evidence standard has been met. The facility is cited for violation of the California Code of Regulations, Title Division Six, regulation 80061(b) Reporting Requirements. Facility was issued a civil penalty of $250.00 for repeat violation of California Code of Regulations, Title 22 80061(b) Reporting Requirements. Refer to LIC809D. An exit interview was conducted, appeal rights explained, and a copy of this report and appeal rights were provided to Victor Hamaker. A copy of this report will be placed in the facility file.

Investigation Findings:
13On October 1, 2025, at 9:55 am, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced at the facility and met with Victor Hamaker, Facility Manager, to discuss the investigative finding for the allegation noted above. LPA conducted an inspection of the facility on July 7, 2025, at 11:15 am, and no deficiencies were observed. LPA interviewed one Staff (S1). LPA reviewed the facility documents during the investigation. On June 29, 2025, Community Care Licensing (CCL) received an allegation that staff are not meeting reporting requirements. It was reported that C1 grabbed a broken object, attempted to break windows, threatened to harm staff, broke the lock to the fence, and left the facility without permission, however, later returned to the facility with staff. Records reviewed indicated that on 04/03/2025, a twenty-four hour notification was sent to Community Care Licensing regarding the incident with C1 as noted above, however, an Incident Report was not completed or sent to CCL until 07/09/2025 after LPA was at the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ORANGE COUNTY RO, THE CITY DR., SUITE FACILITY NAME: HILLSIDE HORIZONFACILITY NUMBER: VISIT DATE: 10/01/2025

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

complaint_status: SUBSTANTIATED


raw_content:
Narrative:
****PAGE CONTINUED: During the investigation, there was no corroborating evidence to support the above allegation. Confidential interviews and documents reviewed revealed that C1 threw books and a planted vase out of C1's bedroom window onto the neighbor's roof. Although the incident occurred the Department was unable to determine if it was due to a lack of supervision. Thus, confidential interviews and records reviewed did not corroborate the allegation with a preponderance of evidence. Based on confidential interviews and records reviewed the allegation lack of supervision resulted in group home minors throwing items out of facility window onto neighbor's house, which may have occurred, however, are not supported or proven by the evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report, LIC 811 and appeal rights was provided to Program Director, Victor Hamaker.

Investigation Findings:
13On October 09, 2025 at 11: AM, Licensing Program Analyst (LPA) Jacqueline Garcia arrived unannounced at the facility and met with Program Director, Victor Hamaker, to discuss the investigative findings for the allegation noted above. LPA spoke with Administrator, Felicia Conover who provided verbal authorization for Victor to sign report. On 05/01/ LPA conducted an inspection of the facility, and no deficiencies were noted. LPA attempted to interview one client (C1), and after several attempts LPA Garcia was not able to reach C1 for an interview. LPA Garcia interviewed one Client (C2) and two Staff (S1, S2) and attempted to interview one staff (S3), however after several attempts S3 did not respond and no longer works at the Facility. During the investigation, LPA Garcia reviewed one client file (C1). On 04/24/25, Community Care Licensing (CCL) received an allegation that lack of supervision resulted in group home minors (C1) throwing items out of facility window onto neighbor's house. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Jacqueline Garcia LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ORANGE COUNTY RO, THE CITY DR., SUITE FACILITY NAME: HILLSIDE HORIZONFACILITY NUMBER: VISIT DATE: 10/09/2025

Allegations:
- UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

met_with: Victor Hamaker-Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On February 29, 2024, at 1: PM, Licensing Program Analyst (LPA) Jacqueline Garcia and Licensing Program Manager (LPM) Ann Valenzuela conducted an announced pre-licensing inspection for Hillside Horizon. LPA and LPM met with Administrator, Blake Larkin. LPA and LPM toured the facility inside and out. The facility is a two story home in a residential neighborhood. The home is about 5,915 square feet. This home will serve 6 males. The facility is set up as follows: Upper level: *A bedroom contains two twin beds equipped with mattress pad, complete sheet set, comforter, extra blanket and pillow. Two night stands, ample lighting, closet with room for storage for clothing and personal belongings. *B bedroom contains two twin beds equipped with mattress pad, complete sheet set, comforter, extra blanket and pillow. Two night stands, ample lighting, closet with room for storage for clothing and personal belongings. Bathroom is located inside the bedroom with full shower and sink/storage. *C bedroom is the master bedroom contains two twin beds equipped with mattress pad, complete sheet set, comforter, extra blanket and pillow. Two night stands, ample lighting, closet with room for storage for clothing and personal belongings. Master bathroom in located inside the bedroom with a master shower and tub. *2 additional bathrooms are located outside of the bedrooms down the hall ways. *2 offices and an additional group office is located upstairs.1 office designated as a therapist office. Private phone call room also located upstairs. *** *entry way of the home begins in the lower level. Equipped with an entry table with log guest sign in book. Posted evacuation and disaster plan, personal rights and grievance procedures. *Living room furnished with sofas, television, book shelves and home decor. *Dining room area equipped with a large table and seating for 10 people. *Kitchen is equipped with operable appliances, kitchen utensils, pot, pans and dishes, pantry is stocked with dry goods, food menu is posted. Knives are stored in the garage inside a locked cabinet. Kitchen has a nook for casual eating with four additional seats. Lower level: *contains 1 office designated for a nursing station/med room, 1 office designated as a waiting room used for intakes and visitations with families. *Laundry room equipped with washer and dryer and space for folding clothing. *Hallway closet equipped with hygiene supplies and extra linens. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. All hazardous items have been properly made inaccessible to areas where children will have access. Medications are locked and centrally stored in the nursing/med office. Cleansers/chemicals were locked in the cabinet located linen room/laundry room. The first aid kit was also in the medical office with all required items. Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment such as pool table/ping pong table/basketball and football equipment available for clients. All facility smoke detectors and carbon monoxide detectors are hard-wired in and are in appropriate working order. Water temperature was tested and was at 115. Trash cans for storage of solid waste had tight fitting lids. ****Continued on the next page. LPA observed a locked cabinet for staff files to be stored in the operations office. Client files will be maintained using the Kipu system which is a portal to store client files and keep all information confidential. Applicant stated licensing will have access to such portal when client files need to be reviewed for any purpose. A copy of this report was given and explained to Administrator Blake Larkin.

visit_type: Prelicensing

met_with: Blake Larkin-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On May 01, 2024, at 09: AM, Licensing Program Analyst (LPA) Jacqueline Garcia conducted an announced post-licensing inspection for Hillside Horizon facility. LPA met with Administrator, Blake Larkin. LPA toured the facility inside and out. The facility is a two story home in a residential neighborhood. The home is about 5,915 square feet. This home serves 6 males. The facility is set up as follows: Upper level: *A bedroom contains two twin beds equipped with mattress pad, complete sheet set, comforter, extra blanket and pillow. Two night stands, ample lighting, closet with room for storage for clothing and personal belongings. *B bedroom contains two twin beds equipped with mattress pad, complete sheet set, comforter, extra blanket and pillow. Two night stands, ample lighting, closet with room for storage for clothing and personal belongings. Bathroom is located inside the bedroom with full shower and sink/storage. *C bedroom is the master bedroom contains two twin beds equipped with mattress pad, complete sheet set, comforter, extra blanket and pillow. Two night stands, ample lighting, closet with room for storage for clothing and personal belongings. Master bathroom in located inside the bedroom with a master shower and tub. *2 additional bathrooms are located outside of the bedrooms down the hall ways. *2 offices and an additional group office is located upstairs one office designated as a therapist office. Private phone call room also located upstairs/quiet reading room. *** *entry way of the home begins in the lower level. Equipped with an entry table with log guest sign in book. Posted evacuation and disaster plan, personal rights and grievance procedures. *Living room furnished with sofas, television, book shelves and home decor. *Dining room area equipped with a large table and seating for 10 people. *Kitchen is equipped with operable appliances, kitchen utensils, pot, pans and dishes, pantry is stocked with dry goods, food menu is posted. Knives are stored in the garage inside a locked cabinet. Kitchen has a nook for casual eating with four additional seats. Lower level: *contains 1 office designated for a nursing station/med room, 1 office designated as a waiting room used for intakes and visitations with families. *Laundry room equipped with washer and dryer and space for folding clothing. *Hallway closet equipped with hygiene supplies and extra linens. Bedrooms were arranged so that no more than two clients share a room, and there was one client per bed. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. All hazardous items have been properly made inaccessible to areas where clients will not have access. Medications are locked and centrally stored in the nursing/med office. Cleansers/chemicals were locked in the cabinet located linen room/laundry room. The first aid kit was also in the medical office with all required items. Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment such as pool table/ping pong table/basketball and football equipment available for clients. All facility smoke detectors and carbon monoxide detectors are hard-wired in and are in appropriate working order. Water temperature was tested and was at 106. Trash cans for storage of solid waste had tight fitting lids. ****Continued on the next page. LPA observed a locked cabinet for staff files to be stored in the operations office. Client files are maintained using the Kipu system which is a portal to store client files and keep all information confidential. A sample of six clients and five staff files were reviewed during the inspection. Six client files were reviewed and there were no deficiencies issued. All staff that work at the facility had proof of Department of Justice and Child Abuse Clearance Index clearances. A copy of this report along with LIC 811 (confidential names) was given and explained to Administrator Blake Larkin.


summary: Facility Evaluation

raw_content:
Narrative:
On April 01, 2025 at 09: AM, Licensing Program Analyst (LPA) Sarah Lo arrived unannounced to Hillside Horizons Group Home (GH) to conduct a Required Annual inspection of the facility. LPA was greeted by Program Director, Sydney Scott, and was allowed entry into the facility. LPA toured the facility and inspected inside and out with the Program Director. The home is a two-story residence with 3 bedrooms and 5 bathrooms. The home was approved for 6 ambulatory male clients ages 12-17. The Program Director stated current census is six. Bedrooms are arranged so that no more than two clients share a room, and there is one client per bed. Beds were observed with appropriate clean linens, pillows, comforters, and mattress in good repair. There are adequate hygiene supplies stocked in the home available for clients. There is adequate shelf and closet space for client's belongings. The beds and dressers in all the bedrooms are in good repair, and all window screens are attached. LPA observed age-appropriate clothing in the closet of the clients. The bathrooms were clean and in good repair. The bathrooms were clean and in good repair. This home contains a therapist office, a group therapy room, a case managers office, a program director office, a nurse office, 2 living room, a foyer, a kitchen. The temperatures in rooms that clients occupy are maintained between 68 degrees F and 85 degrees F. The hot water temperature was tested and noted to be within the regulations of 105 degrees F to 120 degrees F in the client bathroom. All hazardous items have been properly made inaccessible to areas where clients will have access. The medications were stored and locked in a locked cabinet in the locked closet inside of the nurse office. Cleaning supplies and chemicals are locked and stored in a locked closet next to the laundry room. Sharp knives are inaccessible and stored in a locked drawer and cabinet in the kitchen. The First Aid Kits are located in the nurse office, dining room area and the staircase area; and contains all required items. The facility's smoke detectors and carbon monoxide detector located in each bedroom and common areas were checked and were operable. Fire extinguishers are located in the living room, kitchen and staircase and were properly charged and serviced. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Visitation policies, and current menu. LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients as well. Refrigerators in the kitchen and garage are maintained in a good temperature. Sports equipment/games/ books were observed for children's recreation time. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. The facility has no pools or bodies of water on the grounds. There are no guns or weapons in the facility as stated by Program Director at this time. Based on record review, the facility is being cited three Type B violations and a Technical Assistance. Due to time constraint, LPA will return at another time to continue with the annual inspection. An exit interview conducted and appeal rights were reviewed and provided. A copy of this report along was provided to the Program Director, Sydney Scott.

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
On the date listed above, Licensing Program Analyst (LPA) Charmaine Linley conducted Component III Group Homes via Microsoft TEAMS with Tyler Michaelis and Felicia Conover. A copy of the handout was emailed prior to Component III and the Pre-Licensing Inspection is scheduled for September 11, 2025 at 9:00 am. A copy of this report was emailed to Felicia Conover for a signature and a copy of the signed report will be placed in the facility file.

met_with: Tyler Michaelis and Felicia Conover


summary: Facility Evaluation

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Narrative:
On September 11, 2025, at 9:15 am, Licensing Program Analyst (LPA) Charmaine Linley arrived at the facility to conduct a pre-licensing inspection of the facility. The facility was inspected inside and out with Felicia Conover, Facility Administrator/Clinical Director and Laura Hagan, Director of Compliance. The home is a two-story residence with a swimming pool in the backyard. There are video cameras located in the following external areas: one video camera on the outside of the living room wall, one video camera near the exit door by the living room, one video camera near the exit door of the dining room, one video camera next to the window outside of the entry way/living room, one video camera near the exit by the entry room, on video camera on all three external walls of the garage (total of three), and there are video camera located in the following internal areas: one video camera inside of the garage, one video camera near the washer/dryer area, one video camera in the entry room, two video cameras in the hallway between the entry room and the medical office, one video camera in the medical office, one video camera in the living room, one video camera in the kitchen, one video camera in the dining room, two video cameras in the hallway upstairs, one video camera in the clinical office, and one video camera in the group room. The facility consists of one entry/visitation room, two living rooms, one dining room, one kitchen, one medical office, one group room, one clinical office, and five bathrooms. The garage is located next to the bathroom and washer/dryer area. *** A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris. There is adequate indoor and outdoor activity space. The first living room is furnished with one love seat and two chairs with enough seating for four people. The second living room has a l-shaped sectional couch that has enough seating for six people. The medical office is equipped with one desk, one computer, and one telephone that was tested and was observed to be in working order. The kitchen is equipped with operable appliances, kitchen utensils, pot, pans and dishes. The facility had a seven day supply of non-perishable food. The hot water in the kitchen was tested at 9:50 am and measured at 110 degrees, which is within regulatory requirements. The kitchen's appliances were tested and were observed to be in working order. The facility's smoke detectors are inter-connected with the carbon monoxide detectors and are hardwired. The smoke/carbon monoxide detectors were tested and observed to be in working order. There are seven combination detectors, one in the downstairs hallway, one in the upstairs hallway, one in the medical office, one in the clinical office, one in the group therapy room, and one in each individual bedroom. Fire extinguishers are properly charged and serviced. There are a total of three fire extinguishers located in the entry way, in the second living room, and upstairs in the hallway. The facility has a fully equipped first aid kit and first aid manual stored on top of the file cabinet in the medical office There are no guns or weapons in the facility as stated by the Administrator. Medications are locked and centrally stored in a locked cabinet behind a locked door in the medical office. Disinfectants and cleaning solutions were stored in a locked cabinet above the microwave in the kitchen and additional cleaning supplies were stored in the locked cabinet in the garage. Sharp knives were made inaccessible and stored in a locked drawer in the kitchen Client files will be maintained using the KIPU system which is a portal to store client files and keep all information confidential. Applicant stated licensing will have access to such portal when client files need to be reviewed for any purpose. Employee files are stored electronically and Applicant was reminded that licensing will need access to the electronic files when they need to be reviewed for any purpose. *** The following required posted items were observed accessible to clients: Fire Clearance, Grievance Procedures, Personal Rights, Visitation policies, Emergency Disaster Plan and current menu. The bedrooms are set up as follows: Bedroom #1 will be occupied by two residents; has two twin beds, all required linen, and mattresses are in good condition. There is a bathroom in this bedroom. Bedroom #2 will be occupied by two residents; has two twin beds, all required linen, and mattresses are in good condition. Bedroom #3 will be occupied by two residents; has two twin beds, all required linen, and mattresses are in good condition. Bedrooms are arranged so that no more than two clients share a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is an in-ground swimming pool located in the backyard of the facility which is made inaccessible with a fence and one pool gate. The pool gate was locked and the key was not available during the inspection. The Administrator will record a video of the inside of the pool area and showing the gate swinging away from the pool. LPA observed a self-latching device located no more than six inches from the top of the gate. The fence is constructed so that the fence does not obscure the pool from view. The fire clearance has been approved. The following corrections need to be made: provide additional drawer space for bedrooms #2 and #3. Applicant will take photos of the additional dressers and send a photo to the LPA by end of business day on 09/19/2025. Administrator will send a video of the pool to LPA by end of business day on 09/11/2025. Applicant will send updated copies of the LIC 610 and 500 to the LPA. Upon Licensing Program Manager's final review, the license will be provided. An exit interview was conducted, and a copy of this report was given to the facility.

met_with: Felicia Conover


summary: Facility Evaluation

raw_content:
Narrative:
On November 19, 2025, at 11:45 am, Licensing Program Analyst (LPA) Jacqueline Garcia arrived at the facility to conduct a post-licensing inspection of the facility. The facility was inspected inside and out with Felicia Conover, Facility Administrator/Executive Director. The home is a two-story residence with a swimming pool in the backyard. There are video cameras located in the following external areas: one video camera on the outside of the living room wall, one video camera near the exit door by the living room, one video camera near the exit door of the dining room, one video camera next to the window outside of the entry way/living room, one video camera near the exit by the entry room, one video camera on all three external walls of the garage (total of three), and there are video camera located in the following internal areas: one video camera inside of the garage, one video camera near the washer/dryer area, one video camera in the entry room, two video cameras in the hallway between the entry room and the medical office, one video camera in the medical office, one video camera in the living room, one video camera in the kitchen, one video camera in the dining room, two video cameras in the hallway upstairs, and one video camera in the group room. The facility consists of one entry/visitation room, two living rooms, one dining room, one kitchen, one medical office, one group room, one clinical office, and five bathrooms. The garage is located next to the bathroom and washer/dryer area. *** ****Page Continued: A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris. There is adequate indoor and outdoor activity space. The first living room is furnished with one love seat and two chairs with enough seating for four people. The second living room has a l-shaped sectional couch that has enough seating for six people. The medical office is equipped with two desk, one computer, and one telephone that was tested and was observed to be in working order. The kitchen is equipped with operable appliances, kitchen utensils, pot, pans and dishes. The facility had a seven day supply of non-perishable food. The hot water in the kitchen was tested at 1:00pm and measured at 110 degrees, which is within regulatory requirements. The kitchen's appliances were tested and were observed to be in working order. The facility has a fully equipped first aid kit and first aid manual stored on top of the file cabinet in the medical office. There are no guns or weapons in the facility as stated by Felicia Conover, Facility Administrator/Executive Director. Medications are locked and centrally stored in a locked cabinet behind a locked door in the medical office. Disinfectants and cleaning solutions were stored in a locked cabinet above the microwave in the kitchen and additional cleaning supplies were stored in the locked cabinet in the garage and laundry room in a locked cabinet. Sharp knives were made inaccessible and stored in a locked cabinet in the medical office. The following required posted items were observed accessible to clients: Fire Clearance, Grievance Procedures, Personal Rights, Visitation policies, Emergency Disaster Plan, Let us know poster, activity schedule and current menu. The bedrooms are set up as follows: Bedroom #1 occupied by two residents; has two twin beds, all required linen, and mattresses are in good condition. There is a bathroom in this bedroom. Bedroom #2 occupied by two residents; has two twin beds, all required linen, and mattresses are in good condition. Bedroom #3 occupied by two residents; has two twin beds, all required linen, and mattresses are in good condition. Bedrooms are arranged so that no more than two clients share a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. ****. ***Page 3 continued: The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is an in-ground swimming pool located in the backyard of the facility which is made inaccessible with a fence and one pool gate. The pool gate was locked and the key was locked in a locked cabinet in the medical office room. LPA observed a self-latching device located no more than six inches from the top of the gate. The fence is constructed so that the fence does not obscure the pool from view. A sample of five staff files were reviewed during the inspection. All staff that were reviewed and work at the facility had proof of Department of Justice and Child Abuse Clearance Index clearances. Staff records are stored electronically. LPA conducted two staff interviews. LPA will return to review client files and conduct client interviews at a later time. Client records are stored in KIPU system which is a portal to store client files and keep all information confidential. LPA will review client's medication (medical office) at a later time. A copy of this report along with LIC 811 (confidential names) was given and explained to Felicia Conover, Facility Administrator/Executive Director.

met_with: Felicia Conover-Administrator


facility_name: HILLSIDE HORIZON FOR TEENS, LLC

raw_content:
Narrative:
Based on interviews and record reviews the allegation that staff distributed a medication to a client (name unknown) from another client (name unknown) who was placed at another facility, may have occurred, however is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Victor Hamaker.

Investigation Findings:
13On December 27, 2023, at 11:51 am, Licensing Program Analyst (LPA) Darlene Almaraz-Oseguera conducted an unannounced inspection to the facility to deliver the findings of the above allegation. LPA met with Victor Hamaker. LPA Erika Lopez conducted an inspection of the facility on February 3, 2023, at 4:30 pm and no immediate deficiencies were observed. Two of four clients (C1, C2, C3, C4), four staff and facility administrator were interviewed. It was reported to Community Care Licensing (CCL) that staff (S1) distributed medication to a client (name unknown) from another client (name unknown) who was placed at another facility. Confidential staff interviews reported that S1 was in charge of distributing the medications during the time of this alleged incident but does not recall administering a client's medication to another client. Confidential interviews reported that it is unclear which medication and or which client(s) this is regarding. LPA made several attempts to interview all of the clients but due to the clients no longer being placed at the facility, LPA was unsuccessful. Other confidential interviews reported that the allegation was true. The interviews that were provided to the LPA were not consistent regarding the allegation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Darlene Almaraz LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: HILLSIDE HORIZON FOR TEENS, LLCFACILITY NUMBER: VISIT DATE: 12/27/2023

Allegations:
- UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:


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Narrative:
****CONTINUED**** 63 days from hire date 11/07/2022 -02/15/2023. S2 worked in the facility 11 days from hire date 01/19/2023 -02/15/2023. S3 worked in the facility eight days from hire date 01/25/2023 -02/15/2023. S4 worked in the facility 60 days from hire date 11/28/22-02/15/23. ADM confirmed S1, S2, S3 and S4 will not be allowed to work until criminal record clearance has been obtained. Based on confidential interviews, observation, and record review, the preponderance of evidence standard has been met, and the allegation that uncleared staff (S1, S2, S3, S4) are providing care and supervision is supported and proven by evidence, therefore the allegation is substantiated at this time. The facility is cited for violation of Title Regulations 80019(e)(2) Criminal Record Clearance. An exit interview was conducted, a copy of this report along with LIC 9099D, LIC 421BG, LIC 811, and appeal rights were explained and provided to Victor Hamaker.

Investigation Findings:
13On 02/09/2024 at 1: PM, Licensing Program Analyst (LPA), Val Wilson, met with Operations Manager/Facility Manager, Victor Hamaker, to deliver the findings for the above complaint allegation at Hillside Horizon for Teens Group Home (GH). On 02/15/2023 at 3: PM, LPA conducted an inspection of the facility, and no immediate health and safety hazards were observed. During the investigation, interviews were conducted with the administrator (ADM), facility manager (FM), and recruiting manager (RM). LPA reviewed LIC 500, Guardian roster report, and staff files. On February 10, 2024, the Department received a complaint that alleged that uncleared staff are providing care and supervision. Specifically, it was alleged that multiple staff are not cleared to work at the facility. Regarding the allegation that uncleared staff are providing care and supervision, record review of staff files and confidential interviews revealed that staff 1 (S1), staff 2 (S2), staff 3 (S3), and staff 4 (S4) did not have a criminal record clearance. (See LIC 811 dated 02/09/2024). S1 worked in the facility ***CONTINUED*** SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Valerie Wilson LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: HILLSIDE HORIZON FOR TEENS, LLCFACILITY NUMBER: VISIT DATE: 02/09/2024

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:


summary: Complaint Investigation - Substantiated - 1 deficiency - 1 allegation

raw_content:
Narrative:
Confidential record reviews revealed that the facility staff notified law enforcement on 01/19/2025. In addition, a confidential record review revealed that on 02/10/2025, C2 was refusing to eat and lost consciousness, fell, and hit their head on the carpet. Confidential record reviews revealed that facility staff called 911. Confidential record reviews revealed that C2 was transported by paramedics to Inland Valley Hospital. Confidential record reviews revealed that facility staff emailed a 24-hour notice to the assigned Licensing Program Analyst and California Department of Social Services Pacific Inland Children Residential Program Special Incident Report Inbox. The facility did not provide the incident reports that LPA requested during the visit. LPA did not observe any incident reports sent to the Department. Based on confidential record review, the preponderance of evidence standard has been met. The allegation that staff are not following reporting requirements is substantiated. The facility is cited for violation of Title 22, Division 6, Chapter 1, Article 06, Continuing Requirements 80061(b) Reporting Requirements: Upon the occurrence, during the operation of the facility, of any of the events specified in (1)..., a report shall be made to the licensing agency within the agency's next working day during its normal business hours. In addition, a written report containing the information specified in (2)...shall be submitted to the licensing agency within seven days following the occurrence of such event. The facility staff did not submit a written report to the Department within seven days for C1 and C2. An exit interview was conducted, appeal rights were explained, and a copy of this report and LIC 811 was provided to Hillside Horizon Program Administrator (AD) Victor Hamaker.

Investigation Findings:
13On June 26, 2025, at 10:33 am, Licensing Program Analyst (LPA) Jose Gonzalez conducted an unannounced visit and met with Hillside Horizon for Teens Group Home Program Administrator (AD) Victor Hamaker to deliver the findings for the above-stated allegation. LPA inspected Hillside Horizon at 10:33 am/ on June 26, 2025; no health and safety hazards were observed. LPA reviewed two client records (C1 and C2). During the investigation interview was conducted with the Program Director (PD). Interviews were not conducted with the Clients (C1 and C2). On June 24, 2025, the Department received an allegation that staff are not following reporting requirements. Confidential record reviews revealed that facility staff did not submit a written report for two incidents that occurred at the facility on 01/19/2025 and 02/10/2025. Confidential record reviews revealed that on 01/19/2025, C1 was being aggressive and assaultive and was placed in a Crisis Prevention Intervention (CPI) hold. Confidential record reviews revealed that on 01/19/2025, C1 ran away from the group home, and the facility staff lost sight of C1. **CONTINUED on LIC C** SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Jose Gonzalez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: HILLSIDE HORIZON FOR TEENS, LLCFACILITY NUMBER: VISIT DATE: 06/26/2025

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

Deficiencies:
80061(b): Upon the occurrence, during the operation of the facility, of any of the events specified in (1)..., a report shall be made to the licensing agency within the agency's next working day during its normal business hours.  In addition, a written report containing the information specified in (2)...shall be submitted to the licensing agency within seven days following the occurrence of such event.

title: Reporting Requirements


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Narrative:
Confidential interviews indicated that the group home ratio is a one staff for three clients. Confidential witness interviews revealed that clients (C1, C2, C3, C4, C5, and C6) are placed on a staff-to-client one-on-one status for the client's safety. Confidential interviews revealed that the facility staff are trained in Crisis Prevention Institute (CPI) when the clients (C1, C2, C3, C4, C5, and C6) exhibit self-injurious behaviors and suicidal ideation. Confidential witness interviews disclosed that facility staff are trained to use verbal de-escalation techniques and encourage the clients (C1, C2, C3, C4, C5 and C6) to use their coping skills. Confidential witness interviews indicated that facility staff are trained to intervene and safely restrain a client (C1, C2, C3, C4, C5, and C6) when they are danger to themselves or others. Confidential interviews indicated that the facility staff are not supervising clients (C1, C2, C3, C4, C5, and C6) and that the clients engage in self-harming behaviors. Confidential witness interviews revealed that facility staff (unknown) are not adequately trained to deal with minors (C1, C2, C3, C4, C5, and C6) behaviors. Confidential witness interviews revealed that facility staff are not trained to work with the clients (C1, C2, C3, C4, C5, and C6) behaviors. Based on inconsistent confidential interviews, the allegations that due to lack of supervision (staff unknown), minors (C1, C2, C3, C4, C5, and C6) are self-harming and staff (unknown) are not adequately trained to deal with minors (C1, C2, C3, C4, C5, and C6) behaviors are unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted, appeal rights were explained, and a copy of this report and LIC 811 was provided to Hillside Horizon Program Director (PD) Victor Hamaker.

Investigation Findings:
13On July 15, 2025, at 12:37 pm, Licensing Program Analyst (LPA) Jose Gonzalez conducted an unannounced visit and met with Hillside Horizon Program Director (PD) Victor Hamaker to deliver the findings for the above-stated allegations. LPA inspected Hillside Horizon for Teens at 10:10 am on March 18, 2025; no health and safety hazards were observed. LPA reviewed six client's records (C1, C2, C3, C4, C5, and C6). During the investigation, interviews were conducted with Clients (C1, C2, C3, and C4), Program Manager/ Facility Manager (FM), and Program Director (PD). Interviews were not conducted with C5 and C6 due to illness. On March 10, 2025, the Department received an allegation that due to lack of supervision (staff unknown), minors (C1, C2, C3, C4, C5, and C6) are self-harming and staff (unknown) are not adequately trained to deal with minors (C1, C2, C3, C4, C5, and C6) behaviors. Confidential interviews disclosed that facility staff monitor the client's interactions (C1, C2, C3, C4, C5, and C6). Confidential interviews indicated that the facility staff are constantly supervising the clients (C1, C2, C3, C4, C5, and C6) to ensure that the clients are not engaging in self-harming behaviors.***CONTINUED on LIC 9099C*** UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Jose Gonzalez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: HILLSIDE HORIZON FOR TEENS, LLCFACILITY NUMBER: VISIT DATE: 07/15/2025

Allegations:
- UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:

met_with: Program Director (PD) Victor Hamaker


summary: Facility Evaluation

raw_content:
Narrative:
On February 28, 2022, Licensing Program Analyst (LPA) Toni Castillo conducted a teams meeting with applicant Hillside Horizons for Teens, LLC. The purpose of the meeting was to complete Component II. Present at the meeting were Devon Wayt, CEO and group home facility Administrator Tyler Michles. During the meeting LPA discussed with CEO and Administrator the overall operation and services provided in the facility. This is a private placement 6 bed group home application that will provides services to females ages 12-17 years old. During the meeting CEO advised LPA that there will be a change in administrator. LPA informed CEO that all forms with new administrator will need to be resubmitted and administrator will need certificate and attend the group home orientation. During the meeting the program statement and application was discussed. Applicants were informed the following items were missing or in need of revision: Application Section A: 1. Application (LIC 200): need with new administrator 2. Applicant information (LIC215): need with new administrator 3. Designation of Administrative Responsibility (LIC308): need with new administrator 4. Administrative Organization (LIC 309): need with new administrator 5. Affidavit Client Cash Resources (LIC 400): completed 6. Monthly Operating Statement (LIC401): need with new administrator 7. Supplemental Financial Information (LIC 401a): completed 8.Surety Bond (LIC 402): completed 9. Balance Sheet (LIC 403): need with new administrator 10. Balance Sheet Supplemental (LIC403a): need with new administrator 11. Financial Information Release (LIC404): account needs to be in applicant name 12. Personnel Report (LIC 500): need with new administrator 13. Personnel Record (LIC 501): need with new administrator 14. Health Screening (LIC 503) with TB: need with new administrator 15. Resume for Administrator/CEO: need with new administrator and need transcripts and copy of degrees. Need Administrator certificate for new administrator 16. Emergency Disaster Plan: need with new administrator 17. Facility Sketch (LIC 999) with dimensions: completed 18. Criminal record clearances: need with new administrator, need to check everyone else has cleared 19. Corporation: Board resolution need with new administrator. Missing by laws & organizational chart 20. Verification of Administrator Qualifications: resume needed for new administrator 21. Job Descriptions, Duties & Responsibilities, Line of Supervision, Job Titles, Qualifications and experience with client population: complete 22. Personnel Policies: Work hours/shifts, hiring practices, abuse reporting procedures: This is not an adult home, remove APS. 23. In Service Training; completed 24. Facility Program Description: completed 25.House Rules: more specific house rules. - Curfew hours on school nights, weekends and holidays; -- Smoking; -- Dating other children in placement; -- Completing homework; -- Cleaning bedrooms and other areas; -- Use of entertainment equipment (the child's and the facility's); -- Dress code; -- Laundry; -- General prohibited behaviors 26. Admission Policy: Describe the program's admission/intake procedures. Include: (gender and age qualifying for admission) -- Criteria for evaluating appropriateness of referrals for placement; -- Information required to assess referrals for placement; -- Timeframe for responding to referring agencies regarding acceptance or rejection of referral; -- Staff position responsible for intake; and -- Procedures for accepting emergency placements on a time-limited and/or trial basis. -- Eviction procedure --More specific on phone use. (hours?) --On visitation policy state hours, will you have a visitation log, check for ID, who will be in charge of visitation? 27. Transportation Procedure: Transportation log, who will maintain? Who will check vehicle or often? 28. Sample Menu: completed 29. Control of property: completed 31. First aid: Need for new administrator 32. water safety certificate: N/A 33. Administrator certificate: Need for new administrator 34. Neighborhood Complaint Procedure: completed 35. Fire Clearance: pending 36. City Planning Approval: completed 300 foot rule 37. Emergency Intervention-missing [Reference: Title CCR 84300(d), 84300.1, and 84322] Include a copy of your agency's approved Emergency Intervention Plan which must address the following areas: -- Techniques of group and individual behavior management; -- Methods for de-escalating volatile situations; -- Alternative methods of handling aggressive and assaultive behavior; -- Describe the physical techniques of applying manual restraints, if applicable; -- Techniques for returning the child to planned activity following an emergency intervention; -- A written test and evaluation criteria for the hands-on competency test; and -- Include the name and qualifications of the individual who designed the Emergency Intervention Plan. 38: AWOL/Runaway Plan: [Reference: Title CCR 84322.2] Describe the plan for responding to an incident of a child running away. Include: -- Time frames for determining when a child is absent without permission; -- Continuum of interventions; -- Actions to locate the child; -- Staff training plan; -- Plan to involve law enforcement; and -- Plan to notify the child's authorized representative. 38. Chores: Describe any chores children are required to perform as part of their regular routine 39. Planned activities and use of community resources: [Reference: Title CCR 80022(b)(13), 84065(e), 84079] Describe the program's planned SOCIAL and RECREATIONAL activities. Include: -- The plan for indoor and outdoor activities; -- The plan for individual child activities and group interaction activities; -- Which children are involved in the activities; and -- A list of community resources used by the program (for example, YMCA, YWCA, libraries, parks, church groups). Describe the program's planned educational activities and services. [Reference: Title CCR 84079(a)(5), 84068.2] Include: -- Special education; -- Use of public and/or private schools; -- On grounds school; and -- Tutoring, if applicable. Provide a SAMPLE DAILY ACTIVITY SCHEDULE for one week, including weekends and holidays. The schedule must include social, recreational and educational activities. 40. Discipline Policy 1. Describe the program's discipline policy. [Reference: Title CCR 80072(a)(3), (7) - (8), 84072, 84072.1] Include: -- Type(s) of discipline used; -- Conditions under which each type of discipline will be used; -- Types of discipline not permitted (corporal punishment and violation of personal rights); -- Provisions for contact with parents and/or placement representatives (conferences). NOTE: Prone containment and like techniques shall not be included as part of a program's discipline policy nor written into individual needs and services plans. Such techniques are not to be a planned step in modifying behavior. They are considered to be only last resort emergency physical control techniques designed to prevent injury to the assaultive child or others. Exit Interview was conducted. It was discussed with referenced facility representative that in the event of any other corrections be needed LPA will notify applicant. The above corrections are to be received by the licensing office by the end of business day on March 21, 2022. LPA emailed applicant a copy of this report for signature. Applicant signed report and sent back to LPA.

met_with: CEO Devon Wayt


summary: Facility Evaluation

raw_content:
Narrative:
On March 25, 2021, Licensing Program Analyst (LPA) Toni Castillo conducted an announced pre-licensing inspection for Hillside Horizon For Teens, LLA. LPA met with CEO Devon Wayt, Administrator Tyler Michles and Compliance Specialist Christina Kiesselbach. LPA was provided revisions to the program statements and application forms as stated during the component II meeting. LPA will review revisions and inform applicant if any further corrections are needed. Administrator Tyler Michles has completed the administrator certification however, is scheduled to attend the group home orientation on April 14th. LPA toured the facility inside and out. The facility is a two story home in a residential neighborhood. The home is about 2,772 square feet. This home will serve both male and females. 4 females will be assigned to two bedrooms down stairs and 2 males to one bedroom up stairs. The facility is set up as follows: Upper level: *1 client bedroom, designated for 2 male clients. Bedroom contains two twin beds equipped with mattress pad, complete sheet set, comforter, extra blanket and pillow. Two night stands, ample lighting, closet with room for storage for clothing and personal belongings. *1 full bathroom designated for 2 male clients equipped with operable sink, toilet and shower. *1 half bathroom designated for staff and visitors. *4 offices 1 office designated for a nursing station/med room, 1 office designated as a therapist office, 1 office designated as a waiting room used for intakes and visitations with families and 1 office used for operations/clinical. *entry way of the home begins in the upper level. Equipped with an entry table with log guest sign in book. Posted evacuation and disaster plan, personal rights and grievance procedures. *Living room furnished with sofas, television, book shelves and home decor. *Dining room area equipped with a large table and seating for 10. *Kitchen is equipped with operable appliances, kitchen utensils, pot, pans and dishes, pantry is stocked with dry goods, food menu is posted. Knives are stored in an upper locked cabinet. Kitchen has a nook for casual eating. Lower level: *2 client bedroom, designated for 4 female clients.(2 clients in each room) Each bedroom contains two twin beds equipped with mattress pad, complete sheet set, comforter, extra blanket and pillow. Two night stands, ample lighting, closet with room for storage for clothing and personal belongings. *1 client bedroom contains its own bathroom for use of those 2 clients. There is another full bathroom down the hallway designated for the other 2 female clients.Both bathrooms are equipped with operable sink, toilet and shower. *Laundry room equipped with washer and dryer and space for folding clothing. *Hallway closet equipped with hygiene supplies and extra linens. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. All hazardous items have been properly made inaccessible to areas where children will have access. Medications are locked and centrally stored in the nursing/medl office. Cleansers/chemicals were locked in the cabinet located in the kitchen. The first aid kit was also in the medical office with all required items. Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment/toys/books/games were observed for children's recreation time . All facility smoke detectors and carbon monoxide detectors are hard-wired in and are in appropriate working order All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster in main entrance of the facility. No firearms or weapons are in the facility. Water temperature was tested and was at 118. Trash cans for storage of solid waste had tight fitting lids. LPA observed a locked cabinet for staff files to be stored in the operations office. Client files will be maintained using the Kipu system which is a portal to store client files and keep all information confidential. Applicant stated licensing will have access to such portal when client files need to be reviewed for any purpose. The following needs to be corrected: All windows that open need to have screens. Applicant will submit a photo of screens on all windows by April 11, 2021. A copy of this report was given and explained to CEO Devon Wayt.


summary: Facility Evaluation

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Narrative:
On July 14, 2022, Licensing Program Analyst (LPA) Val Wilson conducted an unannounced post-licensing inspection for Hillside Horizon For Teens, LLA. LPA met with Beau Moore, Administrator and Co-Founder. The facility is a two-story home in a residential neighborhood. The home is about 2,772 square feet. This home will serve both male and females. 4 females will be assigned to two bedrooms downstairs and 2 males to one bedroom upstairs. There are currently 3 females placed in the facility. LPA was provided a tour of the facility inside and out. The facility is set up as follows: Upper level: Long driveway with an outdoor garage, bonus room underneath. The facility van has registration and first aid kit. *Entry way of the home begins in the upper level. Equipped with an entry table with log guest sign in book and 1 half bathroom designated for staff and visitors. 1 office is designated as a waiting room used for intakes and visitations with families *1 client bedroom with bathroom, designated for 2 male clients. Bedroom contains two twin beds equipped with mattress pad, complete sheet set, comforter, extra blanket, and pillow. Two nightstands, ample lighting, closet with room for storage for clothing and personal belongings. 1 full bathroom designated for 2 male clients equipped with operable sink, toilet and shower. *Living room furnished with sofas, television, bookshelves, and home decor. There are French doors that lead to an outdoor furnished balcony. Dining room area equipped with a large table and seating for 10. Kitchen is equipped with operable appliances, kitchen utensils, pot, pans and dishes, pantry is stocked with dry goods, food menu is posted. Knives are stored in an upper locked cabinet. Kitchen has a nook for casual eating. The pantry, freezer and refrigerator had plenty of perishable and non-perishable food. Next page Lower level: *Posted evacuation and disaster plan, personal rights, and grievance procedures. These will be moved upstairs to the entryway. Laundry room equipped with washer and dryer and space for folding clothing. Hallway closet equipped with hygiene supplies and extra linens. *3 offices: 1 office designated for a nursing station/med room, 1 office designated as a therapist office, and 1 office used for Facility Manager. *2 client bedroom, designated for 4 female clients (2 clients in each room). Each bedroom contains two twin beds equipped with mattress pad, complete sheet set, comforter, extra blanket and pillow (pillow protector). Two night stands, ample lighting, closet with room for storage for clothing and personal belongings. *1 client bedroom contains its own bathroom for use of those 2 clients. There is another full bathroom down the hallway designated for the other 2 female clients. Both bathrooms are equipped with operable sink, toilet and shower. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. All hazardous items have been properly made inaccessible to areas where children will have access. Medications are locked and centrally stored in the nursing/medication office. Cleansers/chemicals were locked in the cabinet located in the kitchen. The first aid kit was also in the medical office with all required items. Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment/toys/books/games were observed for children's recreation time. All facility smoke detectors and carbon monoxide detectors are hard-wired in and are in appropriate working order. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster, They are in the process of being moved to the main entrance of the facility. No firearms or weapons are in the facility. Water temperature was tested and was at 117* F. Trash cans for storage of solid waste had tight fitting lids. Next page LPA observed a locked cabinet for staff files to be stored in the Facility Managers office. Client files will be maintained using the Kipu EMR system which is a portal to store client files and keep all information confidential. Applicant stated licensing will have access to such portal when client files need to be reviewed for any purpose. Due to time constraints, LPA will return to complete the inspection at a later date. An exit interview was conducted, and a copy of this report was provided to Beau Moore, Administrator.

met_with: Beau Moore, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced post-licensing inspection was conducted by Licensing Program Analyst (LPA), Val Wilson, on August 5, 2022, at 11:30am, at Hillside Horizon For Teens, LLC, Group Home(GH). The purpose of the inspection was to complete the continuation post-licensing inspection that was initiated on July 14, 2022. LPA already completed the physical inspection of the facility on the first day of inspection. The LPA was met by Facility Manager, Jeff Denison. During time of inspection, staff and client records were reviewed, Staff and client interviews were also conducted. During this inspection continuation, LPA reviewed personnel files to ensure they contained all required documentation per Title Regulations and Interim Licensing Standards (ILS). Personnel Files are maintained at the HR office electronically. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances. All personnel files met the training requirement and have valid CPR and first aid cards. Ten of ten personnel files were complete. During the inspection continuation, LPA reviewed four of four client files (Client 1- C1; Client 2- C2; Client 3- C3; Client 4-C4 ) to ensure they contained all required documentation per Title Regulations and Interim Licensing Standards (ILS). Client Files are maintained at the facility electronically. There were 3 children present at the facility. Three of four child interviews (Client 1- C1; Client 2- C2; Client 3- C3) were conducted and revealed that all personal rights are protected, treatment plans are reviewed, and that they receive all their services. Needs and Services Plans are written within 30 days with approval from the child and authorized representative prior to implementing the plan, then reviewed and updated as needed, and every 6 months. The disaster plan is complete and last updated on 07/14/22. LPA reviewed the fire drills for the last two months that were done monthly and rotates each shift quarterly. Nursing services are available on-site 40 hours each week and on call, as needed. Exit interview conducted. A copy of this report and a copy of the appeal rights was provided to Administrator, Beau Moore.


facility_name: HILLSIDES GROUP HOME

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the allegations that staff did not respect C1's religious beliefs, did not treat him with dignity and did not provide him with food appropriate for Ramadan. LPA interviewed C1, S1, S2 and S3. LPA could not interview other clients because they were all relocated due to the closure of the Unaccompanied Minor Program. LPA also reviewed the internal investigation and a copy of the email thread regarding food options and scheduling adjustments for those clients who observe Ramadan. C1 informed this LPA that he felt that his rights were violated and he was the victim of racial and religious based descrimation. However S1, S2 and S3 deny these allegations. LPA Jones-Steward resolved these allegations as unsubstantiated due to inability to interview other clients who were witness to the events, An unsubstantiated finding means that although an allegation my be true, there is not a preponderance of evidence that it is true. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Andrew Hernandez, Senior Director of Campus Based Services


summary: Facility Evaluation

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Narrative:
On October 20, 2022 at 10:00am, Licensing Program Analyst (LPA) Daphne Edison and Licensing Program Manager (LPM) Lakescia Smith arrived at Hillsides Group Home for the purpose of conducting a Pre-Licensing Inspection Visit. LPA's and LPM met with Casey Meinster, Senior Clinical Director and Andrew Hernandez, Director of Cottage Services who granted access into the facility and together a tour was conducted. There is a secured swimming pool located on the main campus. The facility will provide care and supervision to fifty (50) children, male and female, ages 6-17 years, ambulatory only. The census on the day of this visit is thirteen (13). Hillsides Group Home is set up as follows: There are five (5) cottages (Sierra, Tradewinds, Canyon, Arroyo, and Redwood) located on the main campus. Each cottage has a common living area equipped with adequate seating and a television, dining area with adequate seating for family style dining, three (3) - four (4) bathrooms, a laundry room with storage for extra linens, bedding, and comforters, kitchen, and ten (10) bedrooms. Each bedroom is equipped with one (1) twin-size bed, dresser, desk, adequate lighting, and ample closet space. All beds have clean and adequate bedding. Laundry supplies are kept in the laundry room in a locked storage cabinet. Individual personal hygiene boxes are kept in a cabinet in the laundry room. Extra hygiene products are kept in all staff offices. All kitchens are equipped with a four (4) burner gas stove. LPA observed perishable and non-perishable foods for more than a one (1) week supply. Sierra Cottage: Houses 13-17-year-old Co-Ed. Has an attached common area to the living area. Equipped with two (4) bathrooms with tub, shower, and toilet. Bathrooms are clean, sanitary, and operable. Tradewinds Cottage: Currently under construction. Will house 13-17-year-old, Co-Ed. Canyon Cottage: Currently under construction. Will house 14-17-year-old, females only. Continued on LIC 809-C Arroyo Cottage: Houses 14-17-year-old, male only. Redwood Cottage: Houses 6-12-year-old, Co-Ed. Equipped with three (3) bathrooms with tub, showers, and toilet. Bathrooms are clean, sanitary, and operable. All prescribed and over the counter medications will be kept locked in the central nurse's office located on Hillsides main campus accessible and administered only by nursing staff. The smoke detectors and carbon monoxide alarms were tested and are operable. All regulation fire extinguishers are fully charged. Facility also has a Fire Alarm Pull System. First aid kits are complete with scissors, tweezers, thermometer, and a First Aid manual located in all cottage staff offices. Hot water was tested and is in a safe temperature range. LPA observed the facility to have adequate indoor and outdoor activity space and are free from debris and hazards. Activities include a basketball court, gym, music room, art center, indoor gym, game room and recording studio. Foster Youth Bill of Rights and grievance procedures were posted. All posting requirements have been met. LPA advised that a LIC 508, LIC 9182, and an exemption request, if staff needs an exemption, must be submitted to LPA Edison for Casey Meister and Andrew Hernandez along with a photocopy of their driver license. LPA advised requested documents to be emailed to LPA Edison. The following must be corrected: Sierra Cottage: Bedroom #3 window screen needs to be repaired/replaced. Post a larger visible Foster Youth Bill of Rights. Tradewinds Cottage: Currently under construction. Paint, furniture, and bedroom set-up for placement. Canyon Cottage: Currently under construction. Paint, furniture, and bedroom set-up for placement. Arroyo Cottage: Paint, furniture, and bedroom set-up for placement. Redwood Cottage: Bedroom #3, missing window screen. Bedroom #6, missing window screen. Continued on LIC 809-C LPA will conduct a follow-up visit once all corrections have been made and facility is placement ready. Provider is converting from a Short-Term Residential Therapeutic Program (STRTP) to a Group Home (GH). Exit Interview was conducted, and a copy of this report will be emailed to the Senior Clinical Director.

met_with: Casey Meinster-Senior Clinical Director


summary: Facility Evaluation

raw_content:
Narrative:
On November 18, 2022 at 10:00am, Licensing Program Analyst (LPA) Daphne Edison and Licensing Program Manager (LPM) Lakescia Smith conducted a Component II, Face-to-Face meeting with Hillsides staff. In attendance were the following: Casey Meinster, Division Chief and Andrew Hernandez, Director of Cottages. The purpose of the meeting was to discuss the pending Group Home application and Program Statement review. LPA discussed and advised staff to submit the incomplete documentation by December 7, 2022. The following concerns were discussed with Casey and Andrew: • Submit Administrator Qualification documents and Administrator Certificate for Yadira Lopez • UPDATED LIC 200 was received on 11/18/2022 due to capacity reduction and to correct facility name to: Hillsides Pasadena • LIC 308 - Designate the Administrator • LIC 309 (Section 10) Incomplete • LIC Requested updated forms for the new facility type • LIC 402 - Surety Bond (was not completed) • LIC Staff must complete a monthly estimate, not an annual estimate. • LIC 404 (LPA will follow up with financial institution) • LIC 508 - Missing for Administrator. LPA received for all staff on 11/18/2022. • LIC 9182 - Missing for Casey, Stacy, and Administrator (LPA received Transfer request for all employees 11/18/ Continued on LIC 809-C • Fire Inspection: LPA was informed inspection completed. LPA will follow up with fire inspector. • LIC 503/TB Screening: Needed for Yadira Lopez, Administrator • First Aid Certificate: Needed for Yadira Lopez, Administrator • LIC 9106 - Group Home Program Statement General Instructions. LPA advised staff to complete and submit the UPDATED LIC 9106 (REVISED 11/2019). Due to major construction being completed in one of the cottages, CCL will be unable to include the capacity for this cottage. Once construction has been completed, submit a new application with the updated capacity so a fire clearance can be requested. Your analyst will conduct a follow up inspection after the construction has been completed. LPA advised Division Chief to submit a camera waiver to CCL to utilize cameras on the premises. LPA will email instructions to Division Chief. A Component III meeting will be conducted virtually on November 29, 2022 from 2p-4p. A follow-up Pre-Licensing Inspection will be conducted by LPA Edison on December 13, 2022 at 10:00am. An exit interview was conducted, and a copy of this report was given to the Division Chief.

met_with: Casey Meinster -Division Chief


summary: Facility Evaluation

raw_content:
Narrative:
On December 13, 2022 at 9:52am, Licensing Program Analyst (LPA) Daphne Edison arrived at Hillsides Group Home for the purpose of conducting a follow-up visit for a Pre-Licensing Inspection Visit which took place on October 20, 2022. LPA met with Casey Meinster, Senior Clinical Director and Andrew Hernandez, Director of Cottage Services who granted access into the facility and together a tour was conducted. There is a secured swimming pool located on the main campus. The facility will provide care and supervision to forty (40) children, male and female, ages 6-17 years, ambulatory only. The census on the day of this visit is twelve (12). Hillsides Group Home is set up as follows: There are five (5) cottages (Sierra, Tradewinds, Canyon, Arroyo, and Redwood) located on the main campus. Tradewinds Cottage is currently under construction and not set up for placement. Each cottage has a common living area equipped with adequate seating and a television, dining area with adequate seating for family style dining, kitchen, three (3) - four (4) bathrooms equipped with a toilet, sink, shower and tub/shower combination. Each bathroom is clean, sanitary and in operable condition. Arroyo and Canyon cottages are equipped with a laundry room with an operable washer and dryer and will also be utilized as a phone room for clients to make confidential telephone calls. Sierra and Redwood cottages are equipped with a laundry room with operable washer and dryer and storage for extra linens, bedding, and comforters. All cottages house ten (10) bedrooms. Each bedroom is equipped with one (1) twin-size bed, dresser, desk, adequate lighting, and ample closet space. All beds have clean and adequate bedding and linens. Laundry supplies are kept in the laundry room in a locked storage cabinet. Extra hygiene products are kept in all staff offices. All kitchens are equipped with a four (4) burner gas stove, dishwasher, refrigerator/freezer combination, and microwave oven. All cleaning supplies are kept in a locked cabinet. LPA observed perishable and non-perishable foods for more than a one (1) week supply. Continued on LIC 809-C Each cottage has a staff office which includes a staff office equipped with a toilet, sink, and shower in clean, sanitary, and operable condition. First aid kits are complete with scissors, tweezers, thermometer, and a First Aid manual located in all cottage staff offices. All regulation fire extinguishers are fully charged. Hot water was tested and is in a safe temperature range. LPA observed three (3) missing bedroom window screens in Canyon and Arroyo Cottages. Missing window screens were replaced during LPA inspection. All posting requirements have been met. LPA observed the following corrections have been made: Sierra Cottage: Bedroom #3 window screen has been repaired/replaced. A visible Foster Youth Bill of Rights. Canyon Cottage: New paint, carpet, furniture, and bedrooms set up for placement. Arroyo Cottage: New paint, carpet, furniture, and bedrooms set up for placement. Redwood Cottage: Bedroom #3 window screen has been repaired/replaced. Bedroom #6 window screen has been repaired/replaced. Exit Interview was conducted, and a copy of this report will be emailed to the Senior Clinical Director.


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst Connie Jones-Steward, visited the facility to determine if a capacity increase can be granted at the licensee's request. The facility currently has 40 beds but wishes to add the 10 beds located in the Tradewinds Cottage. LPA observed the following: Tradewinds cottage consists of 10 bedrooms and 3 full bathrooms. Each bedroom has a single twin bed with linens in good condition. All bedroom windows are operable. There are no security bars on bedroom windows. All bedrooms have working carbon monoxide detectors and sprinkler valves. There is a fire pull station and a fire extinguisher in the cottage. All three bathrooms have equipment that is clean and in working order. Hot water is at a safe temperature. There is a kitchen stove and refrigerator in good working condition. There is a washer and dryer in the laundry room. There are locked storage areas for kitchen utensils and household chemicals. There are two sofas and two dining room tables with a combined seating capacity of 12. Sharp kitchen knives are stored in the central dining hall. Medications are centrally stored in the nursing station. There is a complete first aid kit in the cottage. A capacity increase from 40 to 50 may be granted once an updated LIC 200 and an approved fire clearance are received. This amended report supersedes the report previously issued..

met_with: Andrew Hernandez, Senior Director of Program Services


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with Andrew Hernandez, Senior Director of Program Services, to commence the post-licensing inspection. The following was observed: Hillsides group home provides twenty beds to minors under the Office of Refugee Resettlement and twenty Commercial Insurance Beds. There is a pending capacity increase to fifty total beds. Hillsides Group Home is set up as follows: There are five (5) cottages (Sierra, Tradewinds, Canyon, Arroyo, and Redwood) located on the main campus. Each cottage has a common living area equipped with adequate seating and a television, dining area with adequate seating for family style dining, three (3) - four (4) bathrooms, a laundry room with storage for extra linens, bedding, and comforters, kitchen, and ten (10) bedrooms. Each bedroom is equipped with one (1) twin-size bed, dresser, desk, adequate lighting, and ample closet space. All beds have clean and adequate bedding. Laundry supplies are kept in the laundry room in a locked storage cabinet. Individual personal hygiene boxes are kept in a cabinet in the laundry room. LPA Jones-Steward reviewed the following cottages: Arroyo Cottage: This cottage is set up for unaccompanied minors. This cottage has 10 bedrooms and 4 bathrooms. There are currently 8 clients assigned to this cottage. All bedrooms have single beds in good condition and adequate storage space. Each bedroom has a working smoke detector and carbon monoxide detector. There is a laundry room with all cleaning supplies safely stored. All bathroom and kitchen equipment is clean and in good working condition. Floor plan and notice of personal rights are posted. Canyon Cottage: This cottage is set up for unaccompanied minors. This cottage has 10 bedrooms and 4 bathrooms. There are currently 8 clients assigned to this cottage. All bedrooms have single beds in good condition and adequate storage space. Each bedroom has a working smoke detector and carbon monoxide detector. There is a laundry room with all cleaning supplies safely stored. All bathroom and kitchen equipment is clean and in good working condition. Floor plan and notice of personal rights are posted. Sierra Cottage: This cottage is set up for commercial insurance beds. This cottage has 10 bedrooms and 4 client bathrooms and 1 staff bathroom. There are currently 7 clients assigned to this cottage. All bedrooms have single beds in good condition and adequate storage space. Each bedroom has a working carbon monoxide detector and sprinkler head. There is a laundry room with all cleaning supplies safely stored. All bathroom and kitchen equipment is clean and in good working condition. Floor plan and notice of personal rights are posted. Redwood Cottage: This cottage is set up for commercial insurance beds. This cottage has 10 bedrooms and 3 client bathrooms and 1 staff bathroom. There are currently 3 clients assigned to this cottage. All bedrooms have single beds in good condition and adequate storage space. Each bedroom has a working carbon monoxide detector and sprinkler head. There is a laundry room with all cleaning supplies safely stored. All bathroom and kitchen equipment is clean and in good working condition. Floor plan and notice of personal rights are posted. Tradewinds Cottage: Tradewinds was reviewed on 03/22/23. See report for that date. There were no deficiencies cited as a result of today's inspection. LPA will return at a scheduled date to review client and staff files.

met_with: Andrew Hernandez