summary: Facility Evaluation

raw_content:
Narrative:
On 03/3/2021 at 1:45pm, Licensing Program Analyst (LPA) Hernandez, and LPA Nancy O'Connell arrived at the above facility, for the purpose of conducting a follow-up Pre-Licensing Inspection, which was initiated on 11/12/2021. LPAs met with the licensee who granted access into the facility, and who provided a tour of the entire physical plant inside and out. LPA observed the following, during the inspection: · Outside the house, and it is clean and free of obstructions. · LPA received on 11/18/2021 via email by the licensee the First Aid and CPR · Backyard has grass that is overgrown and needs trimming, items contained in fenced in area need to be removed (broom, fan, lawn mower, cardboard box, filled trash bags) · Plugs on exterior wall (right of doorway) need to be covered · Camera is located in ceiling in backyard (left side), and above garage door in front of home. Licensee has completed 20 hours of pre-approval training for Resource Family Approval Training, and 8 hours of Pre-Placement Training. Fire clearance granted on 12/3/2021. This facility is clean, safe, sanitary, and in good repair. Licensee will submit pictures by 03/10/22, of backyard that has been cleaned, mowed, and free from debris. A copy of this report will be email to the licensee due to technical difficulties with the LPA's printer


state: CA

facility_name: HAYDEN SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On July 22, 2022 at 8: AM., Licensing Program Analyst (LPA) Kuliema Calloway and Licensing Program Manager (LPM), Kevin Sauk made an announced inspection to Hayden Small Family Home for the purpose of conducting a Post Licensing Inspection. LPA/LPM met with Licensee who granted access to the facility. The entire physical plant was inspected. The facility is a Level 4G and is licensed to care for ambulatory consumers, age 3-17 years old with mild to moderate development delay and additional mental health deficits that interfere with their ability to function in a less restrictive setting. There are no clients placed at this time. (See confidential name list LIC811 dated 7/22/2022). This is a four -bedroom, three bathroom, two story family residence that includes a living room, dining area, kitchen, family room, laundry area, and a garage. Annual fee is current. LPA observed the follow during the inspection: Bedroom #1 - located on the first floor, was being repainted There was a plastic tarp and a bed in the middle of the room. The dresser drawer was inside the walk-in closet. There was adequate lighting. Bedroom #2(upstairs- left) is occupied by the licensee with a with a queen size bed. adequate drawer space walk in closet and lighting. There is a private bathroom. Bedroom #3: (upstairs) is occupied by legal guardian client (C2) , is equipped with a twin bunk bed, C2 sleeps on the bottom of the bed bunk. Bedroom #4:(upstairs) is temporarily occupied by C1. There are two twin size beds, they were pushed together to make a queen size bed. There were two adequate dresser drawers, closet and lighting. Bathrooms - A total of 3 were observed to be clean, safe, and in good repair. The hot water was kept at a safe temperature at the time of the inspection. Continued on C Living Room: There is adequate furniture which appears to be in good condition. Breakfast Area: One table with capable dining to seat six. There were two (2) chairs, and three folding chairs in the garage. Kitchen: There is gas stove/oven with five (5) burners all working at the time of the inspection. There is a microwave, refrigerator/freezer. The food service in the home is adequate with perishable/nonperishable food supplies. Caregiver ensures three nutritious meals, snacks, and special diets. Water heater closet observed to be locked. Sharp knives, and cleaning solutions are kept out of reach of children. LPA observed the medication lockbox, stored on the top shelf of the Licensee's bedroom closet during the time of the inspection the locked box was locked at the time of the inspection. The trash cans in the bathroom have lids. All smoke detectors and a carbon monoxide detector were tested and are operating properly in the home at the time of the inspection. Fire extinguishers were available and fully charged. Licensee states there are no guns and weapons in the home. The first aid kit was checked to be age-appropriate, and complete with scissors, tweezers, thermometer, and gauzes, antiseptic and 1st Aid Manual. Caregiver shall submit Special Incident Reports to appropriate agencies upon occurrence. Caregiver shall report changes in household composition to appropriate agencies. There was one (1) exterior security cameras in the backyard that licensee reported was working. Licensing staff instructed licensee to deactivate security camera until a camera waiver is approved by CCL. At this time, CCL is not approving any camera waivers. The following deficiencies were cited at this time of this inspection. See LIC D pages 1 and 2. Exit interview was conducted and a copy of this report was left with the Licensee.

report_type: Facility Evaluation

visit_type: Annual

met_with: Angela Hayden, Licensee


facility_name: HEARTFELT SECOND CHANCE

summary: Facility Evaluation

raw_content:
Narrative:
On June 25, 2025, at 9:30 am, Licensing Program Analysts (LPAs) Charmaine Linley and Stefanie Mutialu met with applicant, Arturo Reyes, for Component II Face to Face Meeting for a Small Family Home. Mr. Reyes confirmed the Fire Inspection will be completed on June 26, 2025. Mr. Reyes confirmed the acknowledgement of the revisions needed and will submit the revisions and training certificates via email to LPA by end of day of July 10, 2025. Due to printer difficulties, a copy of this report was emailed to the applicant along with the signed Orientation form indicating Component II has been completed. A copy of this report will be placed in the facility file.

met_with: Arturo Reyes


summary: Facility Evaluation

raw_content:
Narrative:
On July 16, 2025, Community Care Licensing (CCL) conducted an office conference with the Small Family Home (SFH) applicant Arturo Reyes and Rashon Reyes regarding Arturo's application for Heartfelt Second Chance #366000043. Present at the meeting were: Licensing Program Manager (LPM) Ann Valenzuela, Licensing Program Analysts (LPAs) Charmaine Linley and Stefanie Mutialu. The meeting was called to address concerns regarding the applicants submission of an incomplete application. During the Component II Office Meeting held on June 25, 2025, Arturo was asked if he had any other licensed facilities and he stated he did not. Arturo also stated during this meeting; he was the only individual that lived at Osceola Rd. in Apple Valley. However, after further review of the application, it was confirmed that at Osceola Rd. in Apple Valley, there is another licensed facility Reyes Family Child Care #367700054, and the Licensee and Administrator is Rashon Reyes. On the LIC 200/Application for a Community Care Facility, Arturo did not answer #19, which requires applicants to enter the information for any residential care or health care facility previously or currently operated. Arturo did not list that he is the Licensee at Heartfelt Daycare LLC #367750080, and he previously operated as the Licensee at Reyes Family Child Care #367700383. LPM asked Arturo if he had any other licensed facilities located at Osceola Rd. in Apple Valley and Arturo stated he was unaware that the family child care license applied to the application for a Small Family Home. Rashon stated she rents the home to Arturo, and she had planned to surrender the child care license. Rashon stated she will surrender the child care license and send the surrender letter to LPA Linley by Friday, *** July 18, 2025 end of business day. During this meeting, it was discussed for Rashon to be added as the co-Licensee. Rashon agreed and will update and submit the necessary licensing forms to LPA by July 31, 2025. The revisions below were discussed, and revisions are due by July 31, 2025 end of day. The LIC 281 needs to be used as a guide and the sections need to be separated according to the LIC 281. Please send all sections together to review. Section A Documents: A1. Application (LIC 200):  #16 needs to be completed.  #19 needs to be completed  Form needs to be signed and dated. A2. Applicant Information (LIC 215):  This section is incomplete. A3. Applicant Information (LIC 308):  Provide the dates/times and Rashon Reyes position on the LIC 500. A5. Affidavit Regarding Client Cash Resources (LIC 400):  The form states a bond for $2000.00, however the bond is listed as $5000.00. Amounts must be the correct and same amount on both the LIC 400 and 402. The bond must be in the amount of 1500.00 per the amount listed on the form. Surety bond needs to be updated, signed and have a raised seal. A6. Surety Bond (LIC 402):  The form states a bond for $2000.00, however the bond is listed as $5000.00. Amounts must be the correct and same amount on both the LIC 400 and 402. The bond must be in the amount of 1500.00 per the amount listed on the form. Surety bond needs to be updated, signed and have a raised seal. *** A10. Personnel Report (LIC 500):  Rashon Reyes job title needs to be filled out, along with days and hours.  Caregivers need to be included on the LIC 500  Administrator and Licensee are referenced, clarify the role and include on the LIC 500.  Who is the House parent referenced? A11. Personnel Record (LIC 501):  Section 3: Full addresses need to be completed.  Second page is missing. A12. Health Screening Report - Facility Personnel (LIC 503):  TB test is unable to be fully read.  Second page is missing. A15. Facility Sketch (LIC 999):  Client bedrooms must include how many clients there are in each bedroom and whether they are ambulatory or non-ambulatory.  Studio as described during Component II meeting needs to be included on the Facility Sketch. Video Cameras: (1) Where video cameras are - or will be - located, include on the Facility Sketch. (2) The purpose of the video cameras. (3) How children and authorized representatives will be informed of the location of video cameras and their purpose. (4) How licensees will work with placing agencies to address situations in which a child objects to video cameras. (5) How video cameras will be used in a trauma-informed manner. (6) Whether video cameras will be livestreamed only or recorded. (7) If recorded, who will have access to the recordings and how will the recordings be stored and safeguarded. *** Section B Documents: B7: Facility Program Description:  Daily schedule of activities should state who plans, conducts and assists clients in participating in these activities.  One month schedule of planned social, educational and recreational activities should state who plans, conducts, and assists clients in participating in these activities.  Describe the basic services provided by the facility.  Describe the optional services provided in the facility as listed in the admission agreement.  Describe how the facility is going to handle medical emergencies if a client becomes ill or injured, other than calling 911.  Remove the sentence that clients will not be taken to the beach, this can be individualized and documented why a client would not be taken to the beach and would need to be documented and signed by all individuals in a Needs and Services Plan. Personal rights allow youth "To participate in extracurricular, cultural, racial, ethnic, personal enrichment, and social activities, including, but not limited to, access to computer technology and the internet, consistent with the child's age, maturity, developmental level, sexual orientation, and gender identity and gender expression." Medication:  Describe if the Centrally Stored Medication and Medication Administration Records will be used.  Describe how the facility will obtain a copy of the current court order, or written authorization of the child's parent or guardian, for each psychotropic medication, as defined in Section 84001(p)(4). Transportation arrangements:  Secretary/Bookkeeper must be listed on the LIC 500.  List who completes the vehicle inspections.  Describe how the licensee and their staff are prohibited from smoking a tobacco product, or permitting any person from smoking a tobacco product in a motor vehicle that is regularly used to transport children, regardless of when the children are present. This prohibition applies when the motor vehicle is moving or at rest.  Clarify why the facility would occasionally use public transportation and the type of public transportation.  Describe how the licensee shall provide transportation for a child in a timely manner to and from the following: ***  Health-related services. School.  Extracurricular, enrichment, cultural, and social activities, in accordance with the reasonable and prudent parent standard specified in Section 83067.  Describe how the facility shall ensure that the transportation provided safeguards the health and safety of a child and shall not violate the personal rights of a child as required by Section 83072.  Provide a list of the consultants to be used by the facility.  Describe the procedure for immediate response to incidents and complaints and the timeframes including how to submit a grievance/complaint, who responds, the timeframe, how the outcome is documented, where is the procedures documented. B8: Rules of Discipline/Personal Rights:  Clarify why children are not able to have their bedroom doors closed.  Personal belongings, cell phones, and outside communication cannot be removed without prior permission from the Authorized Representative and must be signed with the reason why in the Needs and Services Plan. Please remove this sentence and use alternative discipline methods that do not violate personal rights.  Physical restraints are not approved in Small Family Homes, remove any references to physically restraining clients.  Clarify why "Refusing to participate in group activities may be considered defiance and could result in a loss of extracurricular activities."  This section needs to be rewritten - a Small Family Home is not a "program." Chore completion is part of the program. If the chores are not completed satisfactorily, it can result in non-payment of allowance and extracurricular activities may be paused. All chores must be completed daily. If they are not, the child is on restriction until they are completed, and he/she will not receive allowance for the work. A list of chores will be fairly slash evenly completed and posted for all to see. An established allowance amount needs to be in this section.  This statement needs to be rewritten; this statements is read as a Group Home or STRTP. Children placed with the home have been documented by the juvenile courts as requiring constant supervision. As a general policy, the home does not permit children in care to be away from the home without supervision. Exceptions are made for children in care attending off-site schools and those traveling by bus or airplane for home passes. However, if any issues arise while a child is unsupervised, these exceptions may be revoked. *** B9: Admission Policies:  Describe how the facility will obtain emergency information. B10: Sample Menu: The sample menu will include:  Portion sizes are not appropriate for 5-17, examples are ½ ounces of rice, chicken, and other items. B12. Bacteriological Analysis of Private Water Supply (When Water for Human Consumption is from a Private Source):  This section is missing. A copy of this report was provided to Arturo Reyes. The signed report will be placed in the facility application file.


summary: Facility Evaluation

raw_content:
Narrative:
On the date listed above, Licensing Program Analyst (LPA) Charmaine Linley conducted Component III Small Family Homes via Microsoft TEAMS with Arturo Reyes and Rashon Reyes. A copy of the handout was emailed prior to Component III and the Pre-Licensing Inspection is scheduled for October 6, 2025 at 11:30am. A copy of this report was emailed to the Applicants for a signature and a copy of the signed report will be placed in the facility file.

met_with: Arturo Reyes and Rashon Reyes


summary: Facility Evaluation

raw_content:
Narrative:
On October 6, 2025, at 12:05 pm, Licensing Program Analyst (LPA) Charmaine Linley arrived at the home to conduct a pre-licensing inspection of the facility. LPA met with Applicants, Arturo and Rashon Reyes, who led a tour of the facility. The facility was toured inside and outside with the Applicants. Currently, there are no clients in placement. The facility is a one-story building with six bedrooms and three bathrooms which is set up as follows: Bedroom #1 (Master) has one California King-Sized bed and the Co-Licensee, and sleeps Arturo Reyes Bedroom #2 (Client) has one twin-size single bed and will sleep one client. Bedroom #3 (Clients) has two twin-size single beds and will sleep two clients. Bedroom #4 (Co-Licensee) has one Queen-Size bed and sleeps Rashon Reyes Bedroom #5 (Guest) does not have any beds and is used as a walk in close for clothing and storage. Bedroom #6 (Guest) does not have any beds and is used as the staff office. The facility also consists of a family room, living room, kitchen, dining room, three bathrooms, one music studio, a laundry room located in the hallway next to bathroom #2, a swimming pool and jacuzzi, two horse stalls, two dog cages, and three locked sheds that contain storage supplies and yard tools. There is a properly fenced and secured fire place in the family room. There is a swimming pool in the backyard. It is properly secured with two latched gates that open away from *** the swimming pool. There is also a jacuzzi that has a cover on top of the jacuzzi. The lock/key was removed from the gates and will not be used. The Client's bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. There was adequate closet and drawer space for the client's belongings. There were 11 smoke detectors in every bedroom and all hallways and two carbon monoxide detectors outside of bedroom #4 and in the hallway next to the clients bedrooms. All the smoke and carbon monoxide detectors were checked and in properly functioning order. The home's central air conditioning module was located outside of the home on the roof. The home's water heater was located in bathroom #2 and is a tankless water heater. The home appliances were checked and in working order at the time of this inspection. The Client and Staff files will be locked in a file cabinet located in bedroom #6/staff office. There was adequate food storage space. LPA observed a three day supply of non-perishable food. A trash can for storage of solid waste had a tight-fitting lid and was present in the kitchen. The sharp knives are in a locked cabinet in the kitchen, inaccessible to clients. The medications will be located in a locked cupboard in bedroom #6/staff office. The hot water in the kitchen was measured and registered at 113 degrees at 12:33 pm, which is within the regulatory requirements. The following forms were posted: Activity Calendar, Menu, Grievance Procedure, LIC 610/Emergency Disaster Plan, and Discipline Policy. The home's First Aid kit was accessible and is located in the cupboard in the hallway next to the clients bedrooms and had all the required supplies. There was one fire extinguisher present in the home located in the hallway near the clients bedrooms and it was observed to be properly charged and inspected by the fire department. There was a locked firearm during the inspection; however, LPA verified Mr. Reyes family member removed the firearm and bullets during the inspection. The backyard where clients will have access to play is fenced. The home has five security cameras located on the outside perimeters of the home (door bell, North front of the facility, South Front of the facility, South side of the Facility, and the back door). *** The following corrections need to be made to the home: Update LIC 610 and Facility Sketch to remove emergency exits from bedrooms. Submit updated LIC 610 and Facility Sketch to LPA by end of business day on 10/07/2025. Applicant was asked to notify their assigned LPA when the first client is placed at the facility. An exit interview was conducted, and a copy of the report was provided to Arturo and Rashon Reyes. A copy of this report will be placed in the facility file. Licensing Program Manager will review the application and this report and once approved, the Facility License will be printed out and emailed to the applicant.

visit_type: Prelicensing

met_with: Arturo and Rashon Reyes


summary: Facility Evaluation

raw_content:
Narrative:
On February 20, 2026, at 10:34 am, Licensing Program Analyst (LPA) Val Wilson arrived at the home to conduct a post-licensing inspection of the facility. LPA met with Licensee, Arturo and Rashon Reyes, who led a tour of the facility. The facility was toured inside and outside with the Licensee's. LPA completed two staff interviews [Staff 1 (S1) and Staff 2 (S2)]. LPA is unable to interview Client 1 (C1) who was placed December 15, 2025 through February 17, 2025. The facility is a one-story building with six bedrooms and three bathrooms which is set up as follows: Bedroom #1 (Client) has one twin-size single bed and will sleep one client. Bedroom #2 (Clients) has two twin-size single beds and will sleep two clients. Bedroom #3 (Master) has one California King-Sized bed and the Co-Licensee, and sleeps Arturo Reyes Bedroom #4 (Guest) does not have any beds and is used as a walk in closet for clothing and storage. Bedroom #5 (Co-Licensee) has one Queen-Size bed and sleeps Rashon Reyes Bedroom #6 (Guest) does not have any beds and is used as the corner staff office. The facility also consists of a family room, living room, kitchen, dining room, three bathrooms, one music studio, a laundry room located in the hallway next to bathroom #2, a swimming pool and jacuzzi, two horses in stalls, three dogs in the kennel, and three locked sheds that contain storage supplies and yard tools. There is a properly fenced and secured fire place in the family room. There is a swimming pool in the backyard. It is properly secured with two latched gates that open away from *** ***CONTINUED FROM PAGE 1 the swimming pool. There is also a jacuzzi that has a cover on top of the jacuzzi. There is a floating alarm in the pool that sounds when there is water movement. There is a pool house that has a restroom and shower. The Client's bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. There was adequate closet and drawer space for the client's belongings. There were 11 smoke detectors in every bedroom and all hallways and two carbon monoxide detectors outside of bedroom #4 and in the hallway next to the clients bedrooms. All the smoke and carbon monoxide detectors were checked and in properly functioning order. The home's central air conditioning module was located outside of the home on the roof. The home's water heater was located in bathroom #2 and is a tankless water heater. The home appliances were checked and in working order at the time of this inspection. The following forms were posted: Activity Calendar, Menu, Grievance Procedure, LIC 610/Emergency Disaster Plan, Complaint Hotline, and Discipline Policy. The Client and Staff files are locked in a file cabinet located in bedroom #6/staff office. LPA observed a three day supply of non-perishable food. A trash can for storage of solid waste had a tight-fitting lid and was present in the kitchen. The sharp knives are in a locked cabinet in the kitchen, inaccessible to clients. Medications are located in a locked cupboard in bedroom #6/staff office. A small locked refrigerator is also available for medications. The hot water in the kitchen was measured and registered at 111 degrees at 10:50 am, which is within the regulatory requirements. The home's First Aid kit was accessible and is located in the cupboard in the hallway next to the clients bedrooms and had all the required supplies. There were game and art supplies in the hall cupboard. There was one fire extinguisher present in the home located in the hallway near the clients bedrooms and it was observed to be properly charged and inspected by the fire department. Licensee denies any firearms in the home. The fenced in backyard has access to play equipment. The home has five security cameras located on the outside perimeters of the home (door bell, North front of the facility, South Front of the facility, South side of the Facility, and the back door). *** ***CONTINUED FROM PAGE LPA observed the following: Staff #1 and Staff #2 are missing job duties in their personnel files. Staff #1 and Staff #2 do not have a valid safety water certificates. Items noted outside in the backyard the Licensee said they would have removed or stored; old paint cans, piece of plywood, hoses, blankets, cords, washing machine, and clothes dryer. Based on the facility inspection and file reviews on this date, there are three Technical Assistance issued to the facility: Staffing Records - Technical Assistance: 80066(a)(8) - Staffing Records - Technical Assistance: 80065(e)(2) - Physical Plant - Technical Assistance: 83087.2(a) - An exit interview was conducted, a copy of this report, LIC 811, 809G, three Technical Assistances, and appeal rights were provided to Arturo and Rashon Reyes. A copy of this report will be placed in the facility file.


facility_name: HEAVENLY VISIONS SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On Thursday February 10, 2022, at 11: AM Licensing Program Analyst (LPA) Linda Haynes conducted an annual inspection of the facility. At time of inspection LPA met with Licensee Debra Miller. The facility was toured inside and out with Licensee Debra Miller. The home is a two-story residence with four bedrooms and three bathrooms. There are no clients in placement at this time Bedrooms are arranged so that no more than two clients are in a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathroom was clean and in good repair. Hot water was not measured at this time as there are not children in placement. All hazardous items have been properly made inaccessible to areas where clients will have access. The medications were stored and locked in a cabinet in the laundry room. Cleansers/chemicals are locked and stored in locked cabinet in garage. Sharp knives are inaccessible and stored in a locked cabinet in the garage. The First Aid Kit is located in the laundry room and contained all required supplies. The facility's smoke detectors in each bedroom were checked and were operable. The carbon monoxide detector is located in the hallway and was operable. There are no guns or weapons in the facility as stated by Licensee Debra Miller. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, and Visitation policies,. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is no pool or other body of water. Based on the facility inspection and file reviews this date, there was no deficiencies found at this time. A copy of this report was reviewed and given to Licensee Debra Miller.

met_with: Debra MIller


summary: Facility Evaluation

raw_content:
Narrative:
On August 30, 2024 at 12: PM, Licensing Program Analyst (LPA) Rachel Vanegas arrived to the facility listed above for the purpose of conducting an annual inspection of the facility. LPA met with the Licensee Debra Miller who led a tour of the facility inside and outside. The home is a two-story residence with four bedrooms and three bathrooms. The current census for children in care is zero. The first story of the facility consists of: Living room that is used for visitation, a dining room, a kitchen, family room with recreational games accessible to children in care, a storage closest for extra linen, one restroom, and Bedroom #1. Bedroom #1 has a bunk bed set with two beds that will sleep one client. The licensee will remove the bottom mattress to create a desk space for one client in this bedroom, prior to accepting a child in care. There is adequate space for storage of personal belongings in the closet and drawers. The second story of the facility consists of: A loft area, a laundry room, a storage closet for medication and first aid kit with all required items, and two restrooms. Bedroom #2 is the master bedroom and it sleeps the licensee. Bedroom #3 has a single bed that sleeps the licensee's guardian child (boy). Bedroom #4 has a bunk bed set with two beds that sleeps the licensee's biological 15 year-old daughter and guardian child (girl). All bedrooms are arranged so that no more than two clients are in a room and there is one client per bed. The hot water was measured in the kitchen and registered at 105 degrees F. All hazardous items have been properly stored and are in inaccessible areas to clients. **** Cleansers/chemicals are locked and stored in locked cabinet in the garage. Sharp knives are inaccessible and stored in a locked cabinet in the garage. The facility's smoke detectors were checked and operable. The carbon monoxide detector is located in the hallway on the first floor and was operable. There are no guns or weapons in the facility as stated by the Licensee, Debra Miller. The required postings were observed and accessible to clients including Personal Rights, Emergency Plan, Meal Menus, Visitation policies, etc. The facility outside grounds were also inspected and were observed to be clean and well maintained. Emergency exits were free from obstruction. There is no pool or other body of water. Based on the facility inspection and current census being zero, there are no deficiencies cited at this time. LPA provided technical assistance to the Licensee and discussed the importance of documenting biannual disaster drills and including the date, type of drill, and participants of the drill, etc. for proper Operations compliance with Disaster and Mass Casualty Planning. LPA also discussed the importance of obtaining and maintaining an operational fire extinguisher prior to accepting any children in care. An exit interview was conducted and a copy of this report, LIC 9102, and appeal rights were reviewed and provided to the Licensee - Debra Miller.

met_with: Licensee - Debra Miller


facility_name: HENRY'S SMALL FAMILY HOME

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

report_type: Complaint Investigation

met_with: Licensee Carla Henry

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

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

met_with: Carla Henry, Licensee


met_with: Carla Henry, Staff 1

investigation_findings: UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

allegations: UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:


summary: Facility Evaluation

raw_content:
Narrative:
On Thursday 6/23/22 at 10:00AM, Licensing Program Analyst (LPA) Lisette Valenzuela made an unannounced visit to the facility to conduct a required annual inspection. LPA Valenzuela met with Caregiver/Licensee Carla Henry and informed of the purpose of the visit. The facility has a capacity of 3 and currently has 3 youth in placement. None of the clients/youth were present at the time of the visit. LPA Valenzuela inspected the facility site and grounds. The facility is a two-story house in a residential neighborhood. LPA Valenzuela observed the facility had food that meets the needs of children in care and that meets the 7-day nonperishable, 2-day perishable mandate. LPA Valenzuela observed the first aid kit and the required items were there, except scissors, and adhesive tape. Per Licensee, there are no firearms or ammunition on the premises. LPA Valenzuela observed bleach, raid, and other cleaning chemicals locked inside the laundry cabinet. There were no chemicals under the unlocked kitchen sink. All chemicals were locked and stored where they are inaccessible to children. LPA Valenzuela observed the hot water in the upstairs resident bathroom, downstairs bathroom and kitchen sink and all water temperatures met the permitted range. LPA Valenzuela observed the backyard and everything was good. There were no obstructions to any of the emergency exits. Overall, the facility is organized, clean and tidy. LPA Valenzuela inspected 3 client files and the caregiver's file. All the files were complete and contained all of the required forms. The caregiver has a valid CPR First Aid. Five (5) Technical Violations are being issued, per California Code of Regulations, Title 22, Sections 80088(f)(1), which requires waste bins to have a lid. Section 80075(g)(1)(E) & 80075(g)(1)(D), which requires first aid kits to include scissors and adhesive tape. Section 80023(d), and 80023(d)(2) which requires licensee to conduct disaster drills and provide documentation. An exit interview was conducted, and a copy of this report was emailed to Caregiver/Licensee Carla Henry, whose signature on this form confirms receipt.

met_with: Carla Henry


summary: Facility Evaluation

raw_content:
Narrative:
On 6-21-23 10:27AM, Licensing Program Analysts George Karkazis conducted an unannounced Annual/Random inspection at listed facility. LPA Karkazis met with Carla Henry, Administrator/Licensee and toured the facility inside and out. Safety precautions were taken including screening call and mask wearing. The Small Family Home is licensed to serve 3 clients. Present during the inspection were one staff and no clients. Clients were attending summer school during this inspection. At 10:35AM LPA Karkazis reviewed client and staff files. All client and staff files are complete and locked in a file cabinet in the Administrator's bedroom. At 11:15AM, LPA Karkazis toured the facility. LPA Karkazis observed five bedrooms and four and a half bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms. LPA Karkazis tested the water temperature and found it to be 121.1 degrees which is in range. The thermostat read 68 degrees which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. There is no medication used by clients at this time. The facility is in good repair and clean. LPA Karkazis interviewed one staff and no clients, no clients were present. At 11:30AM LPA Karkazis toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. At this time there were no deficiencies An exit interview was conducted, appeal rights discussed and a copy of this report was given to Carla Henry, Administrator/Licensee.

met_with: Carla Henry, Administrator/Licensee


summary: Facility Evaluation

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Narrative:
On June 17, 2024 at 10:30am, Licensing Program Analysts (LPAs) George Karkazis and Kristin Pierotti conducted an unannounced Annual/Random inspection at listed facility. LPA's met with Carla Henry, Administrator/Licensee and toured the facility inside and out. The Small Family Home is licensed to serve 4 clients. Present during the inspection were 1 staff and 3 clients. At 11:15am LPA Karkazis and Pierotti reviewed client and staff files. Staff and client flies were complete and in good order. At 11:56am, LPA Karkazis and Pierotti toured the facility. LPA Karkazis and Pierotti observed 5 bedrooms and 4.5 bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Karkazis and Pierotti tested the water temperature and found it to be 112 degrees which is in range. The thermostat read 73 which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in cabinet in the master bathroom. The facility is in good repair and clean. LPA Karkazis and Pierotti interviewed one staff and two clients and the third client was non-verbal. At 12:25pm LPA Karkazis and Pierotti toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. An exit interview was conducted and a copy of this report was given to Carla Henry.

met_with: Carla Henry, Administrator/Lincesee


summary: Facility Evaluation

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Narrative:
On July 7, 2025, at 11: AM Licensing Program Analysts (LPAs) Cole Oliver and Kristin Pierotti conducted an unannounced Random Annual Inspection at Henry's Small Family Home. LPAs met with Carla Henry, Administrator/Licensee, and informed her of the purpose of the visit. LPAs toured the facility inside and out, reviewed three client files, one staff file, and conducted one confidential staff interview. During the inspection, two clients were present. The CARE Inspection Tool was used to conduct the inspection. LPAs observed five bedrooms and four and a half bathrooms. They noted the facility license, personal rights, facility sketch, meal menu, and other required forms posted throughout the facility. LPAs tested the water temperature and found it to be within the appropriate range. The thermostat reading was also within range. Sharps were locked, and chemicals were safely stored. There was at least two days' worth of perishable foods and seven days' worth of non-perishable foods present. Medications were stored and locked in a cabinet in the master bathroom. The facility was clean and in good repair. LPAs observed that youth in the home appeared to be wearing clean clothing and comfortable around the staff. LPAs interviewed staff, and clients that were present were nonverbal. LPAs also inspected the backyard. There were no open bodies of water, and the area was clean and in good repair. LPAs observed one area in which technical assistance could be provided see LIC9102. An exit interview was conducted, and a copy of this report was provided to Administrator Carla Henry, whose signature confirms receipt.


summary: Facility Evaluation

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Narrative:
On 07/09/25 at 12:30PM, Licensing Program Analysts (LPAs) Simran Nayyar and Cole Oliver made a unannounced visit to the facility to review and discuss plans of corrections (POCs). LPAs met with Carla Henry, Staff 1 and and Justin Chadstin Henry, Staff 2 informed them of the purpose of the visit. LPAs did a walkthrough of the home and found that the POC made on 06/11/25 has been corrected. The fence was in good repair, the holes in the bedroom closet/wall have been patched, and there is a work order placed for new dressers to arrive on 07/11/25. The facility is now in good repair. Exit interview was conducted and a copy of this report along with appeal of rights was printed and left with Carla Henry, Staff 1 whose signature on this form confirms receipt of these documents.


summary: Facility Evaluation

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Narrative:
On 06/11/25 at 11:25am, Licensing Program Analysts (LPAs) Simran Nayyar and Hanako Primer conducted an unannounced case management inspection at the facility. LPAs met with Carla Henry, Staff 1 and Justin Chadstin Henry, Staff 2. There were 2 clients in the facility at the time of the visit. LPAs conducted a walk through of the facility and observed a panel of the backyard fence which appeared to be broken. Next, LPAs observed a hole in C1 and C3's shared bedroom closet, along with 1 broken dresser drawer in C1 and C3's shared bedroom. LPA's then went to C2's bedroom and observed a hole in the wall of the doorway. See attached LIC-813. One type B citation was issued under 80087(a) Buildings and Grounds. See attached LIC809-D. An exit interview was conducted, and a copy of this report along with appeal of rights was left with Carla Henry, Staff 1 whose signature on this form confirms receipt.

visit_type: Case Management


summary: Facility Evaluation

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Narrative:
On Friday 6/25/21 at 1:53PM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility to conduct a required annual inspection. A screening call was made prior to the visit. Safety precautions were taken, including face masks, hand sanitizer, disinfectants, and social distancing. Additionally, LPA tested negative for COVID-19 on Monday 6/21/21 and does not have any symptoms of COVID-19. LPA met with Licensee Carla Henry and informed of the purpose of the visit. The facility has a capacity of 3 and currently has 3 youth in placement. One youth was asleep, and the other two did not appear to want to speak to LPA. The Licensee and her adult son reside at the site. LPA inspected the facility site and grounds. The facility is a two-story house in a residential neighborhood. LPA observed the facility had food that meets the needs of children in care and that meets the 7-day nonperishable, 2-day perishable mandate. There is a kiddy pool in the backyard, but it is empty. LPA observed the first aid kit to be complete. Per Licensee, there are no firearms or ammunition on the premises. At 2:43PM, LPA observed bleach, raid, and chemicals in the unlocked cabinet under the kitchen sink. LPA also observed bleach stored in an unlocked bottom cabinet in the unlocked laundry room. LPA advised that these chemicals should be located somewhere inaccessible to children in care. At 2:47PM, LPA observed that the hot water in the upstairs resident bathroom measured 137. F, which exceeds the permitted range. LPA advised that the hot water temperature be lowered. At 2:50PM, LPA observed that one of the upstairs bedrooms was locked and Licensee did not have a key. This was an issue at a previous visit as well. LPA advised that Licensee ensure she has a key to the room at the site or on her person so that she always has access to all areas of the facility site. At 3PM, LPA observed that the facility has strings of dust and old webbing hanging from the ceiling in multiple locations that should be removed. The walls behind the kitchen counters need to be wiped down. There is a hole in the ceiling above the kitchen sink that needs to be repaired. The window screen in the upstairs large room has a large hole in it that needs to be repaired. The facility was otherwise organized and tidy. LPA advised that the entire facility be cleaned, dusted, and... ... disinfected. At 2:52PM, LPA observed a pile of pipes stacked in the backyard, which Licensee stated were from a trampoline that was set up in the backyard. Licensee stated that children play in the backyard. LPA advised that these pipes, which could be picked up by children, be removed from the grounds. At 2:45PM, LPA observed that Licensee was unable to open the back door to the backyard, which is one of the facility's fire exits. LPA advised that the door lock be fixed so that access through that door is possible in case of emergencies. At 2:53PM, LPA observed that there is exercise machinery obstructing the outdoor passageway to the side gate, which is one of the facility's fire exit passageways. LPA advised that this item be moved so as not to obstruct the walkway. LPA inspected the facility files. The files were complete, except for resident R1's (See LIC Confidential Names) inventory of personal belongings. Licensee stated she did not make for R1 but was able to make one during visit. At 2:35PM, LPA observed that Licensee's First Aid / CPR certificate expired on 5/21/21. There is one citation per California Code of Regulations, Title 22, Section Buildings and Grounds. Seven (7) advisories are being issued, per California Code of Regulations, Title 22, Section Fixtures, Furniture, Equipment, and Supplies; Section Inspection Authority of the Licensing Agency; Section Buildings and Grounds; Section Children's Records; and Section Health Related Services. An exit interview was conducted, and a copy of this report was left with Licensee Carla Henry, whose signature on this form confirms receipt. 2) CPR/1st Aid; 83075


summary: Facility Evaluation

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Narrative:
On 02/06/25 at 1:15pm, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced Case Management - Deficiencies inspection at the listed facility. LPA met with Carla Henry, Licensee and informed of the purpose of the visit. During an investigation, LPA conducted confidential interviews with staff. During these interviews, LPA observed that there had been multiple incidents that had not been reported to the department. LPA is issuing a citation for California Code of Regulations, Title 22, Division 6, Chapter 1, Article 06, Reporting Requirements 80061(b). See attached LIC809-D. An exit interview was conducted, appeal rights discussed and a copy of this report was left with Licensee whose signature on this form confirms receipt.


facility_name: HERNANDEZ SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On October 27, 2021, at 9: AM, Licensing Program Analyst (LPA) Babatunde Aborchie, met with licensee Ms. Geri Hernandez who granted access to the home. The purpose of this visit is to conduct an annual required inspection of the small family home. Presently there are five foster children in placement and five of five were present during time of inspection (See LIC 811). The home is single story with four bedrooms and three bathrooms. Bedroom #1 has two beds, it is occupied by C Bedroom #2 has two beds, it is occupied by C3 and C Bedroom #3 has two beds, it is occupied by C2 and C Bedroom #4 is occupied by Licensee. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes, rooms are used as bedrooms, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. The fireplace is properly screened. All hazardous items have been properly made inaccessible to areas where children will have access. The medications are locked and stored in the kitchen cabinets. Cleansers/chemicals are locked and stored in the storage room. Sharp knives are inaccessible and stored in a locked storage. The first aid kit is in the locked closet. There are no guns or weapons as stated by Licensee at this time. The hot water temperature was within normal limits. All facility smoke detectors are in appropriate working condition; fire extinguisher is properly charged and serviced. LPA interviewed two staff in the home. S2 and S3.

met_with: Licensee-Geri Hernandez


summary: Facility Evaluation

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Narrative:
On the above date Licensing Program Analyst (LPA) Karen Beal, met with facility Administrator who allowed LPA entrance at 11: AM. The purpose of the visit was to conduct an annual inspection of the Hernandez Small Family Home (SFH). Licensee/Administrator assisted the LPA with a tour of the home at 12: PM. At the time of this visit there were six medically fragile children in care. The home is set up as follow: Bedroom #1- Occupied by two (02) clients. Has two cribs · Bedroom #2- Occupied by two (02) clients. Has two cribs. · Bedroom #3- Occupied by two(02) clients. Has two cribs. Bedroom # Licensee Bedroom · Bedroom #5- Converted for Staff office. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The fireplace is properly screened. All hazardous items have been properly made inaccessible to areas where children will have access. The medications are locked and stored in day room area. Cleansers/chemicals are locked and stored in the laundry area. Sharp knives are inaccessible and stored in locked case in day room. The first aid kit is located in the locked medication area in the day room which is inaccessible to clients. There are no weapons in the home per Ms. Hernandez who lives on the premises.The backyard where children will have access to play is completely fenced and free of hazards.. The home does have a pool that is appropriately fenced. The fence is a 5-foot-tall wrought iron fence that surrounds the pool. The gate is self-latching and opens outward with the latch located at least 54 inches from the ground. There are four (04) windows that access the pool. Toys are safe, clean, and age appropriate for the age group of children being cared for. The licensee's CPR card/First Aid card and Registered Nursing Certificate are up to date. Children and staff records up to date and organized. Administrative records included: A review of staff seven records and five four client records on this date indicates that all facility staff have received criminal record and child abuse index check clearances. Exit interview conducted. A copy of this report and appeal rights were provided to Licensee, Geri Hernandez.

met_with: Stephanie Berges


summary: Facility Evaluation

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Narrative:
On August 8, 2025 at 1:49PM Licensing Program Analyst (LPA) Cynthia Ramos, met with Licensee Geri Hernandez who allowed LPA entrance at 1:55PM. The purpose of the visit was to conduct an annual inspection of the Hernandez Small Family Home (SFH). Licensee/ assisted the LPA with a tour of the home at 2:00PM. At the time of this visit there were five medically fragile toddlers in the home. The home is a single-story home that has four bedrooms and three bathrooms with two-car garage and a pool. Upon entering the home there was a dining table and the kitchen. Next, there was a living room with television and a fireplace which was properly screened. Bedroom #1 is currently occupied by Client #1 and Client #2, bedroom consisted of one medical bed and one crib. Bedroom #2 is occupied by two infants Client #3 and Client #4, this room consisted of two cribs. Bedroom #3 consisted on two cribs and is currently occupied by Client #4. Bedroom #4 is occupied by the Licensee. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. Bathroom #1 and #2 were inspected and were working properly. The water temperate was measured at 119.3 degrees F. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. Client bedrooms were inspected and there was adequate drawer/closet space and bedding for client's belongings. All hazardous items have been properly made inaccessible to areas where clients will not have access. The medications were locked and stored in day room area. Cleansers/chemicals are locked and stored under the sink and remain locked at all times. Sharp knives are inaccessible and stored inside the laundry room. The first aid kit is in the locked medication area in the day room which is inaccessible to clients. Per Licensee, there are no weapons in the home. The backyard is accessible to clients and is completely fenced and free of hazards. The home has a pool that is appropriately fenced. The gate is self-latching and opens outward with the latch located at least 54 inches from the ground. There are four (04) windows that access the pool. The carbon fire alarms were tested and working properly. There were 2 fire extinguishers throughout the home. A review of staff four records and five client records were reviewed during this visit. During this visit, no deficiencies being cited at this time. An exit interview was conducted, and a copy of this report was provided to the Licensee.

met_with: Licensee, Geri Hernandez


facility_name: HIDDEN TRAILS FAMILY HOME

raw_content:
Narrative:
and other children in the home vaping and drinking in the home. Another confidential stated that they were aware that foster children would smoke, but they were never caught or seen smoking and drinking while in care. Another confidential interview stated FC1 would get the vapes from other students at school and would steal the alcohol from Target. LPA received conflicting information. Regarding the allegation that licensee did not ensure minor received one to one care as required, it was specified that FC1 was not receiving one on one care for 20 hours a day. A confidential interview stated FC1 receives one on one care as required. The only time one on one care is not provided is when FC1 is on a visit or sleeping. LPA was unable to verify the information and the confidential interviews didn't elaborate anything about one-on-one supervision. Based on confidential interviews the allegations that licensee did not prevent FC1 from drinking alcohol with other children in the home, FC1 was caught vaping in the home, FC1 was not receiving one on one care for 20 hours a day may have happened or be valid, but there is not a preponderance of evidence to prove that the violations occurred. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted. A copy of this report and appeal rights were explained and given to the Licensee, Jacqueline Johnson.

Investigation Findings:
UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

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

met_with: Jacqueline Johnson


summary: Facility Evaluation

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Narrative:
On October 30, Licensing Program Analyst (LPA) Babatunde Aborchie, met with applicant Jacqueline Johnson this date for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the LIC 184, Notice of Incomplete Application, and additional correspondence to assist with the revisions needed for the application. Copy of this report was provided to applicant.


summary: Facility Evaluation

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Narrative:
On November 17, 2023 at 10: AM Licensing Program Analyst (LPA) Babatunde Aborchie began an inspection for a Small Family Home license. LPA met with applicant Jacqueline Johnson who led a tour of the home. The facility was toured both inside and out with the applicant. The applicant is applying for a capacity of 6 ambulatory clients. The home consisted of: Downstairs: Room #1, It was furnished with couches, it was used as a sitting room, for children to take time off to relax. There were also a family room, a living room, dining area, a kitchen, a pantry, storage, and a half bath. Upstairs: Bedroom #2, Master bedroom. The room consisted of one king sized bed. It sleeps the applicant. Bedroom #3, The room was furnished with two twin separate beds - it was vacant. Bedroom #4, The room was furnished with two twin separate beds - it was vacant Bedroom #5, The room was furnished with two twin separate beds - it was vacant. There was also a theater, three full bathrooms and cabinets. Bedrooms were arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked and were working properly. There was one living room, a playing/therapy area a game room next to the front entrance which was furnished with a pool table and bar area. Inside the facility the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in the closet under the stairs. Cleansers/chemicals were locked and stored in the laundry room. Sharp knives were inaccessible and stored in a locked box in the pantry. There were no guns or weapons as stated by Applicant at this time. The hot water temperature was tested and noted to be 110 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. The home had a pool that was appropriately fenced. The fence was 5-foot-tall and surrounded the pool. The pool gate opens outward toward away from the pool with safe latching mechanism located on the gate. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed for small family home will be forwarded to Licensing Program Manager for final approval. A component III orientation was conducted for the applicant and biological daughter. An exit interview was conducted. A copy of this report was provided to Applicant/Licensee


summary: Facility Evaluation

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Narrative:
On September 4th, 2025 at 12:48PM, Licensing Program Analyst (LPA) Cynthia Ramos met with Licensee Jacqueline Johnson who led a tour of the home. Licensee granted LPA access to the home. The purpose of the visit was to conduct an annual required inspection of Hidden Trails Small Family Home. The facility was toured inside and out with the Licensee. The home is a two-story home with 7 bedrooms and 5 bathrooms. On the first floor of the home, there was a Bedroom #1 which was a private living room area (therapy room) and a play area with pool table, board games and TV which is accessible to clients. The kitchen was inspected and was organized. Next to the kitchen, there was an additional living room with television and large couches. Bedroom #2 was converted into an office which remains locked. Additionally, there was a guest half bathroom on the first floor of the home. All hazardous items have been properly made inaccessible to clients. The medication box was locked and stored in a closet downstairs. Cleansers/chemicals were locked and stored in the laundry room which remains locked at all times. Sharp knives were inaccessible and stored in the kitchen's pantry. The first aid kit was located in the kitchen. The second floor of the home constisted of: Bedroom #1 is master bedroom which was occupied by Licensee and spouse and remains locked at all times, master bedroom contains bathroom. Bedroom #2 contained two twin size beds and was occupied by 17-year-old female client. Bedroom #3 contained two twin size beds and was occupied by 13-year-old female client. Bedroom #4 contained two twin size beds and was occupied by 16- year-old female client. There was also a large theater room that clients have access to. All bathrooms in the home were inspected and were working properly. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for client's belongings. The fireplace is properly screened. ... Per Licensee, there are no weapons in the home at this time. The hot water temperature was tested at 113 degrees F. Proper storage of all food was noted. Trash cans have tight fitting lids. The Emergency Disaster Plan with exit map, Title Personal Rights, and visitation policies were posted. The backyard where children have access to play is completely fenced and free of hazards. The home has a pool that is appropriately fenced. The pool fence was measured at 4 ft 2 inches and surrounds the pool completely. The gate is self-latching and opens outwards. LPA Ramos advised Licensee to ensure pool fence meets CCR pool fence requirements which is 5 feet tall. The garage was also inspected and no hazards were observed, per Licensee garage remains locked at all times. Smoke detectors/carbon monoxide were also tested and working properly. The home has 9 indoor cameras in common areas and 5 cameras outdoors. A total of 3 staff records and 3 client records were reviewed and records were in compliance. Based on today's inspection, there are no deficiencies to be cited at this time. An exit interview was conducted, and a copy of this report was provided to the Licensee.

met_with: Licensee, Jacqueline Johnson


facility_name: HIKARIHOUSE

summary: Facility Evaluation

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Narrative:
On 4/29/25 at 1PM, Licensing Program Analyst (LPA) Mariah Hawkins met with Applicants Takuji Hirayama and Golda Nohay for the Component II face-to-face meeting. The meeting was scheduled in advance. During the meeting, the following topics were discussed. Goal/Purpose of the Small Family Home Basic Services and Planned Activities Needs and Services Plans Care and Supervision Policies Emergency Intervention Policies Emergency Disaster Procedures Reporting Requirements Background Clearance/Guardian Process At the conclusion of the meeting, the prelicensing inspection was scheduled for Friday 5/16/25 at 11AM. LPA thanked Applicants for attending the meeting. A copy of this report was emailed to Applicants.


summary: Facility Evaluation

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Narrative:
On 5/16/25, Licensing Program Analyst (LPA) Mariah Hawkins conducted a prelicensing inspection. LPA met with Applicants Takuji Hirayama and Golda Nohay for the scheduled inspection of the Small Family Home site. LPA toured the site and observed: The site is a single-story house in a residential neighborhood. There are two double-occupancy bedrooms and two bathrooms available for use by served children. The common spaces provide plenty of space for meeting, lounging, and activities. Hot water is set within permitted temperature range. Beds have clean linens, and spare linens are available. Bedrooms have lighting and ample storage space. The outdoor activity space is free of hazards. The kitchen and bathrooms are sanitary. The applicants have prepared their records and storage spaces for confidential records. LPA discussed the following with applicants: - Storage of Medications - Storage of Confidential Records - General Recordkeeping - Activity Schedules Using the CARE Inspection Tool, no items needing correction were observed. LPA determined that the facility and applicants are ready for licensure. LPA discussed the final steps, including the Component III and the final review by the Licensing Program Manager. The Component III was scheduled for 5/29/25 2PM. An exit interview was conducted, and a copy of this report was provided to Applicants.

met_with: Applicants Takuji Hirayama, Golda Nohay


facility_name: HILL SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On October 28, 2021, at 10:20AM, Licensing Program Analyst (LPA) Humberto Flores, conducted an unannounced Annual Inspection at Hill Small Family Home (SMH) and met with Ayan Ukash Hill. The purpose of the inspection was informed to the Licensee. During the inspection a copy of the Register of Facility Clients and Personnel Report was provided upon request. The following topics were inspected: PHYSICAL PLANT: A tour of the facility was conducted, along with the Licensee. The License was placed in a prominent place, in the entrance of the facility. Children's foster rights were available upon request. LPA Flores observed that the facility is clean, safe, sanitary and in good repair. The passageways are unobstructed. The disinfectants and cleaning solutions were stored away from the kitchen areas, food preparation areas to the children. The food is safe and of the quality and the quantity necessary to meet the needs of the clients. Each meal meets at least 1/3 of the recommended in the USDA Basic Food Group Plan-Daily Food Guide. cont.# Supplies of staples non-perishable foods for one week and perishable foods for two days are maintained in the facility. Medications are locked and accessible only to the Licensee and the Director. The temperature in the rooms that clients occupy are maintained between 68 and 85 degrees (F) and the hot water temperature was at 110 degrees (F). Emergency Intervention Plan: LPA Flores reviewed the Emergency Intervention Plan. CLIENT RECORDS: LPA Flores reviewed the 2 (2) client file records. The files contain: Admission Agreement, Medical Assessment, Consent Forms, Emergency Information, Appraisal & Needs Service Plan, Immunization Record and Personal Rights. The Safeguards For Cash Resources was missing for C1. Staff Records: A total of 2 employees' file was reviewed. The files contain the following documentation: Child Abuse Index Checks/Department of Justice (DOJ)/Federal Bureau of Investigation (FBI) criminal record clearances, criminal record statement. # LPA Flores did not observe in the Director's file a health screening and tuberculosis. The Licensee's First Aid Certificate and Cardiopulmonary Resuscitation expired on 07/30/2021. OPERATIONAL REQUIREMENTS: During the inspection review, LPA Flores observed the facility maintained an updated roster of the clients with pertinent information. The Licensee and Director are the responsible and capable for communicating with emergency personnel if needed. A copy of this report, citation pages, appeal rights, LIC Advisory Note / Technical Violation were provided to the SMH representative. Exit interview conducted.

met_with: Ayan Ukash Hill


raw_content:
Narrative:
It was alleged that L1 retaliated against C1 for calling police. LPA's Investigation revealed that L1 stated her forms of discipline are usually taking privileges away. L1 provided a cell phone to the client to support their ability to communicate privately with their case worker and other individuals connected with the client's support and services. L1 removed the phone when the client began to abuse the use of the cell phone. The client still had access to a phone in the event of an emergency. Based on interviews conducted and record review the allegations are unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the allegations occurred. No deficiencies were cited during this inspection. Exit interview conducted. A signed copy of this report was left with Ayan Hill, licensee. Appeal Rights provided and explained. ***This is an amended findings report delivered on September 23, 2024*** to the alleged abuse. The allegation that L1 yelled at C1 while in care also produced inconsistent statements through interviews. L1 and A1 both stated to LPA that they do not yell at the youth in care, but that they will speak sternly when the situation calls for it. There were no known witnesses to the alleged incident. It was alleged that L1 was not providing a safe environment for C1 in care by leaving medicines out on the counter. There were statements made that C1 has impulsive tendencies and often swallows objects. LPA's investigation revealed that L1 and A1 were consistent during independent confidential interviews in detailing how they go about the handling and storing of medications. However, on February 8, 2024, at the time of LPA's inspection, LPA observed a locked medicine box containing client medications that was accessible to persons other than staff and it was not centrally stored as required. L1 and A1 both reported they had a lot of things going on that day and although the medication box was left on the counter, the clients were all in school. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. SFH was issued a Technical Advisory during this inspection. Refer to LIC9102-TA advisory page dated 06/06/24. Exit interview conducted. A signed copy of this report, LIC9102-TA, and LIC 811 dated 2/8/24 were provided to Carissa Williams, Direct Care Staff. Appeal rights provided and explained. ***This is an amended findings report delivered on June 06, 2024***

Investigation Findings:
13On April 3, 2024, at 11:04 a.m., Licensing Program Analyst (LPA) John Bonilla arrived at the Hill Small Family Home for the purpose of delivering findings on the above allegation. On February 2, 2024, the Department received a complaint in regards to the personal rights allegation mentioned above. LPA's investigation consisted of the following: On 02/07/ LPA reviewed facility files in Department databases. On 02/08/ LPA interviewed L1 (See LIC Confidential Names list dated 2/8/24) and Facility Director (A1) at the SFH, the focused client (C1) at their school, and Reporting Party (RP) and C1's County Social Worker (CSW) via telephone. LPA received and reviewed the following documents from the SFH: Needs and Services Plan for C1, Medical Records, & Medication Log, and the SFH's LIC Personnel Report. LPA followed up an interview with C1 on 03/07/24. ***This is an amended findings report delivered on September 23, 2024*** (Continued next page) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: John Bonilla 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 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HILL SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 04/03/2024

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

met_with: Ayan Hill, Licensee


raw_content:
Narrative:
The Following Allegation(s) were reported: 1. Medications were accessible to clients in care. Information obtained from staff member S1, who was present during the incidents on February 24, 2024, and March 18, 2024, suggested that C1 was able to access medication stored in the kitchen cabinet above the microwave with relative ease. A review of records indicated that C1 was taken to the emergency room on two occasions after consuming over-the-counter medications that had been stored in the medication cabinet, which they accessed by unlocking themselves. On March 18, 2024, LPA Moroney noted that over-the-counter medications were secured by a baby lock in a cabinet, while prescribed medications were placed in a separate locked box within that cabinet. However, despite the medications being stored in a locked cabinet, C1 was still able to obtain them, indicating that the existing locking mechanism was ineffective in preventing access as intended. Given these incidents, it is imperative to implement additional measures to enhance the security of the medications. Although staff members attempted to prevent C1 from accessing the medications, they were unsuccessful. In response to these events, the facility has since upgraded to a more secure combination lock to better ensure the safety and well-being of all clients. Furthermore, information from CSW2 and CSW4 indicated that they have no concerns regarding medication management or the care and supervision provided by the Licensee. ***This is an amended findings report delivered on October 16, 2024*** Therefore, based on the information received, the above allegation is determined to be unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation(s) occurred, therefore the allegation is found to be unsubstantiated. Appeal Rights were provided and discussed with the facility Administrator. There are no deficiencies to be cited at this time. An exit interview was conducted and a copy of the report along with the (LIC 811) was emailed to the Licensee.

Investigation Findings:
13On October 22, 2024, at 2: PM, Licensing Program Analyst (LPA) Winston Moroney conducted a follow-up inspection at the Hill Small Family Home. During the inspection, the LPA met with the Licensee (S3) to discuss the findings of the complaint allegation(s). The purpose of the inspection was to deliver an amended finding of the complaint investigation. The inquiry into the aforementioned allegation was carried out by LPA Moroney. This investigation included but was not limited to, a review of relevant records. It was noted that only one staff member (C1) was present during the incidents, during which C1 retrieved over-the-counter medications from the medication cabinets. Interviews with staff S1 on 3/18/24, CSW Kern County Social Worker on 3/27/24, (CSW4) Santa Barbara County Social Worker on 4/4/24, two of four clients were interviewed client (C3) on 4/24/24 by LPA John Bonilla and C1 by LPA Moroney on 6/17/24. (No statements were obtained from C2, and C4 due to being non-verbal). (Reference Confidential Names Form LIC 811, dated October 22, 2024). ***This is an amended findings report delivered on October 16, 2024*** UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Winston Moroney 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 32-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, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HILL SMALL FAMILY HOMEFACILITY NUMBER: 157807011

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

met_with: Ayan Hill


raw_content:
Investigation Findings:
13On June 14, 2024, at 2: PM, Licensing Program Analyst (LPA) Winston Moroney conducted a complaint inspection at the above Small Family Home (SFH) and met with the Licensee. The inspection aimed to deliver the findings regarding the complaint allegation(s). On March 14, 2024, the Community Care Licensing Division of the California Department of Social Services received a complaint with the following allegation(s): Staff inappropriately touched the client. This LPA conducted the investigation of the above allegation(s) and it consisted of but was not limited to a review of records, including the client's needs and services plans, medical records, and interviews with the 1 staff member (S1) on 3/18/24, S2 and S3 on 8/29/23, 1of 2 clients C2 on 12/01/23. (C1 declined to provide a statement). (Reference Confidential Names Form LIC 811, dated June 14, 2024). The Following Allegation(s) were reported: 1. A staff inappropriately touched the client. The accusation was refuted by the staff member (S1) who clarified that a situation occurred where a client was rummaging through the kitchen cabinet and received verbal guidance from the staff member. Nevertheless, before the staff member could intervene, the client successfully grabbed a 12 oz bottle and consumed its remaining contents. S1 mentioned that they made an effort to retrieve the bottle from C1's hand, but C1 pulled it close to their chest, causing the staff member to refrain from taking any further action. Therefore, based on the information received, the above allegation(s) is determined to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred, therefore the allegation is found to be unsubstantiated. Appeal Rights were provided and discussed with the Foster Family Agency. There are no deficiencies to be cited at this time. An exit interview was conducted and a copy of the report along with the (LIC 811) was left with the Licensee. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Winston Moroney 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:
Narrative:
Confidential interviews revealed the complainant was not aware of the caretaker's actions to obtain appropriate care for the client. The complainant admitted not knowing the caretaker had taken to the assigned cardiologist nor that she had stablished a plan for the client's treatment plan. Therefore, based on the compiled information, it cannot be determined whether the above allegations occurred. The complaint allegations are found to be unsubstantiated. Although the allegation may have happened or is valid, there not a preponderance of the evidence to prove that the allegations occurred. No deficiencies were cited. An exit interview was conducted, and a copy of this report provided to the above-named staff.

Investigation Findings:
On 8/5/24, Licensing Program Analyst (LPA) Johanna Lofton conducted a follow up inspection visit to Hill Small Family Home with the purpose of delivering findings for the above complaint allegations. LPA Lofton met with Facility Administrator Ayan Hill and discussed the findings. During the investigation, confidential interviews were conducted with care provider, complainant, and placement agency. (See Confidential Names List-LIC 811 dated 08/5/24). During confidential interviews, the allegations were denied by the care provider. Facility staff reported having client assessed by a pediatrician who assessed the client's condition and prescribed oxygen and follow up with primary care provider. During the investigation, it was confirmed that the care provider followed up with doctor's orders. Furthermore, the care provider took the client to UCLA where a treatment was set in place. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Johanna Lofton 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 32-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, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HILL SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 08/05/2024

met_with: Ayan Hill- Administrator


raw_content:
Narrative:
Additionally, between 7/30 and 8/2/ LPA Mahecha interviewed additional witnesses and staff. Investigation revealed the following: It was alleged that staff mishandled a minor while in care. Interviews conducted with licensee and staff had similar statements and denied the allegation. Staff stated that one child was observed to be under the influence. Staff stated that child became aggressive towards staff because staff were redirecting child to leave shared room and to give staff contraband child was using to smoke in the home. Staff stated that law enforcement was called as child was presenting a danger to self and others. LPA attempted to contact county social workers, child in which complaint was involved and additional witnesses, however, LPA was unable to reach all parties. Documents reviewed identified no concerns with facility or staff mishandling youth. Documents reviewed identified multiple incidents occurring with youth and youth being aggressive and injurious to self and others. Statements made by client in documents reviewed were unclear and identified various people involved. Some people identified by client were not present or working during times of documented incident. Based on the information gathered, although the allegation may have happened or is valid, the preponderance of evidence to prove the allegation was not met, therefore the allegation is unsubstantiated. An exit interview was conducted. A copy of this report Confidential Names Form and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On 8/5/ Licensing Program Analyst (LPA) Johanna Lofton made an unannounced visit to the Hill Small Family Home (SFH) on behalf of LPA Dawn Mahecha for the purpose of closing the above complaint investigation. LPA met with Administrator and discussed the above complaint investigative findings. Investigation consisted of the following: On 6/22/ LPA Lofton conducted initial 10-day inspection and met with representative (See confidential names LIC811, dated 06/22/2024). LPA requested the following documents be emailed to LPA Mahecha: Facilities current LIC500 or staff roster, current client roster, placement history, children's most recent needs and service plans or individualized education plans (IEP). Additionally, LPA requested copies of staffs most recent completed trainings, criminal record clearances for all adults associated to the home, special incident reports or complaints documenting the care and supervision of children or altercations between children and staff. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Johanna Lofton 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 32-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, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HILL SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 08/05/2024


raw_content:
Narrative:
All staff stated that facility provides adequate training and have enough staff on duty to assist with clients' needs or behaviors. LPA was unable to interview children due to children being either nonverbal or unavailable. LPA attempted to contact county social workers and witnesses, but LPA was unable to reach documented social workers. However, documents reviewed identified no concerns with facility or facility staff in caring for the children. Based on information gathered, although the allegation may have happened or is valid, the preponderance of evidence to prove the allegation was not met, therefore the allegation is unsubstantiated. An exit interview was conducted. A copy of this report Confidential Names Form, and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On 11/06/ Licensing Program Analyst (LPA) Dawn Mahecha made an unannounced visit for the purpose of concluding the above complaint investigation. LPA met with Administrator and discussed the above identified findings to complaint investigation. Investigation consisted of the following: On 5/29/ LPA Claudia Portillo conducted initial 10-day inspection. Between 5/29/2024 and 9/13/ LPA Winston Moroney and LPA Dawn Mahecha attempted to contact social workers, staff, and children. Investigation revealed the following: It was alleged staff displays inappropriate behavior in front of children in care. Interviews conducted with Administrator and two (2) staff denied the allegation. Staff and Administrator stated that staff receive training and that no children ever complained about staff displaying inappropriate behavior or show casing themselves inappropriately. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Dawn Mahecha 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 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HILL SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 11/06/2024

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

met_with: Ayan Hill, Administrator


summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Narrative:
Page During the course of the investigation SI Munoz obtained Bakersfield Police Department (BPD) records on 6/14/24 and interviewed confidential witnesses on 6/20/24. Between 09/16/24 and 01/24/25, LPA Larios conducted interviews with two facility residents, one placing agency social worker and seven facility staff. In addition, on 05/12/24, the facility provided LPA Larios copies of the LIC9020, LIC500 and staff contact information. The Department received a complaint regarding allegations of General Neglect/Lack of Supervision and Personal Rights violations on youth in placement. The investigation did not provide sufficient evidence to support the allegations. It was alleged a resident in care was hospitalized due to consuming drugs. Statements obtained from staff, the resident and law enforcement records indicate the hospitalizations resulted from the resident being a danger to self or others. It was alleged that due to lack of supervision a resident had access to vape pens and alcohol. Information gathered from interviews conducted with staff revealed the facility does not conduct searches. In addition, staff denied observing the resident consume drugs or alcohol in their presence. Instated, staff reported the resident would emerge from her bedroom and state she consumed substances. LPA Larios obtained a photograph of the resident consuming alcohol, allegedly while being transported back to the facility by a staff member, however, it was unable to be determined where or when the photograph was taken. It was alleged two staff pulled a resident out of her bedroom by her legs. The resident stated on the date of the incident she refused to surrender her vape pen to staff. During the incident staff attempted to escort her out of the room, the resident struggled, and fell on her back. Staff then grabbed her legs and pulled her out of the room. One of the two staff denied grabbing the resident by the legs and stated the resident began kicking at the staff which did not permit them to escort the resident. The other staff was unresponsive to attempted telephone contacts and resigned prior to providing a statement. The resident roommate is nonverbal and did not provide a statement. Continued on page Page It was alleged staff did not provide a safe environment for a resident. The multitude of allegations made during the complaint were unable to be corroborated. Although one of the residents presented with behaviors, including harm to self and others and incidents of consuming substances, there was no evidence to suggest this was due to lack of supervision by staff. It was alleged a staff member yelled at a facility resident and did not treat the resident respectfully after the resident reported she was handled roughly by said staff. The contact information provided by the facility was out of service and the staff member resigned during the course of the investigation, thus a statement was not obtained. The resident was interviewed and stated staff treat her with respect and denied the allegations were valid. Based on information obtained from interview conducted and record review the allegations are unsubstantiated. Although the allegations may have happened or are valid, the standard of the preponderance of evidence was not met. A copy of this report was provided to the above-mentioned facility representative. Exit interview conducted. No deficiencies were cited.

Investigation Findings:
13An unannounced follow up complaint inspection was conducted on 01/24/25, at 10: AM, by Licensing Program Analyst (LPA) Christopher Larios. During the inspection LPA Larios met with Administrator Ayan Hill. The purpose of the inspection was to deliver findings regarding the above-mentioned complaint allegations. The investigation was conducted by Community Care Licensing Division (CCLD) Investigations Branch (IB) State Investigator (SI) Romelia Munoz and LPA Larios. During the course of the investigation SI Munoz obtained Bakersfield Police Department (BPD) records on 6/14/24 and interviewed confidential witnesses on 6/20/24. Between 09/16/24 and 01/24/25, LPA Larios conducted interviews with two facility residents, one placing agency social worker and seven facility staff. In addition, on 05/12/24, the facility provided LPA Larios copies of the LIC9020, LIC500 and staff contact information. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Christopher Larios 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 32-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, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HILL SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 01/24/2025

Allegations:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 0


raw_content:
Narrative:
The Administrator and facility director are the ones who received training how to change g-tube at the hospital and they are the only ones changing the g-tube. Administrator stated she never provided false information to CCL. Administrator stated that is false accusation. The facility notify within 24 hours and written reports are submitted within seven days to CCL. The LPA was unable to interview children due to children being either non-verbal or unavailable. The statements obtained from the confidential interviews did not provide sufficient information to corroborate the allegations. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that alleged violations occurred, therefore the allegations are unsubstantiated. There were no deficiencies cited during this inspection. An exit interview was conducted. Appeal rights explained and a copy of this report, and Appeal Rights were provided to the facility representative.

Investigation Findings:
13On February 24, 2025, at 2: PM, Licensing Program Analyst (LPA), Karen Suh, conducted a follow-up complaint inspection with the facility above to deliver the findings of a complaint investigation. The LPA met with the representative named above and discussed the findings. The investigation included confidential interviews that consisted of but were not limited to: Administrator (see Confidential Names, LIC811 dated February 24, 2025), two staff on August 1, 2024, one staff on August 13, 2024. The LPA attempted to contact social workers. The LPA reviewed clients' roster and trainings provided to all staff. It was alleged staff do not have proper training to care for minor and licensee provides false information to CCL. Administrator and staff denied the allegations. Staff stated the facility provides adequate training and have enough staff on duty to assist with clients' needs and behaviors. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Karen Suh 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 32-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, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HILL SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 02/24/2025

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

met_with: Asia Armstrong, Facility Director


raw_content:
Narrative:
The investigation revealed that the facility is a General and not a Specialized Small Family Home. It revealed that Client Ref. #1 is a non-verbal special needs client, but does not meet the criteria for a Individualized Health Care Plan. It revealed that the facility has partnered with a hospice care who provides nurses three times a week to check on Ref. #1, and assist with Ref. #1's medication and care. A review of the Training Logs indicated that all staff listed on the Personnel Report received the training outlined in the Program Statement. The LPA observed training on medication in the Hour Training, i.e.- one in the 8-Hour Course Outline and one in the 16-Hour New Hire Training. The LPA observed that all staff received training regarding the G-tube. An interview with at least one staff indicated that they received training on the G-tube from the hospice nurses. LPA McGee was unable to corroborate the allegations. There was no preponderance of the evidence to substantiate the allegations. So, although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the allegations are unsubstantiated. There are no deficiencies to be cited regarding these allegations. A copy of this complaint was provided to the facility representative.

Investigation Findings:
13On March 6, 2025 at 11:25 a.m., Licensing Program Analyst (LPA), Karen McGee delivered the findings of the complaint investigation. The LPA met with Facility Director, Asia Armstrong. On November 6, 2024, the Monterey Park Children's Residential Program (MPCRP), received a complaint with the above mentioned allegations. Confidential interviews were conducted that included, but were not limited to: the Caregiver via telephone on February 26, 2025; the County Social Worker (CSW) via telephone on February 19, 2025. The LPA reviewed the Program Statement, Client Ref. #1's Needs & Services Plan, Discharge Summary, Placement Agreement, Preplacement Appraisal Information, Personnel Report, Staff Annual Training, G-Tube Training Log, Special Incident Reports and Community Care Licensing Annual Inspection dated July 30, 2024. The LPA toured the facility on November 6, 2024, January 23, 2025 and February 20, 2025. On November 6, 2024, the LPA observed one staff cleaning the open-air living room-kitchen area. On all three occasions, the LPA observed the facility to be clean, safe and in good repair. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Karen McGee 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 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HILL SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 03/06/2025

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

met_with: Asia Armstrong