summary: Facility Evaluation

raw_content:
Narrative:
On 3/07/2024 @ 10: AM Licensing Program Analyst (LPA) Zena Phillips made an unannounced visit to KEY TREATMENT 1, LLC for the purpose of conducting Annual inspection. LPA Phillips was greeted by Matthew Cox/Program Director who granted access and provided the current census. LPA Phillips requested LIC 500 and client roster and both provided at time of inspection. The facility is a two-story structure with five (5) bedrooms and three and half bathrooms (3.5) located in a residential neighborhood. The facility is currently using three (3) bedrooms for clients. Current census is two(2). During the inspection LPA Phillips conducted four (4) confidential interviews, reviewed three (3) staff files, and two (2) client files. The files were electronic and reviewed with Program Director. LPA Phillips observed files to be in compliance. The facility kitchen has double sink with garbage disposal, dishwasher, adequate cabinet and drawer space for dishes, utensils, and food storage. There is a large refrigerator and freezer combo in the kitchen with weekly menu posted next to refrigerator. The sharps are locked away in the staff office and used by the facility chef. The stove top has six (6) burners and LPA Phillips observed all burners functioning properly. There is a working hardline phone located in the laundry room, one of four fire extinguishers located on west facing wall of dining area. Next to the kitchen there is a small staff dining area with seating for six (6) and LPA Phillips observed laminated and wall mounted personal rights poster. Emergency Disaster Plan posted on staff dining room wall. Complaint box to submit anonymously concerns located near staff dining area/multipurpose room. cont on 809 c There is a common area with covered non- operable fireplace. LPA Phillips observed large sofa and chairs, tables, lamps with adequate seating for twelve (12). There is half bathroom downstairs for staff use. LPA Phillips observed next to front door storage closet with adequate hygiene products, paper goods. There is a second locked storage room for cleaning supplies to the right of the stairs. The first bedroom downstairs has two (2) double beds with clean linens, lamps, table, wall mounted television and six (6) drawers with adequate closet space for storage. The laundry room has washer, dryer and additional refrigerator and freezer combo storage. This room is locked with locked cabinets for medicine storage and four (4) first aide kits including a thermometer. There is a working sink with counter adequate storage for laundry products.The second bedroom has two (2) double beds with clean linens, table, lamps, wall mounted television. LPA Phillips observed two full bathrooms downstairs to have tub and shower combo, toilet and sink. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. LPA Philips observed the upstairs bedroom with two (2) double beds with clean linens, six (6) drawers, tables, lamps, full bathroom attached, and adequate closet space for storage. LPA Phillips observed the facility's eight (8) working smoke and carbon monoxide detectors. LPA Phillips requested a test of smoke detector and confirmed operational. LPA Phillips observed fire drill roster with date and participants. All windows are in good repair with screens and blinds. LPA Phillips observed the facility has four (4) fire extinguishers fully charged and wall mounted. LPA confirmed smoke detector working properly as staff tested alarm. The facility has a pool with self latching locked gate and LPA Phillips observed gate height to be within compliance requirements LPA observed facility exterior grounds to be landscaped, maintained and clear of all debris. LPA reminded Matt Cox of reporting requirements. LPA Phillips observed the facility to be clean, safe and sanitary. An exit Interview was conducted, and a copy of this report will be emailed to the Evan Powell/ Administrator & Matt Cox/Program Director.

met_with: Matt Cox/Program Director


state: CA

facility_name: KEY TREATMENT 1, LLC

summary: Facility Evaluation

raw_content:
Narrative:
On 3/06/2025 at 10: AM Licensing Program Analyst, (LPA) Kim Dear made an unannounced visit to the KEY TREATMENT 1, LLC facility for the purpose of conducting an annual inspection. LPA Dear was greeted by Jason Sobel, Lead Resident Advisor, who granted access into the facility. A health and safety assessment was conducted. The Executive Director, Elnaz Mayeh and shortly after, Matthew Cox the Program Director met with LPA dear and provided the current census, 5/6 clients. LPA Dear requested the LIC 500 and client roster; both documents were provided at time of inspection. The facility is a two story structure with five (5) bedrooms and three and half bathrooms located in a residential neighborhood. The facility is currently using three (3) bedrooms for clients, (1) room as a school room and (1) room for a lower office space. During the inspection LPA Dear conducted (2), two confidential interviews, reviewed three (3) staff files, and two (2) client files. The files were electronic and reviewed with the Program Director. LPA Dear observed the files to be in compliance. The facility kitchen has a double sink with garbage disposal, dishwasher, adequate cabinet and drawer space for dishes, utensils, and food storage. There is a large refrigerator and freezer combo in the kitchen with the weekly menu posted. The sharps are locked away in the staff office and used by the facility chef. The stove top has six (6) burners that LPA Dear observed to be functioning properly. There is a working land line (310) 589- 5588. Facility phone is located in the laundry room. One of four fire extinguishers was located on west wall facing the dining area, (1) in the kitchen were there is a small staff dining area with seating for six (6). LPA Dear observed the personal rights poster laminated and mounted on the wall. The Emergency Disaster Plan is posted on the staff dining room wall. Facility has a complaint box for clients to submit anonymous concerns located near the school room. Continued on 809- C There is a common area with a non- operable fireplace. LPA Dear observed a large sofa, chairs, tables with lamps and adequate seating for (12), twelve. There is a half bathroom downstairs for staff use. LPA Dear observed a storage closet with adequate hygiene products, paper goods and a fully stocked pantry located at the front door. There is a second locked storage room for cleaning supplies located to the right of the stairs. The first bedroom (downstairs), has two (2) double beds with clean linens, lamps, table, a wall mounted television and a six (6) piece drawer dresser with adequate closet space for storage. The laundry room has an industrial sized washer, dryer and additional refrigerator and freezer combo for food storage. This room is locked with lockable cabinets for medicine storage and (4), four first aide kits thermometers included. There is an additional sink with counter providing adequate storage use. The second bedroom has two (2) double beds with clean linens, table, lamps, and a wall mounted television. LPA Dear observed two full bathrooms (downstairs), to have a tub and shower combo, toilet and sink. The water temperature was measured and found to be within safe temperatures, (at 105) Fahrenheit. LPA Dear observed the upstairs bedroom with two (2) double beds with clean linen, a (6), six dresser drawer, tables, lamps, with a full bathroom attached. Adequate closet space for storage was also observed. LPA Dear observed (8), eight working smoke/ carbon monoxide detectors. LPA Dear requested the detectors to be activated for testing. All units were confirmed operational. LPA Dear observed the facilities emergency drill log with dates and participants listed. All windows were in good repair with screens and blinds attached. LPA Dear observed the facility to have four (4) fire extinguishers, fully charged and wall mounted. The facility has a pool with a self latching locked gate. The gate's height was within compliance requirements. LPA observed the facility exterior grounds to be landscaped, well maintained and clear of all clutter, obstruction or debris. LPA reminded Matt Cox of reporting requirements. LPA Dear observed the facility to be clean, safe and sanitary. An exit Interview was conducted, and a copy of this report was provided to facility Elnaz Mayeh/ Executive Director and Matt Cox/Program Director.

report_type: Facility Evaluation

visit_type: Annual

met_with: Elnaz Mayeh- Executive Director & Matt Cox- Assistant Director


summary: Facility Evaluation

raw_content:
Narrative:
On 12/31/2025, Licensing Program Analyst (LPA) Andrea Aceves made an announced visit to Key Treatment 1, LLC for the purpose of a Case Management- Deficiency and met with Primary Therapist Nonna Milyavskaya. During the course of investigating complaint #34-CR-20251209093224, it was determined that on 11/27/25 a physical altercation between clients took place where one of the clients required medical attention. The licensee did not report this incident to Community Care Licensing as required. Note: LPA informed staff updating the facility program statement to reflect the use of RELIAS for staff training and to submit updates to LPA. Due to facility failing to report incidents in a timely manner per regulations a deficiency is being cited. See LIC 809D. Exit interview completed and copy of the report and appeal rights were emailed to Primary Therapist Nonna Milyavskaya.

visit_type: Case Management

met_with: Nonna Milyavskaya-Primary Therapist


summary: Facility Evaluation

raw_content:
Narrative:
On 02/10/26, at 1:10pm, Licensing Program Analyst (LPA) Andrea Aceves made an unannounced visit to the above facility for the purpose of a Case Management- Deficiency and met with Program Director Elayna Bray. While conducting a complaint investigation (34-CR-20251209093224), LPA had requested a copy of the LIC500-Personnel Report. LPA Andrea reviewed the Personnel Report, Guardian roster and an exemption letter dated 12/18/25. LPA advised Program Director Elayna Bray that Staff #1 was not cleared and associated per licensing regulations. LPA reminded Elayna Bray that all staff working in the home must obtain a criminal record clearance and be associated to the facility prior to working in the home. Due to staff not having a background clearance or exemption prior to working at the facility a deficiency is being cited. See LIC 809D. Exit interview completed and copy of the report and appeal rights were provided to Program Director Elayna Bray.

met_with: Program Director-Elayna Bray


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Based on interviews, there were conflicting statements if staff made the necessary interventions to avoid further escalation when a client was making inappropriate comments to other clients in care. In addition, conflicting statements cannot confirm if staff are recording and maintaining client medication records accurately. Per interviews, LPA reviewed and confirmed that staff are trained on how to administer medication, and a nurse is available should staff have any concerns or questions during medication dispensing. As a result, this investigation is being closed. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur, therefore, the allegations are unsubstantiated. Exit interview was completed and copy of the report and appeal rights were discussed and provided to Program Director Elayna Bray. On 01/15/26, LPA observed in a small Urine Analysis refrigerator several urine samples dated 12/30/25 that have not been disposed of and were not properly labelled or recorded. Based on interviews, LPA was able to confirm that clients were left unsupervised during an incident on 11/27/25, where clients engaged in a physical altercation which resulted in a client receiving medical attention. LPA reviewed medical records and observed that a client was not being given their medication as prescribed. Therefore, the allegations of (1) Staff failed to provide adequate supervision of youths, which resulted in a physical altercation between multiple residents, (2) Staff do not administer youths' medications as prescribed and urine samples being stored in the refrigerator for extended periods and not properly recorded or disposed of are SUBSTANTIATED. Per Title 22, Article 6, Section 84065.2(b)(1)-Personnel Duties and Article 3, Section 80022(k)-Plan of Operation are being cited. (See LIC9909D). Exit interview was completed and copy of the report and appeal rights were discussed and provided to Program Director Elayna Bray.

Investigation Findings:
13On 02/10/26, at 1:10pm, Licensing Program Analyst (LPA) Andrea Aceves made an unannounced visit to the above facility to conclude the investigation and to deliver the findings on the above allegations. LPA Andrea met with Program Director Elayna Bray. During the investigation, LPA Andrea interviewed all available parties and reviewed LIC500-Personnel Report, client rosters, Needs and Services plan, medical logs and pictures of food storage cabinets and refrigerator. It was reported that (1) Staff failed to provide adequate supervision of the youths, which resulted in one youth making inappropriate comments toward another youth; (2) Staff do not ensure accurate resident records are maintained; (3) Staff are not properly trained. In addition, it was reported that clients are being served expired food. Based on interviews, there was insufficient evidence to support the allegations. During the initial visit on 12/17/25, LPA observed that the food in the food cabinets and refrigerator had future expiration dates. Also, any leftover food in containers were clearly labelled with a date. Per interviews, staff remove any food that is expired on a weekly basis. See LIC9099-C. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Andrea Aceves 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 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: KEY TREATMENT 1, LLCFACILITY NUMBER: VISIT DATE: 02/10/2026

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

report_type: Complaint Investigation

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On March 20, 2026 at 11:35am, Licensing Program Analyst (LPA) Emelyn Sanchez P. arrived at Key Treatment 1, LLC for the purpose of conducting an Annual/Required inspection visit. LPA Sanchez P. met with Elayna Bray, Program Director and was granted access into the facility. LPA Sanchez P. toured the interior and exterior of the facility. The facility is a private pay treatment program licensed to provide care and supervision services to six (6) children, ages 12-17 years old, ambulatory only. There is a swimming pool on the premises which meets licensing requirements. The census at the time of the inspection was (6). The facility is a two-story home with 4 bedrooms, 3 and a half-bathrooms, a living room, dining room, kitchen, den, laundry space, two office spaces, and a backyard. The facility is set up as follows: Living room: is furnished with a sofa and two chairs as well as a covered fireplace that is not currently being used. Dining room: is furnished with a wooden table and seven (7) chairs. Kitchen: is equipped with a gas operated 6-burner stove that includes a 2 burner-grill, a microwave, refrigerator/freezer, a dishwasher, and a pantry. Bedrooms: 4 bedrooms are used for clients and all rooms are furnished with beds, have closet space, working lights, and windows. Report Cont. on LIC 809-C. Pg. 1 of Den: is furnished with a sectional sofa with two chairs, and a covered fireplace that is not currently being used. Laundry Space: is equipped with a washer and a dryer. The medications are also stored inside a locked cabinet in the laundry space. Two Office Spaces: One office space is located downstairs and the other is located upstairs. Backyard: is equipped with outdoor seating furniture as well as a volley ball net and miniature golf. Pool: is located in the backyard and is equipped with the required 5-foot fence, that does not obscure the pool from view, and a self-closing latch. Bathrooms: The half bathroom is located at the left once entering the facility; the second full bathroom is located next to bedroom #1; the third full bathroom is located inside bedroom #2 and the fourth full bathroom is located inside bedroom #4 upstairs. All bathrooms were checked and found to be in good repair and working order. The hot water temperature was tested and found to be between 105-120 degrees (F). LPA Sanchez P. tested the carbon monoxide and smoke detectors and found them to be in working order. The facility has 4 fire extinguishers all in working order. The first Aid Kit is located inside the laundry space inside a cabinet and was found to be complete. The facility has a working telephone readily accessible. The food menu is posted in the kitchen area and facility has non-perishable foods for one-week, and perishable foods for two days, the facility has a private chef who prepares meals for clients in care. Clients are also provided with nutritious snacks between meals. Overall LPA Sanchez P. observed the facility to be clean, safe, sanitary and in good repair. The front yard and outdoor recreation area were clean and free of debris. Passageways were unobstructed. There are no firearms or dangerous weapons in the facility. There are no security bars on the windows. Temperatures in client rooms are maintained through central air and heating, and common areas were found to be between 68 - 85 degrees (F). Report Cont. on LIC 809-C. Pg. 2 of The facility operates within license conditions and limitations including capacity limitations. LPA Sanchez P. discussed and advised the Program Director to ensure the following: Children are allowed and encouraged to contact the licensing agency or the Foster Care Ombudsperson, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. Children are supported and encouraged to participate in extracurricular activities. LPA Sanchez P. reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. All posting requirements for Group Home Licensure and Emergency Plan were met. LPA was provided with a copy of the Personnel Report (LIC 500) and Client Register (LIC 9020). LPA will return at a later date to review client and staff records. There are no deficiencies observed or cited at this time during this inspection. An exit interview was conducted with Elayna Bray, Program Director and a copy of this report was left at the facility. Pg. 3 of 3

met_with: Elayna Bray, Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On March 24, 2025 at 2:07pm Licensing Program Analyst (LPA), Emelyn Sanchez P. made an unannounced visit to Key Treatment 1, LLC for the purpose of conducting a Follow-up Case Management- Incident visit regarding a medication incident. LPA Sanchez P. met with Elayna Bray, Program Director to discuss the incident. The special incident report was reported to the Department on 03/13/2026. The incident occurred on 03/06/2026. The incident stated that the child was not taking their prescribed psychotropic medication but was saving their medication to get high later. The incident report also stated that other clients in care had snorted the medication. During this visit, LPA Sanchez P. conducted confidential interviews with a staff and client in care. LPA Sanchez P. requested copies of the Personnel Report (LIC 500) and Client Register. LPA Sanchez P. also obtained copies of the medication training provided to staff. Based on interviews and information gathered no deficiencies are being cited at this time. LPA Sanchez P. will return to continue the investigation. Exit interview was conducted, and a copy of this report was provided to Elayna Bray, Program Director.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
This is an Amended Report Form Lic Dated 03/24/2026. On March 24, 2026 at 9:25am, Licensing Program Analyst (LPA) Emelyn Sanchez P. made an unannounced visit to Key Treatment 1, LLC for the purpose of conducting a Case Management- Annual Continuation Inspection visit. LPA Sanchez P. met with Elayna Bray, Program Director. LPA Sanchez P. was granted access to the facility. The facility keeps staff and client files and documents in digital systems called KIPU and ADP. LPA reviewed the following records during the inspection: Client Records: The program currently has a total of four (4) clients. LPA Sanchez P. reviewed three (3) client records and found each record to meet licensing requirements. Staff Records: The program currently has a total of twenty-six (26) staff. LPA reviewed a total of three (3) staff records and confirmed files contained staff qualifications, current CPR/First Aid cards, health screening, and TB test results. LPA Sanchez P. obtained the LIC 500 to verify staff to client ratio. LPA Sanchez P. reviewed the Facility Profile and Personnel Report and confirmed that personnel have required criminal record clearance: DOJ, FBI and Child Abuse; which meet licensing requirements. LPA Sanchez P. conducted interviews with two (2) clients and a total of two (2) staff. The following deficiency are being cited for violating California Code of Regulations Title 22, Division Regulation Personnel Requirements. (see page D). LPA Sanchez P. also issued a technical violation and two technical advisories. An exit interview was conducted with Elayna Bray, Program Director and a copy of this report was left at the facility.

Deficiencies:
84065(i): Personnel Requirements

(i) Notwithstanding Sections 80065(f)(1) through (6), new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training as specified in (1) and (2) below


summary: Facility Evaluation

raw_content:
Narrative:
On April 16, 2026 at 9:35am Licensing Program Analyst (LPA), Emelyn Sanchez P. made an unannounced visit to the above facility to deliver the findings from a Follow-up Case Management- Incident visit conducted on March 24, 2026. LPA Sanchez P. met with Elayna Bray, Program Director. During the investigation, LPA Sanchez P. conducted interviews with all available parties and gathered pertinent information in reference to the Case Management- Incident visit. LPA Sanchez P. reviewed the LIC 500- Personnel Report, Client Roster, prescription order, psychotropic medication administration record, and a copy of the medication training provided to staff. The incident occurred on 03/06/2026 and the report was received on 03/13/2026. Based on confidential interviews conducted with staff, clients and collateral contacts as well as reviewed documentary evidence regarding the medication incident, LPA Sanchez P. was able to confirm that Client #1 was indeed not taking their medication which resulted in other clients in care finding the hidden medication to then engage in crushing and snorting of the prescribed psychotropic medication. Statements obtained revealed that there was one staff person providing care and supervision to six (6) clients at the time of the incident. Additionally, LPA Sanchez P. reviewed a previously submitted plan of correction submitted to the Department on 03/06/2026 stating that the facility would implement adequate coverage of 1:3 staffing ratio which was not in place at the time of the incident. Lastly, LPA Sanchez P. reviewed the facilities medication procedure which states that staff administering medication to the client(s) needs to immediately retrieve the medication cup from the client(s) which did not occur during the medication incident as the client was able to pocket their prescribed medication. Report Cont. on LIC 908-C. The following deficiencies are being cited for violating California Code of Regulations Title 22, Division 6, Chapter Regulation 80061 (a) Reporting Requirements; Chapter Regulation 84065 (a)(b)(d) Personnel Requirements and 84065. Personnel Duties (b)(1) (see page 9099D). Exit interview was completed and copy of the report and appeal rights were discussed and provided to Elayna Bray, Program Director.


facility_name: KIDS FIRST ALBORADA

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Lourey Bartolome conducted a follow-up complaint investigation inspection and met with Facility Manager Amanda Chairez. The purpose of the inspection was to deliver the findings for the above complaint allegations. Based on the interviews and review of documentation, there are inconsistencies in explanations of the above allegations. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove the above-mentioned allegations. Therefore, the allegations are unsubstantiated. There are no deficiencies to be cited at this time. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Melanie Krage LICENSING EVALUATOR NAME: Lourey Bartolome 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: Amanda Chairez


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Lidia Tinoco conducted an unannounced visit to the Kids First Alborada Group Home in Visalia in order to deliver the findings of the above allegations and met with Amanda Chairez, Administrator. On July 8, 2021 the above allegation was referred to Community Care Licensing for investigation. The investigation included interviews, facility inspection and a review of facility and children's records. The complaint alleged that group home staff inappropriately restrained youth. Based on the interviews conducted and the information reviewed there is not a preponderance of evidence to prove the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED at this time. A copy of this report was discussed and provided to Amanda Chairez along with appeal rights. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Lidia Tinoco 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 2


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Lidia Tinoco conducted an unannounced visit to the Kids First Alborada Group Home in Visalia in order to deliver the findings of the above allegations and met with Amanda Chairez, Administrator. On June 30, 2021 the above allegation was referred to Community Care Licensing for investigation. The investigation included interviews, facility inspection and a review of facility and children's records. The complaint alleged that a child in placement received an unexplained bruise while in care. Although the minor did have a bruise, there is no evidence to show how it happened. Therefore, the allegation is UNSUBSTANTIATED at this time. A copy of this report was discussed and provided to Amanda Chairez along with appeal rights. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Lidia Tinoco 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 2


summary: Facility Evaluation - 4 deficiencies

raw_content:
Narrative:
An unannounced annual inspection was conducted by Licensing Program Analysts (LPA's) Lidia Tinoco, Cynthia Galindo, and Vanessa Galvan traveled to Kids First Alborada in Visalia, CA. LPA's met with Administrator Amanda Chairez and inspected the facility, inside and out. A physical plant inspection was completed and included the following checks. Adequate indoor and outdoor activity space and materials observed. The facility is maintained at 75 degrees. All facility smoke detectors are in appropriate working order, fire extinguisher is properly charged and serviced. Facility maintains an adequate supply of perishable and non-perishable foods. All required forms are posted. Medications are locked and centrally stored. Individual beds were observed. No firearms or weapons are allowed in the facility. Fence surrounding the pool is in compliance. There are no pets at the facility. LPA's reviewed client files and conducted staff. Client interviews were not conducted due to the client being non-verbal. Deficiencies were cited on todays visit, see LIC809-D. A copy of this report was left at the facility at the conclusion of inspection.

Deficiencies:
80019(e): Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility
84361(f): Documentation and Reporting Requirements

(f) The licensee must maintain a monthly log of each use of manual restraints. The log must include
80066(a): Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information
84066(b): Personnel Records

(b) The licensee shall maintain the following personnel records


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analysts (LPA's) Lidia Tinoco and Vanessa Galvan traveled to the Kids First Alborada Group Home for the purpose of conducting a POC visit to make sure all of the appropriate corrections were made. LPA's met with facility manager, Ernest Ratcliff. LPA's conducted a facility walk through and file review of staff and client files. LPA's confirmed that all of the corrections were made and gathered copies of pertinent documentation. No deficiencies were cited or observed on today's visit. A copy of this report was left at the facility with Ernest Ratcliff at the conclusion of the inspection.

met_with: Ernest Ratcliff


facility_name: KIDS TO KIDS - FAITH HOUSE

raw_content:
Investigation Findings:
13On 2/12/24, at 9:45 am, Licensing Program Analyst (LPA) Nestor Gomez made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegations and deliver the findings. LPA spoke with Facility Manager, Madison Pennigton and together, discussed the investigative findings. During the investigative process by Licensing program Analyst (LPA), Nestor Gomez, all relevant parties have been accounted for and interviewed. During the confidential interviews, the validity of the allegations could not be determined. The parties interviewed either confirmed or denied the allegations. Staff/client accounts of the incident were conflicting. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nestor Gomez 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

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

met_with: Madison Pennington - Facility Manager


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13On August 26, 2025, at 12:14PM Licensing Program Analyst (LPA), Rosslyn Gray contacted the Licensee to conclude the complaint investigation. During the investigation, LPA Gray interviewed all available parties and reviewed documentary evidence. Confidential statements and an internal investigation determine that staff did not follow program protocol to prevent inappropriate behaviors between minors and resulting in a minor being sexually assaulted. Statements indicate that clients were not properly supervised, and there was no documentary evidence to support that 15-minute room checks were conducted. Due to the evidence obtained during the investigation, LPA determined that the allegation is substantiated, meaning that the preponderance of the evidence standard has been met. Per California Code of Regulations, Title Division Six, regulation 80078 (a): Responsibility for Providing Care and Supervision. Staff did not provide care and supervision that met the needs of clients in care. An exit interview was conducted, appeal rights provided, and a copy of this report was emailed to the Administrator, David Yasutake. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray 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 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: KIDS TO KIDS - FAITH HOUSEFACILITY NUMBER: 565802328

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

met_with: Administrator, David Yasutake

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
On 5/24/23 at 10:00am, Licensing Program Analyst (LPA) Christine Wilson conducted an announced, prelicensing inspection. LPA Wilson met with the applicant, David Yasutake, Facility Manager Chris Thompson and Assistant Manager Xiomara Lopez. The proposed facility will provide care and supervision for 6 ambulatory only female children, ages 12 through 17 years old. The facility is one-story home which contains three (3) bedrooms, and two (2) bathrooms. The home has a fully equipped kitchen and a spacious living room and dining room, that can be utilized as a multipurpose room for homework and activities. The front yard, and side yard was observed to be secure with a cement fence 7ft in height , free of obstructions, and neat. The facility maintains one facility vehicle, Honda Odyssey not at the facility at the time of the inspection. There are (2) charged fire extinguishers through the facility, last inspected on 3/25/23. (1) Carbon monoxide and (5) smoke detectors were tested and fully functioning. Detergents and cleaning supplies were observed to be locked and inaccessible to minors. Medication closet located in staff office was observed to be secured and inaccessible to minors. Facility files will be maintained within the staff office. LPA observed the following during inspection: Living Room: the living room is a large open space that functions as a area for relaxation, with plenty of seating for 8+ people, a TV will be purchased, books and games are available and a functioning window is without a screen .There is a working smoke detector and a carbon monoxide detector in this space Dining Area: Has a table with seating for (4) as well a a bar with seating for (4) with cabinet space. Kitchen: equipped with a stove (2) burners, microwave, oven, refrigerator, plenty of cabinet space, and enough plates/cups/utensils for all clients. Trash cans are covered. Dishwashing machine is in working order and will not be used. Hallway: The hallway has a (1) linen closet and maintains enough linen and towels for all residents. There is a working smoke detector in this space. (Continued on 809C) Bedroom #1: Is adjacent to the living room, will be occupied by two clients with two twin size beds, dressed with clean linens, on each side of the room. There are adequate closets and (2) drawers (2). The bedroom does not serve as a passageway to any other part of the facility. Bedroom #2: will be occupied by two clients with two twin size beds, dressed with clean linens, on each side of the room. There are adequate closets (2)and (2) drawers. There is a functioning smoke alarm. The bedroom does not serve as a passageway to any other part of the facility. Bedroom #3 :will be occupied by two clients and maintain two twin beds, There is adequate closet (1) and (2) drawers. There is a functioning smoke alarm.. There is no window screen. Bathrooms- there are two (2) bathrooms throughout the facility, each with operational plumbing and running water that meets temperature requirements. Peach bathroom is shared with Bedroom 3 and staff. Blue bathroom is used for Bedrooms 1&2. Outdoor Space- the outdoor space has concrete. The Licensee communicates that it will be used " for clients to come outside and paint" There is a gazebo structure, with an empty, non-functioning covered spa. Laundry: located in the driveway area in a open shed and equipped with a washer and dryer in working order, Laundry detergents and cleaning supplies are kept in locked hallway closet and are inaccessible to clients without supervision. Backyard - there is an enclosed cement fence that extends around the perimeter of the facility that meets height requirements. There is no body of water on the premises. The front and side of the facility appeared clean and orderly with no hazards. Medication station- medications will be stored in a locked cabinet, in a closet in the staff office. The policy for medication administration will be posted on the inside of the door and was reviewed by LPA. Medication boxes were kept locked within the locked cabinet, with a standard key lock. Staff office- this office is located near the driveway and has laptops, a desk, and chairs. This space will be utilized for staff to conduct administrative duties, and where client records will be stored. LPA observed that door does lock. This area also functions to hold locked storage space for sharps, cleaning supplies, hygiene supplies and extra bathroom linen. There is no additional bathroom designated for staff. Licensee indicates that Bathroom #2 will be used by staff and clients. An exit interview was conducted, and a copy of this report was discussed emailed to the licensee.

visit_type: Prelicensing

met_with: Facility Administrator


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 09/22/23 at 9:51am, Licensing program Analyst (LPA) Christine Wilson and Licensing Program Analyst Jhane Haynes visited the above listed facility and met with AM. The purpose of the visit is to conduct a post-licensing inspection. This facility is licensed to provide care and supervision for 6 ambulatory only female children, ages 12 through 17 years old. The facility is one-story home which contains three (3) bedrooms, and two (2) bathrooms. The home has a fully equipped kitchen and a spacious living room and dining room, that can be utilized as a multipurpose room for homework and activities. The front yard, and side yard was observed to be secure with a cement fence 7ft in height , free of obstructions, and neat. The facility maintains one facility vehicle, Honda Odyssey not at the facility at the time of the inspection. There are (2) charged fire extinguishers through the facility, last inspected on 3/25/23. (1) Carbon monoxide and (5) smoke detectors were tested and fully functioning. Detergents and cleaning supplies were observed to be locked and inaccessible to minors. Medication closet located in staff office was observed to be secured and inaccessible to minors. Facility files will be maintained within the staff office. LPAs observed the following during inspection: Living Room: the living room is a large open space that functions as a area for relaxation. There is a new couch with plenty of seating for 8+ people, a TV will be purchased, books and games are available and a functioning window is still without a screen .There is a working smoke detector and a carbon monoxide detector in this space Dining Area: Has a table with seating for (4) as well a a bar with seating for (4) with cabinet space. Kitchen: equipped with a stove (2) burners, microwave, oven, refrigerator, plenty of cabinet space, and enough plates/cups/utensils for all clients. Trash cans are covered. Dishwashing machine is in working order and will not be used. Water temperature is 111 degrees. Hallway: The hallway has a (1) linen closet and maintains enough linen and towels for all residents. There is a working smoke detector in this space. (Continued on 809C Page 2) Bedroom #1: Is adjacent to the living room, will be occupied by two clients with two twin size beds, dressed with clean linens, on each side of the room. There are adequate closets and (2) drawers (2). The bedroom does not serve as a passageway to any other part of the facility. Bedroom #2: will be occupied by two clients with two twin size beds, dressed with clean linens, on each side of the room. There is a new area rug. There are adequate closets (2)and (2) drawers. There is a functioning smoke alarm. The bedroom does not serve as a passageway to any other part of the facility. Bedroom #3 :will be occupied by two clients and maintain two twin beds, There is adequate closet (1) and (2) drawers. There is a functioning smoke alarm.. There is still no window screen. Bathrooms- there are two (2) bathrooms throughout the facility, each with operational plumbing and running water that meets temperature requirements. Peach bathroom is shared with Bedroom 3 and staff. Blue bathroom is used for Bedrooms 1&2. Water temperature is 111 degrees. Outdoor Space- the outdoor space has concrete. The Licensee communicates that it will be used " for clients to come outside and paint" There is a gazebo structure, with an empty, non-functioning covered spa. There are wires dangling from the building that pose a safety risk when clients are in care. AM stated he will find a way to secure wires to mitigate safety risk. Laundry: located in the driveway area in a open shed and equipped with a washer and dryer in working order, Laundry detergents and cleaning supplies are kept in locked hallway closet and are inaccessible to clients without supervision. Backyard - there is an enclosed cement fence that extends around the perimeter of the facility that meets height requirements. There is no body of water on the premises. The front and side of the facility appeared clean and orderly with no hazards. Medication station- medications will be stored in a locked cabinet, in a closet in the staff office. The policy for medication administration will be posted on the inside of the door and was reviewed by LPA. Medication boxes were kept locked within the locked cabinet, with a standard key lock. Staff office- this office is located near the driveway and has laptops, a desk, and chairs. This space will be utilized for staff to conduct administrative duties, and where client records will be stored. LPA observed that door does lock. This area also functions to hold locked storage space for sharps, cleaning supplies, hygiene supplies and extra bathroom linen. There is no additional bathroom designated for staff. Licensee indicates that Bathroom #2 will be used by staff and clients. There is a functioning smoke alarm. (Continued on 809C page 3) LPA Wilson and LPA Haynes inspected the following: Conducted a review of staff records, Program Statement, Plan of Operation and Emergency Plans. LPAs conducted a staff interview with (AM). There are no clients residing in the facility at this time. Core Theraputic Services: No clients receive core theraputic, psychiatric and medical services, as part of their needs and services plan. There are no clients in care Special Health Care Needs:There are no clients with special health care . There are no clients in care PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Chapter 7. Version 3, The following deficiencies were cited at this time. Six (6) Technical Advisories will be given on this day.(See LIC809-D) ILS 87072(c)(6)(A ILS 87072(c)(6)(B ILS 87087.2(a) ILS 80066(a)(8) ILS 87065.1(d)(1)(A) ILS 87065.1(d)(1)(D)(4) Three (3) Type B violations will be given on this day. (See LIC809-D) An exit interview was conducted, and a copy of this report was discussed emailed to the licensee.

Deficiencies:
80075(h): Health-Related Services

(h) There shall be at least one person capable of and responsible for communicating with emergency personnel in the facility at all times. The following information shall be readily available

met_with: Facility Assistant Manager (AM)


summary: Facility Evaluation

raw_content:
Narrative:
On March 29, 2024 at 10:00am, a Non-Compliance Conference Meeting was held virtually, with the El Segundo Regional Office. Those In attendance were: · Regional Manager (RM), Kellee Coleman · Licensing Program Manager (LPM), Kevin Sauk · Licensing Program Analyst (LPA), Christine Wilson · CEO/Administrator, David Yasutake · Facility Manager, Chris Thompson · Facility Manager, Madison Pennington · Assistant Manager, Vanessa Duarte The office meeting was called to discuss the Licensee's attempts and efforts at obtaining a Mental Health Program Approval (MHPA), in order to determine whether an extension shall be provided for the provisional license. RM Coleman provided an overview of Community Care Licensing's (CCL's) history of support towards the licensee. Kids to Kids has not yet been able to obtain a MPHA, and discussions with CCL's legal department will explore whether the Licensee will be able to extend their provisional license expiration date. The meeting included a discussion of the attempts and challenges the Licensee has been facing with regard to obtaining an MPHA, and with staffing. Continued on 809C page 2 of 2. Page The licensee (CEO) agreed to the actions specified below: Licensee is to Provide LPM and LPA weekly contact with updates each Friday. Licensee is to continue communications with DHCS and Kern County. Licensee is to explore other facility types. Licensee is to send CCLD update and/or copy of CARF Accreditation Approval. Licensee is to ensure all staff are associated to this facility through the use of Guardian. The Regional Office can support with association transfers. Licensee is to submit a closure plan if the Licensee is unable to obtain a MPHA approval by the 12-month expiration date. This meeting ended at 11:22am. Exit interview completed, and a copy of this report was emailed to the Licensee.

met_with: Licensee - David Yasutake


summary: Facility Evaluation

raw_content:
Narrative:
On 05/31/24 at 09:50AM Licensing Program Analyst (LPA) Jhane Haynes made an unannounced visit to the above facility for the purpose of conducting annual inspection. LPA met with Madison Pennington (FM) who granted access to the facility and provided tour of the home. It is a three bedroom and two bathroom home in a residential area. LPA observed the following: Office is inaccessible to clients unless allowed for 1:1 or privacy. It contains desk, chairs, client hygiene boxes,two exterior exits,staff fridge, secured freezer for extra food stock, board with client and facility information. It also contains a secured closet that holds client medications, sharps, extra hygiene products, client files and electronics. Hall connects both bathrooms and two bedrooms. The wall contains emergency contact numbers, complaint procedures, personal rights and license. It also contains a secured closet that contains cleaning supplies. Bathroom #1 is called the peach bathroom containing functional toilet, sink and tub/shower combo. Bedroom #1 rooms C2 and contains two twin beds, two dressers and closet. Bathroom #2 is called the blue bathroom and contains functioning toilet, sink, and tub/shower combo. Bedroom#2 rooms C3 and contains two twin beds, 2 dressers, and closet. Kitchen/Dining Area contains operational kitchen appliances table and adequate seating for clients during meal times. Menu is posted on fridge. Fridge maintains perishables for at least two days. Cabinets maintain non-perishables for up to a week, adequate plating and silverware for clients. There is an exterior exit. Bedroom #3 rooms C1 and C4. It contains two twin beds, dresser, shelf, three closets and desk. Living Room contains two couches, TV, and shelf with books and games. There are two exterior exits. Exterior is free of debris and contains utility shutoffs. Laundry appliances are stored on side of the home and functional. Facility utilizes Chevrolet Tahoe with current registration and insurance to transport clients. (Continued on LIC809-C) Due to time constraints. LPA will return to complete file review. No deficiencies will be cited today. An exit interview was conducted and a copy of this report was left at the facility.

met_with: Madison Pennington (Facility Manager)


summary: Facility Evaluation

raw_content:
Narrative:
On 05/31/24 at 09:50AM Licensing Program Analyst (LPA) Jhane Haynes made an unannounced visit to the above facility to conduct a case management inspection for the purpose of documenting deficiency observed 04/30/24. LPA met with Madison Pennington (FM) who granted access to the facility. On 04/30/ It was observed during initial complaint inspection that 11 out of 17(S1-S11) staff did not obtain criminal record clearance. Per Title Division Chapter 1, one deficiency will be cited. See LIC809-D for details. A copy of this report and appeal rights were left at the facility.

met_with: Madison Pennington Facility Manager (FM)


facility_name: KIDS TO KIDS - SERENITY HOUSE

summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
continued from 9099 page It was reported that FM stated the PO said to keep C1 home from school so that they wouldn't have to track C1 at school, and in other interviews it was communicated by FM with management and staff that the PO said to keep C1 home. Based on confidential interviews, and a review of supportive documentation AGPA Woodard could not corroborate that the PO requested C1 to stay home from school in order for the PO to take C1 into custody. The facility violated C1s's personal rights by not allowing C1 to go to school and also telling C1 false information in order to keep C1 at the facility while the PO was enroute to take C1 into custody. Therefore, the preponderance of the evidence standard has been met, and the Department has determined the finding is substantiated and a citation will be documented on the LIC 9099D. An exit interview was conducted, a copy of this report, LIC 9099D, and appeal rights were left at the facility.

Investigation Findings:
13On January 20, 2023 at 3:50 p.m., Associate Governmental Program Analyst (AGPA) Tonya Barnes-Woodard conducted an unannounced complaint inspection at Kids to Kids - Serenity House for the purpose of delivering the findings. Upon arrival, AGPA Woodard was greeted by Geniveve Heikes. AGPA Tonya L. Barnes-Woodard was assigned the complaint on December 2, 2022. During the investigation process, AGPA Woodard conducted confidential interviews with staff, clients and C1's Probation Officer. C1 refused to be interviewed. AGPA Woodard reviewed supportive documentation which revealed that C1 did miss school on a few days due to not waking up and/or being ill. The PO states that the facility told PO that they would be keeping C1 home from school and the PO was under the impression that C1 wasn't feeling good the day PO prearranged to pick C1 up. ***continue on 9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard 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 31-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, FACILITY NAME: KIDS TO KIDS - SERENITY HOUSEFACILITY NUMBER: VISIT DATE: 01/20/2023

met_with: Geniveve Heikes


raw_content:
Investigation Findings:
13On March 7, 2023 at 9:20am Licensing Program Analyst (LPA) Nancy O'Connell made unannounced inspection to the above said facility for the purpose of concluding the investigation on the above allegation and deliver the finding. LPA O'Connell met with FM and discussed the investigative finding. On 11/29/22, the Department received a complaint alleging that minor did not receive therapeutic services while in care. During the investigative process, LPA O'Connell conducted confidential interviews with all relevant parties and collected information on the above allegations. After reviewing all the statements and the information obtained, the above allegation is supported, as the confidential interviews confirmed that the minor was transferred to the above facility, at which time, was not enrolled into therapeutic services. Further confidential interviews revealed that the facility did not retain records that could confirm the provision of therapeutic services during the time that the minor was residing in the facility. Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, one deficiency is being cited on the attached LIC 9099D Exit Interview conducted, and sent copy of this report was sent to the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell 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 31-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, VENTURA BLVD., STE. WOODLAND HILLS, CA FACILITY NAME: KIDS TO KIDS - SERENITY HOUSEFACILITY NUMBER: 565802325

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

met_with: Madison Pennington, Facility Manager (FM)


raw_content:
Narrative:
--Continued from page LIC9099-- Confidential statements and record review revealed a lack of evidence to prove the alleged as information obtained indicates denial of claims that former residents were given tobacco vape pens and marijuana wax pens by facility employees. Facility staff denied providing vape pens, wax pens, alcohol or any other contraband to the residents and no evidence to support the allegations was uncovered. Based on information from confidential statements and record review, the allegations concerning Staff engaging in illegal activities with minors and that Staff are purchasing substances for minors cannot be substantiated due to a lack of evidence. The findings are therefore determined Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies cited per Short-Term Residential Therapeutic Program Interim Licensing Standards or California Code of Regulations, Title 22, at this time. Exit interview completed. A copy of this report and LIC811 was provided to the Facility Representative

Investigation Findings:
13On June 9, 2023, at 1: PM, Licensing Program Analyst (LPA) Regina Martin conducted a follow-up complaint inspection to deliver findings from the Department's investigation. LPA met with Facility Representative, Madison Pennnington Facility Manager to discuss the outcome. On June 22, 2022, Community Care Licensing Division (CCLD) received allegations that Staff engaged in illegal activities with minors and that Staff purchased substances for minors while in care at the facility. The allegation was referred to CCLD Investigations Bureau, Investigator Douglas Real. On June 30, 2022, LPA Kuliema Calloway and Licensing Program Manager Kevin Sauk conducted the initial complaint inspection and met with the facility Administrator. The investigation included confidential interviews of current and former youth residents, staff members and related parties, as well as review of facility file history. (Continued on page LIC9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin 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 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY NAME: KIDS TO KIDS - SERENITY HOUSEFACILITY NUMBER: VISIT DATE: 06/09/2023

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

met_with: Madison Pennnington Facility Manager


raw_content:
Investigation Findings:
13On October 11, 2023 at 1:25 pm, Licensing Program Analyst (LPA) Christine Wilson made an unannounced inspection to the above listed facility, and met with the Facility Manager(S1), for the purpose of concluding the investigation, and delivering findings on the above allegation. Based on the confidential interviews conducted during the investigation process, record review, statements obtained, LPA Wilson concluded the allegation: Staff did not ensure that minor had fair and equal access to placement at the facility is unsubstantiated. During the investigative process by Licensing Program Analyst (LPA), Christine WIlson, victim could not be located, therefore all relevant parties could not be accounted for. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. There are no deficiencies to be cited, at this time, regarding the above allegations. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Christine 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 1

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

met_with: Facility Manager


raw_content:
Investigation Findings:
13On November 9, 2023 at 12:53pm, Licensing Program Analyst (LPA) Christine Wilson made an unannounced inspection to the above listed facility, Kids to Kids Serenity House STRTP, for the purpose of concluding the investigation on the above allegation. The investigation included confidential interviews with client, social worker, facility and administrative staff across various licensed facilities. The licensee neglegted to take immediate action, for client (C1), by not taking (C1) to the hospital after sdtaff discovered client was under the influence of drugs. Based on all interviews conducted, and documents obtained, the Department has found the above allegation to be substantiated, meaning that, the preponderance of the evidence has been met. A Type a violation is given this day An exit interview was conducted, and appeal rights were discussed. A copy of this report, and appeal rights were provided to Facility Administrator. (Continued on page LIC9099-D) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Christine 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 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION WOODLAND HILLS S.Ro, Ventura Blvd., STE. WOODLAND HILLS, CA FACILITY NAME: KIDS TO KIDS - SERENITY HOUSEFACILITY NUMBER: 565802325

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


raw_content:
Narrative:
(9099C Pg.2) The facility is issued a citation in accordance with the California Code of Regulations, Title 22, Division 6, Chapter 1, Personal Rights [See page LIC9099-D for cited deficiencies]. An exit interview was conducted, and appeal rights were discussed. A copy of this report, and appeal rights were provided to the Facility Manager and emailed to Facility Administrator. (Continued on page LIC9099-D)

Investigation Findings:
13On November 9, 2023 at 12:53pm, Licensing Program Analyst (LPA) Christine Wilson made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation and deliver the finding. LPA spoke with Program Manger (PM) and together, discussed the investigative finding. Further investigative processs by Licensing Program Analyst (LPA) Christine Wilson, included all relevant parties, and supporting evidence includes: interviews with administrative staff. Records review of section K of the Plan of Operation/Program Statement, Admissions Policies and Procedures, which states the licensee shall "ensure that there is no discrimination against any youth or NMD based on sexual orientation, gender identity or expression, religion, culture, race when considering clients for admission." Interview with the (PA) revealed the licencee normally does not admit biological males who identify as female. Based on the discrepancy between the licensee's program statement, and their intake practices, the allegation is substatiated SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Christine 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 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION WOODLAND HILLS S.Ro, Ventura Blvd., STE. WOODLAND HILLS, CA FACILITY NAME: KIDS TO KIDS - SERENITY HOUSEFACILITY NUMBER: VISIT DATE: 11/09/2023

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

met_with: Program Manager


raw_content:
Narrative:
Confidential statements and documentary evidence, including review of medical records determined Y1 overdosed on Fentanyl and recovered within two days after being admitted to the hospital. Y1 was then placed on watch by the hospital staff; however, Y1 was able to obtain drugs and overdosed a second time resulting in Y1's death. Based on gathered information obtained and reviewed, there is not enough evidence to support neglect/lack of supervision; therefore, the findings are determined Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There are no deficiencies per California Code of Regulations or Interim Licensing Standards (ILS) cited at this time. Exit interview completed. A copy of this report and LIC811 was provided to Facility Administrator by email for signature.

Investigation Findings:
13On April 9, 2024, at 4: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection at Kids to Kids - Serenity House to deliver findings concerning the above-mentioned allegation. LPA Martin spoke with David Yasutake, Administrator via telephone to discuss the investigative outcome. The investigation was conducted by Investigator Peter Zertuche of the Community Care Licensing Division (CCLD) Investigations Branch. The investigation, including confidential interviews of three residents, three staff members, Facility Manager, Youth #1's (Y1) assigned Social Worker, Therapist, assigned Detective, Ventura Police Department, review of Y1's records and review of related medical reports revealed on December 21, 2023, CCLD received a complaint allegation concerning neglect/lack of supervision related to Y1. Youth #1 was first placed at Kids to Kids - Serenity House on September 6. 2023. On December 6, 2023, CCLD received a self-reported incident indicating that on December 3, 2023, staff found Y1 at the facility at "6:06 am" of an apparent drug overdose. Y1 was unresponsive so 911 emergency was called. Staff performed Cardiopulmonary Resuscitation (CPR) until paramedics arrived then transported Y1 to the hospital where Y1 recovered. (Continued on page LIC9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin 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 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: KIDS TO KIDS - SERENITY HOUSEFACILITY NUMBER: VISIT DATE: 04/09/2024

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

met_with: Facility Representative


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegations. LPA Jones-Steward interviewed several staff, several witnesses and the alleged victim (C1). LPA also reviewed police reports and the facility's runaway plan. LPA did not find a Special Incident Report for this incident. During the course of the investigation LPA Jones-Steward determined that the staff on duty during the incident waited for several hours after the onset of C1's crisis to contact law enforcement and paramedics. Likewise it was determined that staff are not adhereing to the facility's runaway plan. Staff often waits in excess of an hour to report missing clients even though the runaway plan indicates that missing clients will be reported to law enforcement within 30 minutes. It was also determined that the facility had no clear plans for accompanying C1 to the hospital or supervising her while she was there. Based on information found during the investigation, the above allegations are resolved as substantiated, meaning that the "preponderance of the evidence" standard has been met. SubstantiatedEstimated 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 Control Number 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: KIDS TO KIDS - SERENITY HOUSEFACILITY NUMBER: 565802325

met_with: Madison Pennington, Facility Manager


raw_content:
Investigation Findings:
13On 06/26/2024 at 01:05PM Licensing Program Analyst (LPA) Jhane Haynes made an unannounced visit to the above facility for the purpose of concluding the investigation on the above allegations. LPA spoke with Facility Manager(FM) and together discussed the investigative findings. During the investigation, LPA Haynes interviewed and accounted for all relevant parties. Based on interviews conducted, it was reported that there are at least two staff on shift, and planned activities and outings for youth in care. Interviews also reflect that the facility initiates their AWOL procedures should a youth abscond from care and attempt to de-escalate if youth show signs before absconding. Statements to corroborate the above allegation could not be obtained. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. Therefore, the allegation is UNSUBSTANTIATED. There are no deficiencies to be cited at this time. An exit interview was conducted, and a copy of this report was emailed to the administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Jhane Haynes 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

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

met_with: Facility Manager(FM) Madison Pennington


raw_content:
Narrative:
During the confidential interviews, the validity of the allegations could not be determined. The parties interviewed either confirmed or denied the allegations. The Licensee stated that pest control was called to the facility and LPA observed traps during his on site unannounced visit. LPA observed mice droppings in the staff office office closet. LPA observed the vehicle to be properly maintained. However, at the time of inspection on 10/05/24 the registration of the vehicle expired on 9/20/2024. LPA could not determine the facility to be in financial distress based on the claims made in the referral. LPA observed the facility to have an appropriate amount of food for three clients that was not expired. Interviews revealed that clients were given options when being provided food and not limited on the amount they received. Based on the statements and documents obtained, the allegations are inconclusive, meaning that an investigation concluded that an allegation in a complaint is not substantiated or unfounded. There are no deficiencies cited at this time. Exit interview completed. A copy of this report was provided to Facility Administrator by email.

Investigation Findings:
13On 2/6/25, at 1:25pm, Licensing Program Analyst (LPA), Nestor Gomez conducted a follow-up complaint inspection at Kids to Kids - Serenity House to deliver findings concerning the above-mentioned allegation that was initiated on 10/16/2024. LPA spoke with Madison Pennington, Facility Manager who granted access to the facility. It was reported that facility is in financial distress, facility is serving unsanitary food to minors in care, facility is serving expired food to minors in care, staff are not serving an adequate amount of food portions to minors, licensee does not ensure facility is free from pests, and staff do not ensure vehicles transporting minors are properly maintained. Documents were reviewed and confidential interviews were conducted with the facility manager (FM1), clients, and relevant contacts. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nestor Gomez 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 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION WOODLAND HILLS S.Ro, Ventura Blvd., STE. WOODLAND HILLS, CA FACILITY NAME: KIDS TO KIDS - SERENITY HOUSEFACILITY NUMBER: VISIT DATE: 11/21/2024

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


raw_content:
Narrative:
There are no deficiencies cited at this time. Exit interview completed. A copy of this report was provided to Facility Administrator by email.

Investigation Findings:
13On 02/06/2025, at 1:25 pm, Licensing Program Analyst (LPA), Nestor Gomez conducted a follow-up complaint inspection at Kids to Kids - Serenity House to deliver findings concerning the above-mentioned allegation. LPA spoke with Madison Pennington, Facility Manager who granted access to the facility. It was reported that staff did not prevent minor from harming another minor in care. Documents were reviewed and confidential interviews were conducted with the facility manager (FM1), clients, and relevant contacts. During the confidential interviews, the details of the altercation between the clients involved was revealed. There was only one staff present at the time of the incident with the altercation involving two clients. Staff contacted emergency services and the facility manager. Staff was able to remove the fork from the client's posession, as well as separate the clients. Based on the statements and documents obtained, the allegations are inconclusive, meaning that an investigation concluded that an allegation in a complaint is not substantiated or unfounded. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nestor Gomez 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 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION WOODLAND HILLS S.Ro, Ventura Blvd., STE. WOODLAND HILLS, CA FACILITY NAME: KIDS TO KIDS - SERENITY HOUSEFACILITY NUMBER: VISIT DATE: 02/06/2025

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


raw_content:
Narrative:
Based on LPA interviews and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. The licensee is therefore issued a citation in accordance with the Group Home Interim Licensing Standards, Chapter 5 for violation of California Code of Regulations, Title Division Six, regulation ILS 80078 (a) Responsibility for Providing Care and Supervision The licensee shall provide care and supervision as necessary to meet the client's needs. Exit interview was conducted with the facility Administrator. A copy of this report was left with the facility administrator whose signature on this form confirm receipt of this document.

Investigation Findings:
On March 27, 2025, at 10: AM, Licensing Program Analyst (LPA) Justine Armstrong arrived at the facility to deliver the findings of a complaint investigation. LPA Armstrong met Madison Pennington the Facility Manager granted access to the facility. LPA Armstrong discussed the investigative findings related to a complaint that alleged that the facility staff did not prevent altercation between youths in care. During the investigation, LPA Armstrong conducted confidential interviews with all relevant parties and collected information regarding the allegations. After reviewing all the interview statements and information obtained, the allegations have been substantiated due to corroboration from the parties involved. The staff and administrator in the facility confirmed that only one staff member was present during an incident that occurred on 2/22/2025. S5 reported being left alone to handle a crisis because another staff member called off, and neither S1 nor S4 was available to provide support. Although the facility acted promptly by calling 911 when the crisis got out of hand, S5 admitted to being the only staff member in the facility with all the children. This situation presents an immediate health and safety risk for the clients in care. (Continue on LIC9099-C) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Enrique M Hernandez LICENSING EVALUATOR NAME: Justine Armstrong 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 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: KIDS TO KIDS - SERENITY HOUSEFACILITY NUMBER: VISIT DATE: 03/27/2025

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

met_with: Madison Pennington


raw_content:
Narrative:
Based on LPA interviews and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. The licensee is therefore issued a citation in accordance with the Group Home Interim Licensing Standards, Chapter 5 for violation of California Code of Regulations, Title Division Six, regulation ILS 84065. Staff/ Child Ratios( c) If the children require special care and supervision because of age, problem behavior or other factors, the number of on-duty child care staff shall be increased. Exit interview was conducted with the facility Administrator. A copy of this report was left with the facility administrator whose signature on this form confirm receipt of this document.

Investigation Findings:
13On March 27, 2025, at 10: AM., Licensing Program Analyst (LPA) Justine Armstrong arrived at the facility to deliver the findings of a complaint investigation. LPA Armstrong met Madison Pennington the Facility Manager granted access to the facility. LPA Armstrong discussed the investigative findings related to a complaint that alleged that the facility staff did not ensure required staff to resident ratios were maintained. During the investigation, LPA Armstrong conducted confidential interviews with all relevant parties and collected information regarding the allegations. After reviewing all the interview statements and information obtained, the allegations have been substantiated due to corroboration from the parties involved. S3 admitted once arriving at the facility S5 was there alone with the clients and this was also stated by the administrator stating the facility was out of compliance. Although the facility acted promptly by calling 911 when the crisis got out of hand, S5 admitted to being the only staff member in the facility with all the children. This situation presents an immediate health and safety risk for the clients in care. (Continue on LIC9099-C) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Enrique M Hernandez LICENSING EVALUATOR NAME: Justine Armstrong 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 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: KIDS TO KIDS - SERENITY HOUSEFACILITY NUMBER: VISIT DATE: 03/27/2025

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


raw_content:
Investigation Findings:
13On March 27, 2025, at 10: AM., Licensing Program Analyst (LPA) Justine Armstrong arrived at the facility Kids to Kids SERENITY to deliver the findings of a complaint investigation. LPA Armstrong met Madison Pennington the Facility Manager granted access to the facility. LPA Armstrong discussed the investigative findings related to a complaint that alleged that the 1. Facility staff did not have the required training to be left alone with residents 2. The facility staff did not dispense medications as prescribed After conducting confidential interviews and reviewing record documents, there was insufficient evidence or testimony to substantiate the allegations. Although the allegation may have happened or is valid and some evidence was concerning, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has decided that the allegation (s) 1.Facility staff did not have required training to be left alone with residents 2. Facility staff did not dispense medications as prescribed is Unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There were no deficiencies cited. An exit interview was completed, and a copy of this report was provided to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Enrique M Hernandez LICENSING EVALUATOR NAME: Justine Armstrong 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

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


raw_content:
Investigation Findings:
13On 06/25/2025, Licensing Program Analyst (LPA) Nestor Gomez mailed/emailed the findings to the mailing address/email on file. At the time of the complaint determination, the above mentioned facility is closed. During the investigative process, LPA Gomez conducted confidential interviews with all relevant parties and collected information on the above allegations. After reviewing all the statements and the information obtained, the above allegation is supported, as the confidential interviews confirmed that staff does not ensure facility is free from pests. In addition, LPA was not provided with pest control invoices from the facility as proof of the facility being serviced. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6 & Chapter 1), are being cited on the attached LIC 9099D. See 9099-D. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nestor Gomez 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 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION WOODLAND HILLS S.Ro, Ventura Blvd., STE. WOODLAND HILLS, CA This is an official report of an unannounced visit/investigation of a complaint received in our office on 04/03/2025 and conducted by Evaluator Nestor Gomez COMPLAINT CONTROL NUMBER: 31-CR- FACILITY NAME:KIDS TO KIDS - SERENITY HOUSEFACILITY NUMBER: ADMINISTRATOR:DAVID YASUTAKEFACILITY TYPE: ADDRESS: N DOS CAMINOS AVENUETELEPHONE: (805) 896- CITY:VENTURASTATE: CAZIP CODE: CAPACITY:0CENSUS: 0DATE: 06/25/ UNANNOUNCEDTIME BEGAN: 09: AM MET WITH:David Yasutake - Facility AdministratorTIME COMPLETED:10: AM 9Staff did not ensure that facility has adequate food for the minors in care Staff do not ensure that the minors have access to food. Staff did not address mold issue. INVESTIGATION FINDINGS: 13On 06/25/2025, Licensing Program Analyst (LPA) Nestor Gomez mailed/emailed the findings to the mailing address/email on file. At the time of the complaint determination, the above mentioned facility is closed. During the investigative process by Licensing program Analyst (LPA), Nestor Gomez, all relevant parties have been accounted for. The validity of the allegations could not be determined. The parties interviewed either confirmed or denied the allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nestor Gomez 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: 2 of Control Number 31-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION WOODLAND HILLS S.Ro, Ventura Blvd., STE. WOODLAND HILLS, CA FACILITY NAME: KIDS TO KIDS - SERENITY HOUSEFACILITY NUMBER: 565802325

met_with: David Yasutake - Facility Administrator


raw_content:
Investigation Findings:
13On 09/3/2025, Licensing Program Analyst (LPA) Nestor Gomez mailed/emailed the findings to the mailing address/email on file. At the time of the complaint determination, the above mentioned facility is closed. During the investigative process by Licensing program Analyst (LPA), Nestor Gomez, all relevant parties have been accounted for. The validity of the allegations could not be determined. The parties interviewed either confirmed or denied the allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nestor Gomez 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


summary: Facility Evaluation

raw_content:
Narrative:
On March 29, 2022, at 3:33pm Licensing Program Analysts (LPAs) Enrique Hernandez and Nancy O'Connell made an announced inspection to the Kids to Kids- Serenity House for the purpose of conducting Pre-Licensing inspection. LPAs met with applicant David Yasutake and facility representatives Madison Pennington Facility Manager (FM), Danny Bakst Head of Service (HS) who granted access to the facility. The entire physical plant was inspected. This is a three-bedroom, two-bathroom, single story family residence that includes a living room, dining area, kitchen, laundry area and a carport. There is no swimming pool or bodies of water on the premises. The home is currently vacant and there is no food in the home at the time of inspection. LPAs inspected the facility with the Licensee and observed the following: Bedroom #1: Is vacant, it has two twin sized beds, adequate closet and drawer space. Bedroom #2: Is vacant, it has two twin size beds, adequate closet and drawer space. Bedroom #3: Is vacant, it has two twin size beds, adequate closet and drawer space. Bathrooms: The home is equipped with three (2) Bathrooms. Bathroom one (1) is located next to bedroom #1 is equipped with one sink, shower and a toilet. Bathroom #2 is located adjacent to the master bedroom with one sink, a toilet bathtub and shower. All bathrooms were operable at time of inspection. LPA tested the hot water temperature during the time of the inspection the water temperature is 110 degree which meets the requirements. Living Room: There was an attached room space which will be utilized as game room/study room. There is a fireplace with the cover on. There was a rug and TV on the floor. There were a total of (3) fire extinguisher in the throughout the house. All smoke detectors and carbon monoxide detectors were tested and operable at time of inspection. Continue on LIC809-C Hallway: linen closet for extra storage. The carport is detached to the home is where the facility van is kept and additional refrigerator is stored. Kitchen: There was one (1) refrigerator, one (1) stove one (1) microwave and all appliances were operable at the time of the inspection. Laundry room equipped with a sink, one (1) washer and one (1) dryer. The outdoor space is free of debris and any hazards. Emergency disaster plan and personal rights are posted at the facility. Cleaning solutions, disinfectants, and sharp knives were locked at the time of the inspection. An advisory was provided to obtain locked box for knives due to knives being stored in drawer with other non-cook ware items. Area is designated for medication and will be locked and accessible only to employees supervising stored medications. All smoke detectors and carbon monoxide detectors were tested and operable at the time of inspection. LPAs observed two fire extinguishers in the kitchen and around the home that were operable at the time of inspection. The first aid kits are fully stocked. The bathrooms were inspected and found to be clean. The facility has a working telephone. Licensee states that there is no weapons or guns on the premises. During the time of inspection, the facility vehicle wasn't at the facility and is being utilized by their other facility until clients are present in the current facility. The home is clean, safe, sanitary, and in good repair. LPA O'Connell received a copy of the CPR and First Aid certificate which was completed on 03/25/2022. Applicant stated that he would: Paint the interior of the facility, clean the vent grate in the main hallway Obtain new shower head in bathroom # Clear out backyards weeds Get rid of desk in dining room Continue on LIC809-C Place work order for the following needs: Missing cabinet drawer in closet for Level 4 bedroom Secure cabinet doors to close tightly where chemicals are stored Fire Clearance still pending. The licensee was informed that once the Licensing Program Manager receives and reviews this report, then a provisional license will be granted. Due to technical difficulties with the LPA's printer, a copy of this report will be emailed to the applicant.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Kuliema Calloway and Licensing Program Manager (LPM), Kevin Sauk made an announced inspection to the Kids to Kids- Faith House on June 30, 2022 at 1:00pm for the purpose of conducting a Post Licensing Inspection. LPA/LPM met with FA who granted access to the facility. The entire physical plant was inspected. The facility is licensed to care for six (6) female clients, ages 12-17 years, ambulatory only (See confidential name list LIC811 dated 6/30/2022). This is a three-bedroom, two-bathroom, single story family residence that includes a living room, dining area, kitchen, laundry area and a carport. Annual fee is current. LPA inspected the facility with the S1 and observed the following: Bedroom #1: Is occupied by Client (C4) Bedroom #2: Is occupied by Clients (C1 and C3), Bedroom #3: Is occupied by Client (C2) There is no swimming pool or any other bodies of water on the premises. The passageways, stairways, and open porches are unobstructed. The rules, menu, regulations, licenses, emergency disaster plan and personal rights are posted at the facility. The outdoor space is free of debris and any hazards. Cleaning solutions, disinfectants, medication and sharp knives are inaccessible to the clients. Medication is locked and accessible only to employees supervising stored medications. All smoke detectors and carbon monoxide detector were tested and operable at the time of inspection. LPA/LPM observed a fire extinguisher in the kitchen and in near the front door of the facility that was operable at the time of inspection. Report continues on LIC-809C The first aid kit is fully stocked. The bathrooms were inspected and found to be clean. The facility has a working telephone. FA states that there is no weapons or guns on the premises. Clients are allowed to use the telephone unless restricted by court order. Clients are accorded dignity in personal relationships with staff and others. Clients live in a safe, healthy, comfortable facility and are treated with respect. Clients attend school, extracurricular, cultural, and personal enrichment activities. Clients can contact Community Care Licensing or Foster Care Ombudsman office in confidence without threats or punishment. Facility operates within license conditions and limitations including capacity limitations. Facility has a current, written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. There were no deficiencies cited at this time. Exit Interview was conducted with FA and a copy of this report was left with Facility Administrator.

met_with: Facility Administrator (FA)


summary: Facility Evaluation

raw_content:
Narrative:
On July 28, 2022, at 09:30am, Licensing Program Analyst (LPA) Olivia Rosas conducted an unannounced inspection to Kids to Kids- Serenity House Short Term Residential Therapeutic Program (STRTP) for the purpose to continue with open complaint investigation. LPA Rosas and Staff#1 (S1), Staff#2 (S2) discussed the allegations details on the open complaint investigation (See confidential name list LIC811 dated 07/28/22). During the course of this inspection LPA Rosas, interviewed S1, S2, Client#1 (C1), Client#2 (C2). Client#3 (C3). LPA Rosas did record review and did facility inspection. Additional interviews with pertinent parties will be conducted on later date. Based on the interview, information gathered, and documentation received there was insufficient information to support that the above allegation occurred. This complaint allegation needs further investigation. Exit interview was conducted and a copy of this report was left to S#1.

met_with: Staff#1 (S1)


summary: Facility Evaluation

raw_content:
Narrative:
On August 25, 2022, at 12:30 p.m., Licensing Program Analyst (LPA), Kuliema Calloway, and Licensing Program Manager (LPM), Kevin Sauk, conducted an unannounced Continuation Annual Inspection at Kids to Kids Serenity House located at the above address. David Yasutake, Facility Administrator (FA), granted access into the facility and together conducted a tour of the entire facility, inside and out. The purpose of this inspection is to continue the Annual Inspection initiated on 06/30/2022. LPA/LPM interviewed four (4) clients: C1, C2, C3, C4, and C5. [ See confidential names forms LIC 811 dated 8/25/2022.] There are no deficiencies cited at this time. Exit interview was conducted and a copy of this report was left with Madison Pennington, Facility Manager.