summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday 6/2/21 at 10:30AM, Licensing Program Analyst (LPA) Mariah Hawkins conducted an announced prelicensing inspection at the facility site. LPA met with Core Program Supervisor Damian Nomellini and Administrator/Core Program Director Monique Nervis. COVID-19 safety precautions were taken during visit, including screening, sanitizer, disinfectant, and mask-wearing. There are two care staff and one child present. The child was asleep in the large bedroom. At 10:33AM, LPA conducted a tour of the facility and grounds. The facility is a blue, two-story, historical house that has received a fire clearance for 4 ambulatory only youth ages 0-17. The main entrance is on the side near the parking lot. The front entrance opens to the street. LPA observed the street to be a somewhat busy main road. The upstairs consists of the administrator's office, the nurse's office, and the storage room, and the downstairs consists of two double-occupancy bedrooms, the living room, kitchenette, and staff office space, hallway, bathroom with only shower/tub (no toilet) and laundry, and bathroom with no shower or tub (only toilet, sink, changing table). All rooms upstairs are kept locked. The upstairs offices are both clean and tidy, and the nurse's office is stocked with first aid supplies. The first aid kit is centrally stored in the black cabinet in the living room. A sign in sheet and a no contact thermometer are ready for screening upon entry and placed on a table near the main entrance. The locked upstairs storage room is organized and currently holds plenty of school supplies, backpacks, hygiene products, toilet paper, paper towels, and clothing of different sizes and styles to be appropriate for all groups of youth. The client files are kept in a locked cabinet in the storage room. All rooms and areas downstairs are tidy and free of obstruction. Both bedrooms are double-occupancy with single beds fitted with mattress pads. The facility stores a crib under one of the beds in the small bedroom that is to be set up and used as appropriate for admitted youth. Core Program Supervisor stated the crib is usually set up in the living room rather than the large bedroom so that staff can have eyes on the youth at all times. LPA recommends the crib be placed in a bedroom, per OS Section 84087(a)(4)-(5). The following items need to be completed in order for the facility to be granted full licensure. A follow-up virtual inspection will be conducted to verify completion. The follow-up visit is anticipated to be conducted within four weeks from today. 1. Notify LPA once access is obtained to the locked storage space in the upstairs storage room. 2. Notify LPA of the plan to secure the attic access door to ensure it is only accessible to authorized staff. 3. Notify LPA when the alarm on the upstairs balcony access door is in working condition. 4. Notify LPA when the side porch has been cleared of webbing and insects. 5. Notify LPA of plan/statement addressing unknown/unauthorized individuals camping of facility grounds. 6. Notify LPA once the mounted television in the small bedroom has been relocated to above the dresser. 7. Notify LPA once the downstairs window has been repaired. 8. Notify LPA of the plan to see if it is possible to sync the smoke detectors to ensure the alarm can be heard throughout the house. 9. Notify LPA once the first aid kit is complete with the first aid manual and tweezers. An exit interview was conducted and a copy of this report left with Core Program Supervisor Damian Nomellini and Administrator/Core Program Director Monique Nervis, whose signature on this form confirms receipt. At 10:51AM, LPA observed the unused entrance on the left side of the house (facing the street). The porch is sturdy but not otherwise well maintained, as there is a large amount of insects and webbing on the wall, railing, and around the porch light. At 10:55AM, LPA observed there to be a white mattress and bag in the yard. Core Program Supervisor stated it may belong to a homeless individual. The homeless camp set up is on facility grounds. There is no fencing surrounding the lot, but there is a fence surrounding neighboring lots behind the facility. There is no physical barrier between the outdoor activity space on the facility grounds and the main road on which the facility is located. It is a potential concern if unknown individuals frequently camp on the grounds, as this has been observed at previous visits. At 11AM, LPA observed in the smaller bedroom that there is a small flat screen television mounted above the head on the bed nearest the street side of the house. Above the television is a mounted shelf with a DVD player on it. It is a potential concern that this television placement is not the most ideal and may be a hazard. LPA strongly recommends a more suitable location. Core Program Supervisor stated the facility already has plans to move the television to above the dresser so it is viewable from both beds. At 11:10AM, LPA observed that one of the downstairs windows in the living room was broken and boarded up with cardboard and tape inside and wood on the outside. The facility had notified LPA beforehand that this was caused by one of the youth in placement the week prior to the visit. Please review OS Section Buildings and Grounds, Line (a). At 11:14AM, the smoke detectors were tested. LPA requested that the sleeping youth be gently notified a few minutes prior to testing the alarm. LPA was in the upstairs administrator's office and observed that the alarm was fairly faint from the office. LPA stood in the upstairs hallway and noticed it was still faint and that the upstairs alarm was not beeping and appeared to not be synced with the downstairs alarm. Please review OS Section 80045, Line (c)(2)(A) and applicable Health and Safety Code sections related to fire clearances and smoke detectors. LPA recommends ensuring the alarms are synced. At 11:28AM, LPA inspected the first aid kit and observed the first aid manual and tweezers to be missing. At 11:35AM, Core Program Supervisor searched the nurse's office and confirmed the facility did not have a manual or tweezers. Please review OS Section Health-Related Services, Line (f)(1). The facility has plenty of cleaning solutions, detergents, and disinfectants stored in locked cabinets in the shower/laundry room. Bath linens are stored in this room as well. The bathroom with toilet is clean and in sanitary condition. Broom and mop are stored in a closet under the stairs. Craft supplies, toys, and entertainment are available for youth of varying ages. Furniture is sturdy and in good condition. The kitchenette is stocked with utensils and dishware to serve the intended population. There is currently perishable and nonperishable food that is in date and in supply to meet the needs of youth in care. Food items were date labeled. At 10:33AM, LPA observed that the stairs to the upstairs are very steep. Administrator stated that she needs to walk at an angle in order to support herself up the stairs. LPA also had to walk at an angle. The facility has placed gates at the top and bottom that could secure in place but did not have locks. Two signs were posted at the bottom of the stairs: one read "Children are NOT allowed on the 2nd floor if not accompanied by staff"; and the second read "Steep Stairs Use Hand Rail." At 10:40AM, LPA observed there to be a small, locked door in the storage room. Administrator and Core Program Supervisor were unable to locate the key to the door and stated they did not know what was behind the door but assumed it was additional storage. At 10:45AM, LPA observed there to be an attic access point in the middle of the upstairs hallway. There is no drop ladder and the door can be opened by pushing up while stepping on a ladder. A ladder was leaning against the wall at the end of the hall. Core Program Supervisor confirmed that there is no lock on the door. At 10:47AM, LPA inspected the balcony access door at the end of the upstairs hallway. There is an alarm on the door but it was observed to not be working. No alarm could be heard from upstairs or downstairs. At 10:49AM, LPA observed an exposed telephone cord poking out of the ceiling in the upstairs hallway. Core Program Supervisor stated he did not know what the purpose of the cord was. LPA recommends concealing the cord. At 10:50AM, LPA inspected the facility grounds and shed in the side yard. The shed is used as extra storage and is kept locked. LPA observed a painter's spatula near the shed and requested Core Program Supervisor remove the item from the yard.

met_with: Core Program Supervisor Damian Nomellini, Administrator/Core Program Director Monique Nervis


state: CA

facility_name: HARMONY HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
On Thursday 9/16/21 at 9:27AM, Licensing Program Analyst (LPA) Mariah Hawkins conducted a visit at the facility for a Post-Licensing Inspection. LPA met with Core Program Supervisor Damian Nomellini and informed of the purpose of the visit. Prior notice of the visit was provided to conduct a screening. Safety precautions were taken including mask-wearing and hand hygiene. There were three staff present, including Core Program Supervisor, and two youth in care. LPA observed the youth to be in good spirits and engaging well with staff. Staff were knowledgeable of facility procedures, reporting requirements, and trauma-informed care practices. LPA toured the facility and observed the site to be clean, in good repair, and free of obstructions and hazards. There are no bodies of water on the premises, and Program Supervisor confirmed there are no firearms. The exterior and entry way of grounds were well-maintained and clear of debris. The entry space has staff desks, and there is a staff office and a nurse's room upstairs. There is also a locked storage room upstairs. Resident records are stored in a file cabinet in the upstairs storage room. Staff files are maintained at the administrative office, but copies are kept on site as well. The first aid kits were stored downstairs and were observed to be complete. License, facility sketch, and personal rights were posted in the facility. Room temperature was comfortable and within permitted range. Hot water in the bathroom was measured to be both too high and too low. Initially and for about a minute, the water temperature reached high temperatures and for at least a second reached as high as F and was steaming. It then lowered and would not go above F, and the water pressure dropped significantly. Core Program Supervisor stated maintenance was working on the sink this morning and they would be called back to resume their work. For now, because the system appears to have malfunctioned rather than to be consistently delivering too hot water, LPA advises, per Operating Standards (OS) Section 80088, that the facility post a sign cautioning of hot water temperatures at the sink and continue monitoring temperatures. The kitchen and living room area was observed to be clean and tidy. The facility keeps clean and appropriate games and activities for all age groups. The kitchen space was sanitary. Chemicals are stored in a locked cabinet in the laundry/shower room. Medications and sharps are stored in a locked cabinet behind the staff desks downstairs. There are two double-occupancy bedrooms. Beds are single beds with clean linens. The facility has extra bed linens in storage. LPA inspected resident records and staff files. Records were complete and contained necessary forms and/or equivalents of required forms. LPA observed the following items and issued advisories per the facility Operating Standards (OS). 1) Files for staff S1, S2, and S3 (See LIC Confidential Names) are missing first aid certificates, LIC Criminal Record Statement, and LIC Statement Acknowledging Requirement to Report Child Abuse. LPA advises, per OS Section 80066(a) Personnel Records, that all staff files are updated to include current forms and certificates and be made available at the facility site. 2) Staff health screenings and TB tests are not maintained at the facility site. Also, the staff training record maintained on site does not include training record for all staff, and staff files do not contain training records. LPA advises, per OS Section 80066(e) Personnel Records, that the facility ensure that these records are available on site. 3) File for resident R1 (See LIC 811) has a medication administration record that does not reflect medication was administered on resident's first day in care. This is due to the facility not receiving the resident's medication until the following day. LPA advises as technical assistance that the facility note on the log why medication was not administered on any day medications are not administered for R1 and future youth. The facility has otherwise maintained compliance with applicable licensing requirements during the provisional licensure period. There are no pending items for the licensee to complete in order for the facility to qualify for full transitional shelter care facility licensure. The regular, non-provisional license will be generated and provided to the facility. An exit interview was conducted, and a copy of this report was left with Core Program Supervisor Damian Nomellini, whose signature on this form confirms receipt.

report_type: Facility Evaluation


summary: Facility Evaluation

raw_content:
Narrative:
On 6/19/23 at 10:30 am, Licensing Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to conduct the required two year inspection. LPA met with Damian Nomellini, Core Program Supervisor (CPS) at the above facility to conduct the required annual inspection. LPA reviewed five client files. At this time the inspection is not complete, LPA will return to complete the inspection. LPA conducted an exit interview with Damian Nomellini, CPS and a copy of the report sent to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 6/20/23 at 10:30 am, Licensing Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to conduct the required two year inspection. LPA met with Damian Nomellini, Core Program Supervisor (CPS) at the above facility to conduct the required annual inspection. LPA reviewed and completed physical plant and emergency preparedness sections. At this time the inspection is not complete, LPA will return to complete the inspection. LPA conducted an exit interview with Damian Nomellini, CPS and a copy of the report sent to the facility.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On 6/26/2023 at 1:00PM, a meeting was coordinated between Dept. of Social Services representatives, Contra Costa County, and Facility Representatives. The attendees were as follows: Nelson Martinez - Regional Manager, Community Care Licensing (RM) Helga Wong - Licensing Program Manager, Community Care Licensing (LPM) Selena Hood - Licensing Program Analyst, Community Care Licensing (LPA) Alicia Bernstein - Manager of Placement Support Services, Family Intake and Engagement Unit Julie Waters - Manager, Family Intake and Engagement Unit Adele Carson - Program Analyst, Family Intake and Engagement Unit Lori Castillo - Division Manager, Contra Costa County Hannah Slade - Children and Family Analyst, Contra Costa County Kathy Marsh - Contra Costa County Vernon Brown - CEO, Aspiranet Laurie Walsh - Aspiranet Monique Nervis - Program Director of Receiving Centers, Aspiranet During the meeting the attendees discussed the Harmony House Annual Review Response initially sent on 6.9.2023 as well as Contra Costa and Aspiranet's response to the review. County representatives discussed the actions that Contra Costa County has taken to lower overstays at the receiving centers, including working with Dept. of Behavioral Health, supporting existing STRTPs and resource family homes, increasing relative placements, focusing on Intensive Services Foster Care (ISFC) homes, and contracting with a company that does extra family searching for relative placements. Continued on LIC809C... County representatives relayed that they have conducted outreach in the community for more placements. According to the representatives, this has included reaching out to other counties, current providers, and currently certified homes. Aspiranet representatives discussed that a youth would not be accepted in the facility if there was a consistency of not being able to provide services to the specific youth; however, youth with no history will typically be accepted into placement. Aspiranet representatives relayed that a youth would not be accepted if there was an inability to safely maintain the youth, but there is an option to accommodate these youth depending on the current status of the two homes. The meeting adjourned at 2:28PM.

visit_type: Annual

met_with: Vernon Brown


summary: Facility Evaluation

raw_content:
Narrative:
On 6/27/23 at 10:30 am, Licensing Program Analyst (LPA) Paul Simien conducted an unannounced visit to the above facility. The purpose of this visit was to conduct the required two year inspection. LPA met with Damian Nomellini, Core Program Supervisor (CPS) at the above facility to conduct the required annual inspection. LPA reviewed and completed emergency interventions, operations, staff files sections. LPA conducted two staff interviews (only two staff members to interview) and one client interview (Only two clients available, one client declined). The staff section did not process correctly due to software error. LPA had to manually create eight Technical Assistance forms. The inspection is complete. Four Technical Violations, and nine Technical assistance were cited at this time. LPA conducted an exit interview with Damian Nomellini, CPS and a copy of the report sent to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On May 1, 2026 at 01:27pm, Licensing Program Analyst (LPA) Celeste Aparicio made an announced collateral visit to the facility to conduct a confidential interview. LPA met with Youth Specialist, Zeida Alvarez and informed Youth Specialist on the purpose of the visit. LPA conducted one confidential interview related to an outside investigation. An exit interview was conducted, and a copy of this report was left with Youth Specialist.

met_with: Youth Specialist, Zeidea Alvarez


summary: Facility Evaluation

raw_content:
Narrative:
On 05/12/2026 at 12:30 p.m., Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced Annual Inspection at the above listed facility. LPA met with Bomnica Bonheur, Site Supervisor. The Temporary Shelter Care Facility is licensed to serve 4 clients. Present during the inspection were 4 staff and 0 clients. No clients were currently placed at the facility during inspection. During the inspection, LPA obtained an updated LIC 500 (Personnel Report) to ensure the facility's records are current. A review of the Guardian background check system on May 12, 2026, confirmed that all staff present and associated had cleared Department of Justice (DOJ), Federal Bureau of Investigation (FBI), and Child Abuse Central Index (CACI) background checks. At 1:00 p.m., LPA conducted a tour of the facility and evaluated the facility using the CARE inspection tool. LPA observed two bedrooms and one bathroom. In one of the bedrooms, LPA observed a baby crib that meets the under-six requirements. Each bedroom was equipped with a smoke detector and carbon monoxide detectors. LPA observed the facility license, personal rights poster, facility sketch, meal menu, and other required forms posted throughout the facility. LPA Medina tested the water temperature and found it to be 115.2 degrees Fahrenheit, which meets the acceptable limit. The thermostat reading was 68 degrees Fahrenheit, which is also within the acceptable range. Sharps and chemicals were safely stored. There was no medications on the premises as there is currently no clients. LPA observed at least two days of perishable food and seven days of non-perishable food on site. No deficiencies were observed in this section. Continues on LIC809-C At 2:15 p.m., LPA began the client records section of the CARE inspection tool. Five client files were reviewed at random. The files contained admission agreements, emergency information, medical and mental health assessments, LIC 613B Personal Rights form, client inventories, and youth observation notes. No deficiencies were observed in this section. At this time, no deficiencies were cited. The annual inspection was not completed on todays visit. LPA will return at a later date to complete the inspection. An exit interview was conducted, and a copy of this report was provided to Bomnica Bonheur, Site Supervisor. Signature on this report acknowledges receipt.

met_with: Bomnica Bonheur - Site Supervisor


facility_name: HARMONY HOUSE TOO RECEIVING CENTER

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
... with residents and staff, there is not a preponderance of the evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegations are Unsubstantiated. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Administrator Monique Nervis, whose signature on this form confirms receipt.

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:

report_type: Complaint Investigation

met_with: Administrator Monique Nervis

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13At 11AM, Licensing Program Analyst (LPA) Madi Fremont traveled to the home above for the purpose of conducting an unannounced complaint investigation inspection. LPA met with Program Supervisor Angel Panlasigui who helped facilitate this inspection. Currently in care are 5 ambulatory youth. LPA started the inspection by taking a tour of the home. LPA toured the staff room, living room, bedrooms, bathrooms, garage, and kitchen. In the kitchen, LPA observed at least 2 days of perishable food, and at least 7 days of nonperishable food. This agency has investigated the allegation "Facility does not have adequate amount of food for client meals, and has found that although the allegation may be true or is valid, the preponderance of evidence standard has not been met, therefore the allegation is unsubstantiated. This finding is based on the reporting party's observation that there was no food in the home at the time this agency received the alegation, and the presence of food in the home observed by LPA Fremont on the day of this inspection. At this time, no deficiency was cited for this allegation. An exit interview was conducted and a copy of this report was sent to Program Supervisor Angel Panlasigui, whose signature on this form confirms receipt. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Madeleine Fremont LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

met_with: Program Supervisor Angel Panlasigui


raw_content:
Investigation Findings:
13On 03/14/23 at 1: PM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at listed facility and spoke with Monique Nervis, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the investigation, LPA Ng reviewed documents and conducted interviews with staff and client. Based on documents reviewed, the facility separated the clients, offered mediation between the clients, and offered to put personal property in a secure area. In addition to the documents reviewed, all interviewed parties confirmed that client was allowed to go on walks. Although, the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that client is making verbal and physical threats to another client, Client is stealing and damaging another client's personal property, Staff is not making arrangements for transportation for a client's medical appointments, Client feels unsafe in the facility and Client is not allowed to go on walks for physical therapy. Therefore, the above allegations are unsubstantiated. Exit interview was conducted and a copy of the report was given to Monique Nervis, Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng 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 3

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

met_with: Monique Nervis


raw_content:
Investigation Findings:
13On 03/14/23 at 1: PM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at listed facility and spoke with Monique Nervis, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the investigation, LPA Ng reviewed documents and conducted interviews with staff and client. Based on documents reviewed, the facility put personal property in a secure area at the request of the client, staff followed facility Emergency Intervention Plan, and did not handle the client roughly. Although, the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that client is being denied access to personal belongings, staff handled client roughly, staff did not follow facilities Emergency Intervention Plan during a client incident. Therefore, the above allegations are unsubstantiated. Exit interview was conducted and a copy of the report was given to Monique Nervis, Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng 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 3

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


raw_content:
Narrative:
The preponderance of evidence standard has been met, and therefore the above allegations are found to be substantiated. LPA is issuing citations of Operating Standards (OS) Sections 84072(d)(13) and 84076(b)(5). See LIC 9099-D. An exit interview was conducted, and plans of correction (POCs) were developed in consultation with Clinical Care Coordinator Sarah Raney. A copy of this report and the licensee's appeal rights were provided at the end of the visit.

Investigation Findings:
13On 7/8/25, Licensing Program Analyst (LPA) Mariah Hawkins visited the facility as part of the investigation of the above complaint allegations. LPA met with Clinical Care Coordinator Sarah Raney and informed of the purpose of the visit. Based on confidential interviews, observations, and record review, multiple witnesses reported observing at least one staff member yelling at children in care directly or at staff in the presence of children in care. Additionally, multiple witnesses reported at least one staff member restricted children's access to the kitchen, including restricting kitchen use after 7pm, preventing a client from getting a glass for water, limiting developmentally appropriate meal preparation, and placing locks on kitchen cabinet doors. The locks have since been removed. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins 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 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: HARMONY HOUSE TOO RECEIVING CENTERFACILITY NUMBER: VISIT DATE: 07/08/2025

met_with: Clinical Care Coordinator Sarah Raney


summary: Facility Evaluation

raw_content:
Narrative:
On 6/17/22 at 10:20AM, Licensing Program Analyst (LPA) Mariah Hawkins met with Administrator Monique Nervis for a case management visit. LPA informed of the purpose of the visit. During an investigation at the facility, LPA observed that an incident report for an incident on 12/05/21 did not match the shift notes describing the incident on that day. Per the submitted incident report, the youth left on an unauthorized absence because the youth wanted to go to the park and had asked staff to take the youth but no staff were available at that time. However, the shift notes indicate there was a longer, escalated event in which the youth was upset about television time and the need to take turns with other youth in care. This incident required multiple staff to engage with the youth to attempt to de-escalate the youth. Then, the youth left. However, staff statements of the incident were consistent and indicate, along with the shift notes, that staff followed program procedures to attempt de-escalation and prevent unauthorized absence. The tmie of the unauthorized absence matches, as well. Additionally, the facility has not shown a trend of missing information in incident reports or not following reporting requirements. LPA advises the facility, per Operating Standards (OS) Section Reporting Requirements, that incident reports should include a detailed narrative of the incident and events leading up to the incident. See LIC 9102, dated 6/17/22. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Administrator Monique Nervis, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/03/22, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility and met with Administrator Monique Nervis. During the visit, LPA conducted a confidential interview with a resident. No deficiencies were cited at today's visit. An exit interview was conducted, and a copy of this report was left with Administrator Monique Nervis, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
At 11:30AM, Licensing Progra Analyst (LPA) Madi Fremont traveled to the home above for the purpose of conducting an unannounced Required - Year inspection. LPA met with Program Supervisor Angel Panlasigui, who helped facilitate this inspection. Currently in care are 3 ambulatory clients. At the time of this inspection, there were 2 staff and 2 clients present in the home. During this inspection, one more staff arrived at the home. [Please reference LIC811 - Confidential Names] During this inspection, LPA conducted a review of the facility's Policies and Plan of Operation, Emergency Disaster Plan, Emergency Intervention Plan, required facility documentation as described in the inspection tool utilized, and 3 client records. LPA also conducted interviews with 2 staff who were present in the home at the time of inspection. LPA requested a copy of the facility's LIC Facility Personnel Report. LPA also consulted with Program Supervisor Angel Panlasigui on requirements for client records. LPA requested copies of staff records, but was informed that that administrator who keeps staff personnel records was out of office this week. LPA made plans with the Program Supervisor to return to the facility on Monday 3/6 when the administrator will be present in the facility and available to help with the completion of this inspection. At this time on 03/01/2023, no deficiencies were observed or cited. An exit interview was conducted and a copy of this report was emailed to Program Supervisor Angel Panlasigui, whose signature on this form confirms receipt.

met_with: Tanya Lopez - Childcare worker


facility_name: HIDDEN VALLEY TRSCF

raw_content:
Investigation Findings:
13On 12/24/24, at 10: AM, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced visit to the facility. The purpose of this visit was to deliver the findings on the above listed allegation. LPA Lam met with Priscilla Mojica-Angelo, Administrator. At the time of the visit, there were 4 youth and 4 staff in the facility. Based on confidential interviews, a file review, and evidence that were obtained during the course of the investigation, there is a preponderance of evidence to SUBSTANTIATE the above-mentioned allegation. As a result, a deficiency was cited at the visit (refer to LIC 809-D). The citation includes 86661(b) Reporting Requirements under the TrSCF Operating Standards. An exit interview was conducted with Priscilla. A copy of the report and an appeals rights page were discussed at left with Priscilla Mojica-Angelo, Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Mona Lam 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN JOSE RO, N. First Street, Ste. FACILITY NAME: HIDDEN VALLEY TRSCFFACILITY NUMBER: 435390059

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

met_with: Priscilla Mojica-Angulo


raw_content:
Investigation Findings:
13On 12/24/24, at 10: AM, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced visit to the facility. The purpose of this visit was to deliver the findings on the above listed allegations. LPA Lam met with Priscilla Mojica-Angelo, Administrator. At the time of the visit, there were 4 youth and 4 staff in the facility. Based on conflicting confidential interviews, a police report, and observations in the facility, though the above allegations may have happened or are valid, there is not enough of the evidence to support that a violation had occurred. The preponderance of the evidence has not been met, and these allegations are unsubstantiated. As a result of the visit, there were no deficiencies observed. An exit interview was conducted, and a copy of this report was provided to Priscilla Mojica-Angelo, Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Mona Lam LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


raw_content:
Investigation Findings:
13On 12/24/24, at 10: AM, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced visit to the facility. The purpose of this visit was to deliver the findings on the above listed allegation. LPA Lam met with Priscilla Mojica-Angelo, Administrator. At the time of the visit, there were 4 youth and 4 staff in the facility. Based on confidential interviews and record observation, though the above allegation may have happened or is valid, there is not enough of the evidence to support that a violation had occurred. The preponderance of the evidence has not been met, and this allegation is unsubstantiated. As a result of the visit, there were no deficiencies observed. An exit interview was conducted, and a copy of this report was provided to Priscilla Mojica-Angelo, Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Mona Lam 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:


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
As a result, two deficiencies were cited at the visit (refer to LIC 809-D). A Type A citation includes 86670 (h)(13) Client Records and a Type B citation includes 86672(c)(14) Personal Rights under the Transitional Shelter Care Facility (TrSCF) Operating Standards. A technical violation is issued under 86620(a) under the TrSCF Operating Standards. An exit interview was conducted with Clarence Cisneros-Jones. A copy of the report and an appeals rights page were discussed and left with Clarence Cisneros-Jones.

Investigation Findings:
13On 12/27/24, at 2: PM, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced visit to Almaden Expressway TrSCF. The purpose of this visit was to deliver the findings on the listed allegations. LPA Lam met with Clarence Cisneros-Jones. Based on medication administration records between October 2024 and November 2024, there are multiple unmarked days observed on the documents. In addition, within confidential interviews, staff admit some incidents of client's prescription not available for client to take. Based on confidential interviews, staff have confirmed that packages and/or mail are inspected prior to handing to clients. Based on transitional shelter monthly reports of October 2024 and November 2024 and confidential interviews, some clients are found to be staying at the facility beyond the 10-day placement limit. There is a preponderance of evidence to SUBSTANTIATE the above-mentioned allegations. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Mona Lam 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN JOSE RO, N. First Street, Ste. FACILITY NAME: HIDDEN VALLEY TRSCFFACILITY NUMBER: VISIT DATE: 12/27/2024

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

met_with: Clarence Cisneros-Jones

complaint_status: SUBSTANTIATED


raw_content:
Investigation Findings:
13On 5/30/2025 at 3: PM, Licensing Program Analyst (LPA) Mona Lam conducted an announced inspection at Almaden Expressway TrSCF. The purpose of this visit was to deliver the findings for the above allegations for a closed site. LPA met Priscilla Mojica-Angelo. During the investigation, LPA conducted 8 confidential interviews. LPA reviewed incident reports. Per confidential interviews, there were inconsistent statements regarding whether a client was physically assaulted by staff and if staff failed to get medical attention for client. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. LPA conducted an exit interview with Priscilla Mojica-Angelo whose signature confirms the receipt of this document. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Mona Lam LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Priscilla Mojica-Angelo


summary: Facility Evaluation

raw_content:
Narrative:
On 3/18/2024 at 12:33pm, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the unlicensed site. LPA met with John Young, Social Worker I. At the time of the visit, there were two staff members and six clients present. LPA was informed that the current census is eight clients. During the visit, one staff member and one client had returned to the facility from an outing. LPA conducted a walk through of the facility. LPA observed that there are three bedrooms utilized for clients as well as 2.5 bathrooms. One bathroom was not currently in use; a maintenance appointment was scheduled for 8:30am the following morning (3/19/2024). LPA observed that there were three clients sharing one room and one client that slept in a foldable bed in the living room area. During the physical plant inspection, LPA observed that the medications were kept in a locked cabinet in the staff office. LPA also observed that there was sufficient perishable and non-perishable food kept in the kitchen and the back-up food storage in the garage. LPA conducted eight confidential interviews. LPA conducted an exit interview with Laura Alexander, Social Worker I at 2:17pm whose signature confirms the receipt of this document.

met_with: John Young


summary: Facility Evaluation

raw_content:
Narrative:
On 6/26/2024 at 2:00pm, a virtual meeting was conducted with an applicant to discuss observations made during a visit to the listed unlicensed facility on 3/18/2024. The attendees were as followed: Nelson Martinez - CCL Regional Manager (RM) Helga Wong - CCL Licensing Program Manager (LPM) Selena Hood - CCL Licensing Program Analyst (LPA) Chadwyck Moore - Program Analyst, System of Care Branch (PM) Damion Wright - Director of Santa Clara County Department of Family and Children Services Gilbert Murillo - Acting Assistant Director of Santa Clara County Department of Family and Children Services During the meeting it was discussed that the County should not operate any additional unlicensed care sites. The current status of the application was discussed. The listed site is currently pending fire clearance, a second request to the fire department has been sent on behalf of the county. CCL representatives discussed that the applicant operate within the bounds of their applications, which includes adhering to a capacity limitation of six clients. CCL representatives discussed physical plant requirements, access to internet, food service, incident reporting, administrator requirements, and a pending internal investigation. The meeting was adjourned at 2:55pm. This report will be sent to Damion Wright, Director for virtual signature.

met_with: Damion Wright


summary: Facility Evaluation

raw_content:
Narrative:
On 7/30/2024 at 10:30am, a virtual meeting was conducted to discuss the Component II and Component III for the facility application. The following attendees were present at the meeting: Nelson Martinez - CCL Regional Manager (RM) Helga Wong - CCL Licensing Program Manager (LPM) Mona Lam - CCL Licensing Program Analyst (LPA) Chadwyck Moore - Program Analyst, System of Care Branch (PM) Gilbert Murillo - Acting Assistant Director of Santa Clara County Department of Family and Children Services Damion Wright - Director of Santa Clara County Department of Family and Children Services Priscilla Mojica-Angulo - Designated Administrator for Morgan Hill and Riverview TrSCF During the meeting, applicant and CCL representatives discussed the TrSCF Operating Standards, Program Statement, and program policies. Incident reporting, safeguarding personal property, basic services, accountability, ratios, personal rights, manual restraints and emergency intervention plan, admission agreements, medical assessment, client/personnel records, register of clients, transportation, health related services, food services, building and grounds, inspection authority, waivers & exceptions, neighborhood policy and community resources, and online resources were discussed during the meeting. LPA Lam shared the Community Care Licensing Division website, Provider Information Notices (PINs), and CARE tools used for TrSCF annuals. LPA Lam requested LIC610C and updated LIC500 for facility. The pre-licensing requests are due to CCL on 8/7/2024. The meeting was adjourned at 11:55am. This report will be sent for digital signature.


facility_name: MCKEE ROAD TRSCF

raw_content:
Narrative:
Based on LPA's interviews, observations, and record review, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation did or did not occur. Therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was left with Erica Kemp, Social Worker I whose signature on this form confirms receipt.

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: Erica Kemp - Social Worker I


summary: Facility Evaluation

raw_content:
Narrative:
On 12/10/2024 at 1:30PM, a virtual meeting was conducted to discuss the Component II and Component III for the facility application. The following attendees were present at the meeting: Helga Wong - CCL Regional Manager (RM) Carolyn Flynn - CCL Licensing Program Manager (LPM) Mona Lam - CCL Licensing Program Analyst (LPA) Simran Nayyar - CCL Licensing Program Analyst (LPA) Chadwyck Moore - Provider Analyst, System of Care Branch Damion Wright - Director of Santa Clara County Department of Family and Children Services Priscilla Mojica-Angulo - Program Manager, Santa Clara County Clarence Cisneros Jones - Designated Administrator for Riverview TrSCF and Hidden Valley TrSCF Teana Box - Management Analyst, DFCS Nandini Iyer - County Counsel, Santa Clara County During the meeting, applicant and CCL representatives discussed the TrSCF Operating Standards, Program Statement, and program policies. Incident reporting, personal property, basic services, accountability, personnel requirements, personnel records, ratios, personal rights, manual restraints and emergency intervention plan, admission agreements, medical assessment, client records, register of clients,transportation, health-related services, food services, building and grounds, inspection authority, waivers and exceptions, planned activities, neighborhood policy and community resources, compliance and the LPA, deficiency types, and administrative actions were discussed during the meeting. LPA Lam shared the Community Care Licensing Division website, Provider Information Notices (PINs), quarterly provider meetings dates, different LIC 624 forms, and psychotropic training information. CCL representatives reiterated information on unlicensed care and penalties pertaining to it. LPA Lam discussed the pending items pertaining to the applicant: clarification on roles equivalent to facility manager, physical plant corrections for Almaden TrSCF, and cleared staff background checks. LPA Lam discussed that revisions for McKee TrSCF is due on December 26, 2024 and the Welcoming Center application is due on December 30, 2024. LPA Lam stated if extensions are needed, they need to be requested via email. DFCS stated that Morgan Hill TrSCF application is on pause. The meeting was adjourned at 3: PM. This report will be sent for digital signature.


summary: Facility Evaluation

raw_content:
Narrative:
On 01/22/25 at 2: PM, Licensing Program Analyst (LPA) Mona Lam and Licensing Program Manager (LPM) Joel Segura conducted an announced visit to the applicant location. The applicant location is located in a residential neighborhood in a high-traffic area. The purpose of this visit was to conduct the Pre-Licensing inspection for the applicant. LPA and LPM met with Priscilla Mojica-Angulo, Clarence Cisneros-Jones, and Teana Box. Daniel Lopez, Wendy Kinnear, and Matthew Hornung were present at the visit. LPA and LPM conducted a tour of the facility. The facility has two units. One unit is in used for solely clients. Posted bill of rights and clients complaint procedures were observed at the entrance of the unit. The unit contains a five bedrooms and four bathrooms (three client bathroom and possibly one staff bathroom) residential home. The unit uses smoke and carbon monoxide dual detectors, which were tested and found to be working during inspection. The facility maintains the required perishable items within refrigerator. Refrigerator temperature reached 24 degrees Fahrenheit. Freezer temperature reached -12 degrees Fahrenheit. Room temperature reached 70 degrees Fahrenheit. Water temperature reached 105.6 degrees Fahrenheit. Grievance forms were observed in living room. Telephone service was observed on kitchen counter. Priscilla stated that knives and sharps will be locked within staff office. LPA and LPM observed locked hygiene products. LPA Lam advised in buying combs regarding hygiene products. LPA and LPM observed a complete first aid kit. LPA Lam observed school supplies in locked supply cabinet. LPA and LPM observed the second living unit. Priscilla stated that staff will only have access to this living unit. This unit has two floors. On the first floor, there is a living room, two staff meeting rooms, and staff bathroom. On the second floor, there is a staff kitchen with had sufficient amounts of non-perishable items, and two meeting rooms. (See LIC809-C) LPA and LPM inspected the outdoor area and did not observe any health and safety hazards. The outdoor area had a table with benches. Fencing is around five feet, covering the perimeter of the property. LPA and LPM inspected the garage. Laundry applicances were observed in the garage. In addition, Priscilla stated that locked detergents, cleaning compounds, and soaps will be locked in storage closet within garage. Currently, no detergents or cleaning compounds were observed. The electrical breaker for for the garage was not working at the time of the inspection therefore the lighting was non-operational. There is no pool on site and no weapons were stored at the facility. LPA and LPM observed disaster preparedness plan, which was in compliance. LPA additionally reviewed individual forms of client intake, registrar of clients, and youth info. LPA inspected five staff files. LPA and LPM discussed with Priscilla, Clarence, and Teana on ensuring compliance with staff files. LPM Segura advised on reviewing waiver request to include reporting requirements. In addition, LPA Lam advised applicant facility on OS 86661(s) Reporting Requirements. LPA conducted an exit interview with Priscilla Mojica-Angulo, Clarence Cisneros-Jones, and Teana Box. The report will be submitted to management for approval of licensure. Priscilla's signature confirms the receipt of this document. A copy of this report was printed and left at the site. The outstanding items pending for approval are Component I meeting and review of the Program Statement (amending reporting requirements).


summary: Facility Evaluation

raw_content:
Narrative:
On 07/15/25 at 10: AM, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced inspection to the facility. The facility is located in a residential neighborhood in a high-traffic area. The purpose of this inspection was to conduct the post-licensing inspection. LPA met with Erica Kemp, John Carr, Priscilla Mojica-Angulo, Teana Box and Clarence Cisneros-Jones who assisted with the inspection. LPA conducted a physical plant check. The facility has two units. One unit is in used for solely clients. Posted bill of rights and clients complaint procedures were observed at the entrance of the unit. The unit contains a five bedrooms and four bathrooms (three client bathroom and one staff bathroom) residential home. License was posted in staff office and not in a prominent location. LPA issued a technical assistance under 86609(a) Posting of License. The facility maintains the required perishable items within refrigerator. Refrigerator temperature reached 38 degrees Fahrenheit. Freezer temperature reached 9 degrees Fahrenheit. LPA issued a technical violation under 86676(b)(2) Food Service. Room temperature reached 69 degrees Fahrenheit. Water temperature reached 118.9 degrees Fahrenheit. Grievance forms were observed in living room. Telephone service was observed on kitchen counter. Knives and sharps are locked within staff office. LPA observed locked hygiene products. LPA inspected and observed a complete first aid kit. LPA observed school supplies in locked supply cabinet. LPA inspected fresh linen in closet. (Continued on LIC809-C) LPA inspected the outdoor area and did not observe any health and safety hazards. The outdoor area had a table with benches. LPA observed missing window screening and observed it to be in neighbor's yard. Staff disclosed youth threw it in yard two days prior. LPA inspected locked detergents, cleaning compounds, and soaps in storage closet within garage. There is no pool on site and no weapons were stored at the facility. LPA inspected two client files. One medication did not have information regarding on specific symptoms for usage. Information was not mentioned in doctor's note. LPA issued a technical assistance under 86675(b)(6)(A) Health Related Services. LPA did not observe one client file on authorization of psychotropic medication, but has consent of medical treatment. LPA issued a technical assistance under 86670(h)(12) Client Records. LPA inspected client registrar. Client registrar did not include information on contact information of client's attending physician, but information was located in client files. LPA issued a technical assistance in 86671(a)(1)(B) Register of Clients. LPA observed disaster preparedness plan, which was in compliance. LPA additionally reviewed individual forms of client intake, registrar of clients, and youth info. LPA inspected five staff files. LPA did not observe two files to have complete job descriptions. LPA issued a technical violation under 86666(g)(1) Personnel Records. Performance evaluations were unavailable due to their evaluation is conducted end of July. LPA conducted two staff interviews and one client interview. One client was unavailable for interview due to going out on a visit. LPA did not finish emergency intervention and staff file review. LPA will return at a later date to finish the inspection. LPA issued two (2) technical violations and four (4) technical assistances. LPA conducted an exit interview with Clarence Cisneros-Jones Clarence's signature confirms the receipt of this document. A copy of this report was printed and left at the site.

met_with: Clarence Cisneros-Jones, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 07/17/25 at 9: AM, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced inspection to the facility. The facility is located in a residential neighborhood in a high-traffic area. The purpose of this inspection was to conduct the continuation post-licensing inspection. LPA met with Erica Kemp, John Carr, Jacqueline Mercado, and Priscilla Mojica-Angulo who assisted with the inspection. One client was unavailable for interview due to sleeping. LPA inspected emergency intervention training, which was complete in all five staff files. A log for manual restraints was observed. LPA reviewed five staff files regarding training. Some staff files do not have annual training due to recent hires and licensee have not reached one year mark of opening the site. No citations were issued at this time. LPA conducted an exit interview with Priscilla Mojica-Angulo. Erica Kemp's signature confirms the receipt of this document. A copy of this report was printed and left at the site.

met_with: Priscilla Mojica-Angulo, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 11/14/25 at 3: PM, Licensing Program Analyst (LPA) Mona Lam and LPA Amee Li conducted an unannounced case management inspection at the above licensed facility to follow up on an incident. LPAs met with Teana Box and Clarence Cisneros-Jones. Based on confidential interviews, review of program statement, background clearance, a Type A deficiency was issued to the licensee for allowing a staff member to work on site without a background clearance. This was cited under TrSCF Operating Standards 86619(c) Criminal Record Clearance. In addition, the Department did not receive an incident report regarding within 7 days of an incident occurring. LPA issued a Type B deficiency under TrSCF 86661(b) Reporting Requirements. (See attached 809-D form.) In addition, LPA Lam issued technical assistance in amending the program statement under TrSCF Operating Standards 86651(a) Serious Deficiencies. An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to Teana Box prior to exiting the facility.

met_with: Teana Box, Management Analyst


facility_name: RIVERVIEW TRSCF

raw_content:
Narrative:
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED. A copy of this report was given to Clarence Cisneros-Jones.

Investigation Findings:
13On 08/01/25 at 12: PM, Licensing Program Analyst (LPA) Mona Lam conducted an unannounced inspection at another site with Clarence Cisneros Jones who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged that staff do not provide adequate supervision to minors in care. LPA Mona Lam conducted confidential interviews. Based on the confidential interviews, staff followed appropriate protocol for youth that AWOL, including following some youth outside and filing missing person's report. Interviews were consistent on changing and re-evaluating protocol based on individualized clients' needs. Within April 2025, five shift reports were indicated AWOLs. Reports are detailed in time stamps of supervising clients' activities and applied de-escalation. Based on client supervision plans, plans indicated strategies in moderating youth's behaviors. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Mona Lam 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN JOSE RO, N. First Street, Ste. FACILITY NAME: RIVERVIEW TRSCFFACILITY NUMBER: VISIT DATE: 08/01/2025

met_with: Clarence Cisneros Jones


summary: Facility Evaluation

raw_content:
Narrative:
On 8/9/2022 at 2:00PM, a virtual meeting was conducted with an applicant for the purpose of providing technical assistance prior to the third revision of the application. Present at the meeting: Helga Wong - CCL Licensing Program Manager (LPM) Nelson Martinez - CCL Regional Manager (RM) Carolyn Flynn - CCL LPM Selena Hood, CCL Licensing Program Analyst (LPA) Damion Wright - Assistant Director for Department of Family and Child Services (DFCS) of Santa Clara County (SCC) Adele Gray - Program Analyst for Family Centered Safety and Support Bureau (FCSSB) Julie Waters - Program Analyst for Family Centered Safety and Support Bureau (FCSSB) Brian Hawkinson - DFCS Gilbert Murillo - DFCS LPA Hood led introductions. SCC and CCL representatives discussed questions about the examples provided and general regulations requirements expected in Articles 1-4. RM Martinez informed SCC about CCL inspection authority and that due to a reported incident CCL would be conducting a follow-up visit to the facility. SCC and CCL agreed that the third revision would be provided on 9/9/2022. The meeting concluded at 2:45PM.


summary: Facility Evaluation

raw_content:
Narrative:
On 8/17/2022 at 10:30AM, Licensing Program Analyst (LPA) Selena Hood and LPA Vaishali Singh-Sood conducted an unannounced visit to the above unlicensed facility. The purpose of this visit is to conduct a case management visit to follow up with a reported incident. LPAs met with Joseph Laraz, Social Worker I, and conducted a walk through of the facility. There were three staff members, one security guard, and one client present at the time of the visit. The facility has three clients currently, one who is AWOL. LPA Hood and LPA Singh-Sood conducted four confidential interviews (see LIC812s). LPAs conducted an exit interview with Joseph Laraz, Social Worker I, at 11:20AM whose signature confirms the receipt of this document.

met_with: Joseph Laraz


summary: Facility Evaluation

raw_content:
Narrative:
On 09/02/2022 at 1:05PM, Licensing Program Analyst (LPA) Selena Hood and LPA Lisette Valenzuela conducted an unannounced visit to the above unlicensed facility. The purpose of this visit is to conduct a case management visit to follow up with a reported incident. LPA Hood and LPA Valenzuela met with Diana Barrientos Social Worker III and Shawn Dawnson, Social Worker I. Staff member Shawn Dawnson assisted LPA's and conducted a walk through of the facility. There were two staff members, and during the visit one client arrived home from school. The facility has one client currently. LPA Hood and LPA Valenzuela conducted three confidential interviews (see LIC812s). LPA Hood and LPA Valenzuela conducted an exit interview with Diana Barrientos Social Social Worker III, at 2:00PM, whose signature confirms the receipt of this document.

met_with: Shawn Dawson and Diana Barrientos


summary: Facility Evaluation

raw_content:
Narrative:
On 9/20/22 at 12:30PM, Licensing Program Analyst (LPA) Selena Hood and LPA Lisa Schlembach conducted an unannounced inspection to the above unlicensed facility. The purpose of this visit is to conduct follow-up on an incident that resulted in a client being sent to the hospital with minor injuries. LPAs met with Marlin Brown, Social Worker, who assisted in a walk through of the house. LPAs observed there to be a sufficient amount of perishable and nonperishable food. LPAs observed there to be soap at the hand washing sinks, disinfectants and cleaning supplies were kept locked, and there were no obstructions in the walkways. Social Service Program Manager II, Yazmina Letona, disclosed prior to the visit that there was property damage done within the last week and there was an order out to fix it. The facility currently has a census of one client. At the time of the visit, there were two staff members and one client present. The security guard was on shift, but taking their lunch at the time of the visit. LPAs conducted two staff interviews. The client present declined to interview at this time. LPAs requested copies of the Child Family Team (CFT) notes for two clients from August 2022, the incident report documenting the incident, and notes from the incident described. LPAs conducted an exit interview with Marlin Brown, Social Worker at 1:20PM, whose signature confirms the receipt of this document.

met_with: Marlin Brown


summary: Facility Evaluation

raw_content:
Narrative:
On 9/29/2022 at 1:00PM, a virtual meeting was conducted with an applicant for the purpose of providing technical assistance prior to the third revision of the application. Present at the meeting: Nelson Martinez - CCL Regional Manager (RM) Selena Hood, CCL Licensing Program Analyst (LPA) Damion Wright - Assistant Director for Department of Family and Child Services (DFCS) of Santa Clara County (SCC) Adele Gray - Program Analyst for Family Intake and Engagement Unit Julie Waters - Program Analyst for Family Intake and Engagement Unit LPA Hood led introductions. SCC and CCL representatives discussed questions submitted from SCC (see LIC812). SCC and CCL agreed that the third revision of the Riverview TSCF application would be provided on 9/30/2022. The meeting concluded at 1:30PM.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/29/2022 at 10:30AMM, a virtual meeting was conducted with an applicant for the purpose of providing technical assistance prior to the fourth revision letter being sent on 11/10/2022. Present at the meeting: Nelson Martinez - CCL Regional Manager (RM) Selena Hood, CCL Licensing Program Analyst (LPA) Damion Wright - Assistant Director for Department of Family and Child Services (DFCS) of Santa Clara County (SCC) Gilbert Murrillo - DFCS Adele Gray - Program Analyst for Family Intake and Engagement Unit Julie Waters - Program Analyst for Family Intake and Engagement Unit SCC and CCL representatives discussed questions about the revision letter and the delegation of authroity. SCC mentioned that they will be following up to potentially request an extension for the next revision. LPA Hood will resend the revision letter with a few adjustments about delegation authority that were discussed during the meeting. SCC stated they will be sending applications for other Transitional Shelter Care Facilities in early 2023. The meeting concluded at 11:50AM. LIC809 will be sent virtually for signature.


summary: Facility Evaluation

raw_content:
Narrative:
On 1/9/2022 at 1:00PM, a virtual meeting was conducted with an applicant for the purpose of providing technical assistance prior to the next application revision due on 1/20/2023. Present at the meeting: Nelson Martinez - CCL Regional Manager (RM) Selena Hood, CCL Licensing Program Analyst (LPA) Carolyn Flynn - Licensing Program Manager (LPM) Helga Wong - LPM Damion Wright - Assistant Director for Department of Family and Child Services (DFCS) of Santa Clara County (SCC) SCC and CCL representatives discussed questions about the revision including the LIC309 and administrator designation. SCC stated that they are still on track to submit the revised application on 1/20/2023. The meeting concluded at 1:16PM. LIC809 will be sent virtually for signature.


facility_name: SAN BERNARDINO COUNTY TRANSITIONAL SHELTER

summary: Facility Evaluation

raw_content:
Narrative:
Children's Residential Program Administrator Kim Taylor, Licensing Regional Manager, LaCresha Cook, Licensing Manager, Jennifer Smith, and Licensing Program Analyst (LPA) Carmen Escobar met with Rosie Mayzum, Children and Family Services (CFS), Hannah Gutierrez, CFS Supervisor, Dianne Wolkenhauer, San Bernardino Department of Behavioral Health Manager, Adele Gray, California Department of Social Services (CDSS) Analyst, Julie Waters, CDSS Manager, and Nancy Satterwhite San Bernardino County CFS Deputy Director, to conduct a meeting to discuss and review the San Bernardino County Transitional Shelter Program Statement submitted to Community Care Licensing on February 24, 2022. During the meeting the following was discussed: Application and Supporting Documents, Plan of Operation, Program Statement, Core Services and Supports. County representatives were also reminded that all pages in the entire Program Statement should be numbered and all corrections and/or revisions highlighted for ease of reference during the review. After review of the Plan of Operation/ Program Statement LPA Carmen Escobar and CDSS Analyst Adele Gray observed the following: Section B: Supportive Documents Page 4: · Where will staff and volunteer files be kept? How will they be made available for review by CCL (and other departments)? Supportive documents for each position should include: college transcripts, copy of degrees, certifications, work experience, referrals, etc. (staff files). Section B3: Verification of Social Worker Qualifications Page 5: · What specific training will staff receive as the needs of children in can vary. Page 14: · Training plan is very detailed, including different departments and such. Is this considered "community resources"/using "outside trainers" in terms of your training plan? · Provide information as to where training hours are kept, how departments like CCL would be able to request training logs, etc. for review/verification. Section B7: Facility Program Description Page 14: · What about child's strengths (assessments)? · Is this also considered part of the "primary purpose of program"? Section 3 offers different primary purpose, perhaps combine the two? Page 15: · Within what timeframe (in reference to appropriate placement resources being identified)? · What is the actual protocol for crisis intervention at the facility? · Trained in trauma informed practices, is this separate from the training plan provided on pages 8-11? Page 16: · Will staff be doing the visitation? If so, this would change staff ratios at certain times and would need to have more people staffed. · What would a typical daily schedule look like? How would transitions be done though a trauma informed lens to decrease escalation of clients? Also, planning activities should be through a trauma informed lens as some activities can be triggers for youth. Section B8: Rules of Discipline/Personal Rights Page 18: · What is plan if youth becomes assaultive and staff cannot de-escalate? Section B9: Admission Policies Page 19: · Where will client files be kept? Centrally stored/locked? Available for review? ·Please also include information regarding "on call staff" who might be needed in case of emergency and/or ratio requirements. · Verify number of annual training hours. Page 6: · Expected? Should be minimum of 2 staff and plan for on call staff in case of emergency (re: one staff has to take youth to emergency room, etc.) · Please also include information regarding "on call staff" who might be needed in case of emergency and/or ratio requirements. Also, address whether or not volunteers will be considered in staff/child ratios. Section B4: Job Description-each position Page 7: · Are these attached (staff classification statements)? Section B6: In-Service Training for Staff Page 8: · What specific trainings are required for each job classification for the facility? Does training plan specify any job shadowing? How will it be determined staff are competent/adequately trained? Per regulations: · A maximum of 4 hours of the training requirement may be satisfied by successful completion of job shadowing. · Successful completion of job shadowing shall be verified by a statement completed by the experienced facility personnel being shadowed affirming: a) specific activity observed; b) dates and times of shadowing; and, c) training topic listed in Section 87065.1(c)(3)(A) through (X) that is satisfied by the job shadowing activity. Page 13: · Please address how employees will be shadowed, or for how long (per regulations) and how they are assessed as being competent for facility positions. Section B10: Sample Menu Page 20: · What is offered if they do not like that meal or have dietary restrictions? · Describe provisions available for children with special dietary needs. · Portion size (1/2 cup, 1 cup, etc) should be included in menus. Section B11: Control of Property Page 21: · Mention documentation of such incidents (LE incidents/SIR incidents). · Law enforcement should not need to be contacted for disposal of E-cigarette (for example). Please specify protocol further. Page 22: · Are neighbors being made aware of this new facility? Will staff be going door to door? Complaint procedure, grievance procedure for neighbors should also be made available (contact, email, phone number, etc.) PART I PROGRAM IDENTIFICATION SECTION Page 25: · No mention of whether or not the facility operates other activities other than the TSCFs. PART II PROGRAM POPULATION, SERVICES, & CAPABILITIES SECTION Page 26: · Statement regarding the types of children to be served does not mention dependent, neglected, delinquent, pre-delinquent, physically handicapped, developmentally disabled, mentally disordered, or emotionally disturbed children. · What will the volunteers be doing at the facility? · Mention the policy regarding volunteers being alone with clients or providing care or supervision to clients. Page Facility Sketch: · This section requires: -Number of children per room -Bedrooms to be used by non-ambulatory children -All indoor and outdoor space, including driveways, fences, storage areas, gardens, recreation areas, other space used by children (backyard area/front yard area?) Page See Facility Sketch info above. Page 93 (LIC500 example): · Most homes have shifts that overlap each other at beginning/end of shift so staff can update on youth and transition. Other Requirements: · Neighborhood Complaints: How will complainant be notified of findings (phone, email, in-person)? · Complaints/concerns need to be documented and kept on file; please address. Section A required documents that are missing or incomplete: A1. Application-LIC 200: Name listed is Jonathan Byers, should be County of San Bernardino. A2. Application Information-LIC 215: Under "Personal Information" (next to signature), Box A was left blank. A3. Designation of Administrative Responsibility-LIC 308: Needs to be completed for all employees on the LIC 500 who have authorization to act on Administrator (?) Jonathan Byers' behalf. A4. Administrative Organization-LIC A5. Affidavit Regarding Client Cash Resources-LIC A11. Personnel Record-LIC A12. Health Screening Report-Facility Personnel-LIC 503: Need proof of TB test which is included in this screening report. A13. Criminal Record Statement-LIC A14. Emergency Disaster Plan-LIC 610C A16. Fire Inspection-LIC A17. Board of Director Statement-LIC 9165 contained in PUB Section B required supportive documents that are missing or incomplete: B1. Letter from the Board of Sups authorizing approval to apply for a license and a resolution naming a person(s) authorized to apply for the license. *Under this section it states to "See San Bernardino County Board of Supervisors Agenda Item approved February 8, 2022", but agenda is not included. B2. Verification of Administrator Qualifications and Certification: missing. B3. Verification of Social Worker Qualifications: missing (need names of staff/copies of docs). B14. First Aid card: missing, need for all staff. B15. Orientation Certification: missing orientation certificate for Administrator (?) Jonathan Byers. Additional documents missing: LIC 400: Affidavit regarding handling Client Cash Resources. San Bernardino County representatives will contact LPA Carmen Escobar when all corrections and/or revisions have been made. Community Care Licensing LPA requested stated corrections and/or revisions will be completed and submitted by May 17, 2022. If additional time is needed, request will be submitted to LPA Escobar before May 17, 2022. An exit interview was conducted and a copy of this report was provided to Rosie Mayzum, CFS Manager, and Nancy Sutterwhite, San Bernardino County CFS Deputy Director, via email for signature.


summary: Facility Evaluation

raw_content:
Narrative:
On February 16, 2023, Community Care Licensing met with several San Bernardino County agencies, via Microsoft Teams, to discuss the review of the San Bernardino County Transitional Shelter Plan of Operations and Program Statement edits and revisions submitted to Community Care Licensing on November 14, 2022. Children's Residential Program Licensing Regional Manager, LaCresha Cook, Licensing Program Managers, Jennifer Smith and Natasha Dunlap, Licensing Program Analysts (LPAs) Carmen Escobar and Darlene Oseguera and Larry Fluharty, California Foster Care Ombudsperson met with Rosie Mayzum, Children and Family Services (CFS), CFS Supervisor, Eric Raley, Probation Division Director II and Amber McChristian, Social Service Practitioner. During the meeting the following was discussed: revisions to Application and Supporting Documents, Plan of Operation, Program Statement, Core Services and Supports. The opportunity for questions about the revisions was provided to facility representatives with a summarized review of revisions. The following is a summary of the review of the revisions to the Plan of Operation/ Program Statement completed by LPA Carmen Escobar, Systems of Care (SOC) Policy Analyst Gina Jones, and California Foster Care Ombudsperson, Larry Fluharty. Ombudsperson Review and Feedback: - Training on Foster Youth: mandatory training on Foster Youth Rights would go long way toward reducing Rights violations -The social worker must use the materials developed by the OFCO to provide the child their written copy of their rights, WIC §16164(e) -The rights below do not reflect the current 41 rights as updated by AB175(2019) and AB1735 (2022) -It is suggested to abandon use of archaic military term, AWOL. It is recommended to use -As stated above, this form needs to reflect that the youth receives OFCO created materials. -Signature should be for consent not refusal. -Notes on exit log: This could be better developed to include the voice of the youth in this significant transition. The current language is not youth focused or trauma informed. -When child is moved, should you notify the tribe, the court, the parents, the attorney, education rights holder, and CFT? -Visitation orders: This is as drafted is inconsistent with law including but not limited to the ICWA and §16001.9. The child is entitled to unsupervised contact by phone mail, video chat unless prohibited by court order. There should be no approved contact list, only unapproved contact which is based upon court order. If there is no court case it should be based upon safety criteria which should be explicitly spelled out. -Activities not allowed: Dating other youth in placement not being allowed. This is a violation of Foster Youth Rights. -The social worker must use the materials developed by the OFCO to provide the child their written copy of their rights, WIC §16164(e) -Personal rights listed: The rights below are not current. WIC 16001.9 was updated in 2019 and 2022 (AB175 (2019) and AB1735 (2022)). -It is suggested to use, Absent from Placement without Permission, instead of AWOL. -Is there a separate designation for children who are believed or known to have been abducted? -Who AWOLs are reported to: it is suggested adding the child's parents, tribe, tribal social worker for children with tribal affiliation, attorney, juvenile court judge if court involved. -Daily log keeping track of children who have run away from their last placement-- it is recommended to expand on how this is a valid data point. -This section is confusing. It needs to distinguish between Title 22 regulation grievances, OFCO complaints and complaints to the SBC Ombudsman. -Publications PUB 339 and 396 cannot be located. Suggested reference to DSS ACLs. ACL21-69 and ACL 22-34 as these are most pertinent. -Youth are entitled to possession of their own property as well as safe storage for their belonging. This can create some friction. In addition, youth are entitled to as safe home. This would include an description? Also in client medical assessments - section 6 (pg 45), do all youth get medical assessments? Or is there a two step process involved with first a screening and then assessments? Please clarify. What is the time frame? Who does them? Please also clarify who does the screenings in section B Job Description (it currently discusses the site supervisor and Social service practitioners do assessments and the SWII and social service aides- do interviews if interviews include screenings please clarify) -(Do not see this documentation information in the second version- it could be added to B9, creating a client file- screening and assessments are documented in the case plan and kept in the client file) -Don't see information below in version 2 of admission/intake section: This information should be in addition to the separation room discussed on page 70 - as that is discussed as a room for youth who are escalating. What is the plan to separate children when assessments or other circumstances warrant that separation? Will there be increased staffing? Will the separation room discussed on page 70 include sleeping and housing the youth if needed? Please clarify. How many separation rooms are there? How many youth does this hold? What if you have more than 1? Also what considerations or briefings for staff shall occur to support a less restrictive response to an elevated issue/behavior, should one occur in the future? -Missing this information. Pg 19 you discuss assessments to determine if an STRTP is needed but stop there. What is the communication plan/protocol for when a Qualified Individual (QI) assessment referral from the county may seems necessary due to the elevated nature of youths needs? Do you establish relationships with STRTPs in or out of your area- so they know you may be contacting them? If a youth needs an STRTP level of care how do you ensure other youth are safe in the facility while you are searching for placement? -Missing information: Would like to see a timeline and a list of activities for each day from referral to placement. Is this a timeline on Page 90 (under the organizational chart)? If so, please label as Timeline from Referral to Placement. Is it possible to categorize by day? CCL Review and Feedback: -LIC500 needs to be updated and added. -Copy of facility Admission Agreement is not included. environment free of drugs, alcohol and weapons. Obviously, it is a challenge to address all of those competing interests -CFS 222: The youth should not have any burden to sign that they did not consent. It makes more sense to require a signature if the youth did consent. -Youth are entitled to an allowance regardless of placement status. Some youth will be in the shelter longer than 72 hours. They will be there weeks and possibly months. There needs to be a method for the youth to receive an allowance in the event of an overstay for longer than a week. -This section should address culturally appropriate clothing, accessories and jewelry. -This section should address religious and culturally appropriate food choices. -The youth are entitled to an allowance. There needs to be a better solutions that what is described here (as addressed above). -Having property "locked up"/"secured" is a violation of FYBOR to have. -CFS222: The youth should not have any burden to sign that they did not consent. It makes more sense to require a signature if the youth did consent. -Youth purchasing items with own funds: This sentence will result in violations of foster youth rights. Youth should be provided hygiene products of all types which meet the youths needs, for examples the program cannot provide one brand of tampons or soap as that brand may not fit well or cause irritation. This is a matter need and not simply personal choice. SOC Review and Feedback: -What information shall the facility request and use to determine the compatibility for the shelter placement for that individual youth? -In version 2, although this information on screening and assessments was clarified in section B7 facility program description (bottom of pg 18) it also needs clarification in Part II program narrative A. Program description (pg 41). The difference between screening and assessments and who gets them, why, when, by whom is unclear. Do site supervisors and social service practitioners (SSPs) do both screenings and assessments? Or does the social worker II and social service aide do the screenings (the word interviews is used in their job description)? Are mental health assessments done by clinicians from DBH only (pg 18)? Are these clinicians separate from staff listed in section B4- job Absent from Placement without Permission, or something similar. -Is there a separate designation for children who are believed or known to have been abducted? -How is exploitation determined? -It is recommended to add the child's parents, tribe, tribal social worker for children with tribal affiliation, attorney, juvenile court judge if court involved. -Specify how an NMD can be AWOL/ Absent from Placement without Permission. -Is there separate direction on what to do for a youth returning from a period of absence without permission? Does it matter the length of absence 10 mins, 2hrs., 2 days? -This is an overly broad statement and inconsistent with law: CFS is authorized to attain any medically necessary medical services..... -This does not account for religious and culturally necessary diets. -Overall this section does well at protect the youths rights but needs revision to comply with the U.S. and California Constitutions and the Foster Youth Bill of Rights. -Youth are entitled to possession of their own property as well as safe storage for their belonging. This can create some friction. In addition, youth are entitled to as safe home. This would include an environment free of drugs, alcohol and weapons. Obviously, it is a challenge to address all of those competing interests. -The youth should not have any burden to sign that they did not consent. It makes more sense to require a signature if the youth did consent. -There needs to be some better description of the accounting for these items and the consequences for the youth in admitting possession, which could constitute a crime or have other consequence for the youth if documented in case materials. -Is this saying that only LE would conduct searches of youth? I see some value to that but also some problems. -This needs to be better developed to address the youth's right to groom consistent different needs for hair care and skin care based on their culture, ethnicity, gender identity and expression and tribal social and cultural standards. -This should spell out more specifically what is implied that youth 12 and over have a right to choose their own provider and seek health and mental health care including reproductive health without the knowledge of their caregivers or parents. San Bernardino County representatives will contact LPA Darlene Oseguera when all corrections and/or revisions have been completed. Community Care Licensing requested stated corrections and/or revisions will be completed and submitted by March 10, 2023. If additional time is needed, request will be submitted to LPA Oseguera before March 10, 2023. An exit interview was conducted, and a copy of this report was provided to Rosie Mayzum, CFS Manager, via email for signature. Original signature for facility representative is on file.


summary: Facility Evaluation

raw_content:
Narrative:
On June 29, 2023, Community Care Licensing met with several San Bernardino County agencies, via Microsoft Teams, to discuss the review of the San Bernardino County Transitional Shelter Plan of Operations and Program Statement edits and revisions submitted to Community Care Licensing on November 14, 2022. Children's Residential Program Licensing Program Manager, Natasha Dunlap, Licensing Program Analyst (LPA) Darlene Oseguera, Larry Fluharty, California Foster Care Ombudsperson, Systems of Care Analyst, Gina Jones, Provider Policy Implementation Unit Manager, Alcia Bernstein, met with Rosie Mayzum, Children and Family Services (CFS), Kristin Hinds and Social Service Practitioner, Amber McChristian. During the meeting the following was discussed: revisions to Application and Supporting Documents, Plan of Operation, Program Statement, Core Services and Supports. The opportunity for questions about the revisions was provided to facility representatives with a summarized review of revisions. The following is a summary of the review of the revisions to the Plan of Operation/ Program Statement completed by LPA Darlene Almaraz-Oseguera, Systems of Care (SOC) Policy Analyst Gina Jones, and California Foster Care Ombudsperson, Larry Fluharty. Section B: Supportive Documents · LIC500 needs to be updated and added. 1. Is this facility a Transitional Shelter Care Facility? If so, why is it named a Temporary Shelter Care Facility in the title? To prevent confusion with the other licensure type, please change the title to Transitional Shelter Care Facility if you are following the Operating Standards for transitional care facilities and adhering to the limitation on the license, that no individual child stays for longer than 72 hours. 2. Nothing was seen in the application about serving under six or parenting minors. If you plan to be licensed for these populations, please incorporate in your section these sections of the operating standards: . Discharge Removal, Section Page How will a child be notified of the removal or discharge in a manner that is consistent with trauma-informed practices? Will the child have a prior meeting with the new placement or visit before being transferred? How will the staff be transporting the youth to the new placement, while still using trauma informed practices? How will you ensure a timely written child exit log Per OS 86668.4(f)? Pg 57- you say that the goal at the shelter is no more than 30 days. Please revise to say the goal is no more than 3 days. VISITATION RULES AND POLICY Section Page 58 last paragraph- Youth are entitled to visit and communicate with anyone of their choice unless prohibited by court order. DISCIPLINE POLICIES/PERSONAL RIGHTS Section Page First paragraph These are out of date rights. The Foster youth Bill of Rights was amended in 2019 (AB175) Current rights are in statute at WIC16001.9. At each placement change the social worker is to provide the youth with their rights using the material created by the OFCO. RUNAWAY PLAN Section Page 29 & 70 missing AWOL procedures when client returns from AWOL . 86672.1 - discipline policies and procedures 86877- Personal Services 86878- Care and supervison 86888-fixtures, furniture, equipment and supplies 86874- transportation 86876- Food service 86878. Sanitation 86887.3-indoor activity space and 86668.4- removal and or discharge Parenting minors see subchapter 2- section 86872.1 and 86678 3. If the application version sent May 8 includes the operating standards version 1 dated February 2023. Please incorporate more of section 86678. Trauma informed program practices, service and supports. Although you say that you will use and integrate trauma informed interventions and strategies, Please explain how do you individualize strategies for trauma specific interventions to address trauma consequences and facilitate healing? What are examples of your healing practices? How will observable trauma behaviors be identified, documented, and evaluated to assess the need for services? How will you support children, and staff in identifying and accessing services and supports to heal from trauma, reduce the risk of re traumatization and foster well-being and resiliency. How will you seek to build circles of support for children to strengthen organic, lifelong relationships? Review of revisions submitted March Please put the information under these headings even if the content is repeated elsewhere in the application. B8. Rules of Discipline/Personal Rights page These are out of date rights. The Foster youth Bill of Rights was amended in 2019 (AB175) Current rights are in statute at WIC16001.9 page At each placement change the social worker is to provide the youth with their rights using the material created by the OFCO. . Reporting Requirements and Continuous Quality Control How will the licensee work together to ensure the data is collected and provided to CDSS to understand the need and usage for shelters, reduce the length of stay youth experience in the TrSCF, clarify and eliminate the gaps in the continuum of care, and ultimately reduce the state's reliance on shelter-based care? What methods are in place to ensure continuous quality improvement to understand gaps in services and work with CDSS to reduce reliance on shelters? Your reporting requirements section should contain the new requirements around reporting. Please add information on overstay and monthly reports to CDSS in section 86661 (s) (t) and (u). 86661 (p) - Please add to your reporting requirement section Pg 87: #11. The licensee must report to CDSS and child's authorized representative of any incident that affects the health and safety "and personal rights" of any child in the facility no later than the next business day. How will you work with the county to ensure accurate and timely data entry and documentation in CWS/CMS? Limitations and Timelines: Due to the TrSCF placement limitations and the need for the county to secure appropriate placement for a youth, the TrSCF staff, partner agencies and providers must coordinate services to meet the time limits. On page You have created a timeline from the first to last day to ensure that each day there are coordinated efforts to meet the needs of each youth within the required time. Please indicate how you will work to coordinate with your local team to coordinate services in the timeline including schools, regional centers, BCBA and mental health providers and families. How will you build relationship among county entities that will support partnerships and strengthen communication to ensure services and timely placements including interagency placement committees, interagency leadership teams and other individual and system level activities to support you in meeting this timeline.