summary: Facility Evaluation

raw_content:
Narrative:
On February 24, 2024, at AM, Licensing Program Analyst (LPA) Cynthia Robinson conducted an announced pre-licensing inspection follow up. The applicant above submitted a Group Home (GH) application. Presently there are no clients in care at the proposed new location. LPA's visit is to clear the previous deficiencies that was noted on the Pre-Licensing visit on December 6, 2024. The following deficiencies were notated on February 6, 2025. The applicants did not have sufficient drawer space allowing for private belongings to be stored. As of today's date, the applicant did have sufficient storage for all bedrooms so that prospective clients will have drawer space for private belongings. The applicants were still residing in the group home at the time of the first Pre-Licensing follow up visit on February 6, 2025. As of today's date on February 24, 2025 the Applicants no longer reside in the home and have moved out officially since February 17, 2025. The applicant is currently licensed for four clients but have submitted a capacity increase from four to six. The facility holds space for six clients. LPA will submit LIC 200 to office support staff to contact the prospective Fire Marshall for capacity increase. The facility will only accept ambulatory and minor clients. The facility will accept clients from Inland Regional Center and the County. After a final review, the facility will be submitted for licensure. Pre-Licensing inspection follow up was completed, and a copy of this report was given to the Applicant, Angel Vivas.

met_with: Angel Vivas, Applicant


state: CA

facility_name: ASTON REID LLC

summary: Facility Evaluation

raw_content:
Narrative:
On November 21, 2025, at 10:30am, Licensing Program Analysts (LPAs), Cynthia Robinson and Jessica Peete arrived unannounced at the above facility for the purpose of conducting post-licensing inspection at the facility. LPAs were greeted by facility administrator Angel Vivas and Karla Vivas, Facility Manager. The Group Home (GH) is approved capacity of six and has the fire clearance for the approved capacity. There are currently no staff or clients in care at this moment. The facility is located in a gated community that requires a gate code to enter. The facility is a two-story home with four bedrooms and three bathrooms, one loft and one nook and a three-car garage. There is one bedroom (bedroom #1) that will be used for one client and one full bathroom (bathroom #1) downstairs that will be available for client use. The facility has a living room and dining room in the kitchen area with a large dining room table. The nook is located by the garage entry and will be used as a staff office. The smoke and carbon monoxide combination detectors were tested and are in working order. There is a landline telephone that is in working order that will be available to clients. There are three bedrooms upstairs (bedroom #2, bedroom #3 and bedroom #4) and two bathrooms upstairs (bathroom #2 and bathroom #3 which is in bedroom #4). The bedrooms will be arranged so that no more than two clients are in a room, and there will be one client per bed. Bedroom #1 located downstairs was observed to be utilized for personal belongings storage and did not have the required linen making bedroom #1 not readily available for clients. Additionally, Bedroom #4 located upstairs was observed to have one twin bed and one king size bed. The twin size bed did not have the appropriate linens for client use. Additionally, there was a king-size mattress on the floor lying next to a broken bed frame that was not in use. Based on these observations this room was not ready for client occupancy. (Continued on LIC 809C...) The laundry room is located upstairs, has ample storage space and contains chemicals cleaners and client toiletries. The room is kept locked and inaccessible to clients without staff assistance. Per the Administrator's statement, client toiletries are available upon request and as needed. Medication is centrally stored in a locked box located in the pantry. Knives are kept in a locked box located in the garage made inaccessible to clients. LPA tested the water, and it read between 105 - 120 degrees Fahrenheit. There is one sliding door exit in the dining room/living room and one sliding door exit in the kitchen, both exits leading to the backyard. LPA observed a ladder, Christmas tree, and various other objects obstructing the exits to the backyard. There are no pools of bodies of water present. The backyard has a covered patio with a portable basketball hoop, a portable canopy, patio furniture, and two cameras that have view of the perimeter of the home. The cameras do not face the bedroom windows or areas where clients will meet with visitors. Inside the home, there are cameras present in the common area's located in the kitchen, living, and entry way. Per Administrator statement, the cameras do have access to sound. LPA Robinson advised Administrator that cameras must have their audio disabled, muted or turned down so that they cannot capture private conversations between residents, staff, or visitors. LPA Robinson provided Licensee the Provider Information Notice (PIN) 24-09-CRP. LPA did not review staff or client files, as there are currently no staff or clients present at the facility. However, LPA advised the Administrator regarding the required staff background check process and staff-to-client ratio requirements. LPA reminded the Administrator that all facility staff must have a completed and cleared background check prior to having any contact with children in care. The facility has one sedan that seats five present available for transportation for clients and is in good working condition. Per Licensee, they are planning on purchasing a van soon for the transportation of clients and will not accept more than three clients until the van or second vehicle will be purchased. It should be noted the Administrator's personal belongings are still present in the GH throughout the home. Per Administrator's statement, all personal belongings will be removed from the home prior to receiving clients. (Continued on LIC 809C...) Based on LPA's observations, the facility is being cited for Title 22, Division 6 of the California Code of Regulations, Section 84088(c)(1) due to the broken bedframe in Bedroom #4. Additionally, the facility is being cited for Title 22, Division 6 of the California Code of Regulations Section 80087(c) due to the obstructed exit leading to the backyard. Please refer to LIC 809D for more information. Exit interview conducted, LIC 809 and LIC 809D and appeal rights and a copy of this report was provided to facility.

report_type: Facility Evaluation

met_with: Angel Vivas, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On March 20, 2026, at 10:08am, Licensing Program Analyst (LPA), Cynthia Robinson arrived unannounced at the above facility for the purpose of conducting Annual Required inspection at the facility. LPA were greeted by facility administrator Angel Vivas and Karla Vivas, Facility Manager. The Group Home (GH) is approved capacity of six and has the fire clearance for the approved capacity. There are currently no clients in care at this moment The facility is in a gated community that requires a gate code to enter. The facility is a two-story home with four bedrooms and three bathrooms, one loft and one nook and a three-car garage. There is one bedroom (bedroom #1) that will be used for one client and one full bathroom (bathroom #1) downstairs that will be available for client use. The facility has a living room and dining room in the kitchen area with a large dining room table. The nook is located by the garage entry and will be used as a staff office. The smoke and carbon monoxide combination detectors were tested and are in working order. There is a landline telephone that is in working order that will be available to clients. There are three bedrooms upstairs (bedroom #2, bedroom #3 and bedroom #4) and two bathrooms upstairs (bathroom #2 and bathroom #3 which is in bedroom #4). The bedrooms will be arranged so that no more than two clients are in a room, and there will be one client per bed. The laundry room is located upstairs, has ample storage space and contains chemicals cleaners and client toiletries. The room is kept locked and inaccessible to clients without staff assistance. Per the Administrator's statement, client toiletries are available upon request and as needed. Medications will be centrally stored in a locked box located in the pantry. Knives are kept in a locked box located in the garage made inaccessible to clients. There were no deficiencies observed for the physical plant. (Continued on LIC 9099C...) LPA did not review staff or client files, as there are currently no staff or clients present at the facility. Per Licensee, the facility is currently in the process to be vendorized with Inland Regional Center (IRC) to start accepting clients. LPA reminded the Licensee regarding the required staff background check process and staff-to-client ratio requirements along with staff training requirements. LPA reminded Licensee of submitting Special Incident Reports to Regional Office email and provided the email. LPA also reminded Licensee to review the disaster plan annually and ensure that the client rosters are updated. At this time, no deficiencies were observed. Exit interview conducted, LIC 809 and appeal rights and a copy of this report was provided to the Licensee, Angel Vivas.

visit_type: Annual

met_with: Licensee, Angel Vivas


facility_name: AUSTIN PLACE

summary: Facility Evaluation

raw_content:
Narrative:
On 6/16/ Licensing Program Analyst (LPA) Reagan Cohen conducted the Component II - Face to Face Interview with Applicants Pamela Dixon & Luther Waters. Application and program statement was reviewed and discussed with Applicants. The applicants will oversee a Group Home Austin Place. The following documents were received and verified by LPA: 1. LPA verified the orientation certificate for Component I. 2. LPA made a copy of Licensee's ID for the records. 3. LPA observed that the criminal record clearance is pending for Luther Waters, and advised applicants that Pamela Dixon has not been cleared yet. 4. LPA reviewed the Program Design which was out of compliance with Group Home Regulations and General Licensing Requirements. Applicant will refer to application instructions to revise and adhere to Section B Documents: B7-B9. Licensee will provide more details when revising B7: Facility Program Description, including: adding more specifics about reasons for discharge and procedures, adding specific community resource examples for Activities, and adding the "maintenance of clients cash resources" in Basic Services. Licensee Licensee will provide more details when revising B8: Rules of Discipline including adding specific discipline tactics and practices for clients (Licensee can also include positive incentive structures) and specific reasons for discharging a client. Licensee will provide more details when revising B9: Admission Policies including, adding a sample admission form, adding a section about the pre-appraisal plan, changing the ISP's to be created by the Social Workers, and updating the program statement if needed. Licensee will also add sections that cover "Visitations, Program Modifications, Transportation, Facility phone, Mail, Children's Rights, and Clothing/Incidentals." LPA application and Program Design and returned to applicant for revision. Applicant will submit updated Program Design by 6/20/25. LPA scheduled a Pre-Licensing visit for Austin Place for 7/1/25. A copy of this report was given to the applicants. Exit interview completed.

met_with: Applicants Pamela Dixon & Luther Waters


summary: Facility Evaluation

raw_content:
Narrative:
On 7/1/25, Licensing Program Analyst (LPA) Reagan Cohen arrived at the above facility, for the purpose of conducting a Pre- licensing inspection for a Group Home License. LPA met with applicants Luther Waters and Pamela Dixon, who granted access into the home. The applicant and LPA toured the facility both inside and out. Applicant is requesting to be licensed for 4 clients ages 15-17 ambulatory only. The home was inspected and the following was observed: This is a one-story house, with a front yard, backyard, a separate unit and garage in the back. There are working duel smoke/carbon monoxide detector in every bedroom. They are synched throughout the house. Living Room: There is adequate lighting and air conditioning. There is a TV. There is a sofa with adequate seating. The living room leads to the kitchen/dinning area and to the bedrooms which are lined along the side. There is a decommissioned fire place with no gas line, no place for fire wood, and a blocked chimney. Bedroom #1: For clients. There is one bed. There is adequate lighting and a ceiling fan. There is a TV. There is adequate closet storage space and two dressers one small and one medium. Storage space is filled with extra towels. There are two windows in working order. There is a hamper for dirty cloths and a container with basic toiletries. Bedroom #2: For clients. There is one bed. There is adequate lighting and a ceiling fan. There is a TV. There is adequate closet storage space and two dressers one small and one medium. Storage space is filled with extra towels. There is one window in working order. There is a hamper for dirty cloths and a container with basic toiletries. Bathroom #1: is located off next to bedroom#2. It is clear of all cleaning solutions with a working toilet, dual sinks, and shower. Water temp was measured to be 110 degrees F. Bedroom #3: For clients. There is one bed. There is adequate lighting and a ceiling fan. There is a TV. There is adequate closet storage space and two dressers one small and one medium. Storage space is filled with extra towels. There is one window in working order. There is a hamper for dirty cloths and a container with basic toiletries. Bedroom #4: For clients. There is one bed. There is adequate lighting and a ceiling fan. There is a TV. There is adequate closet storage space and two dressers one small and one medium. Storage space is filled with extra towels. There is one window in working order. There is a hamper for dirty cloths and a container with basic toiletries. There is a sliding glass door that leads to the back yard, the door will be kept unlocked. There is a fuse box that applicants must make inaccessible to clients. Bathroom #2: is located off next to bedroom #4. It is clear of all cleaning solutions with a working toilet, sink, and open shower. Water temp was measured to be 110 degrees F. Kitchen/Dinning Room: Is equipped with an operable 4 burner stove, dish washer, and refrigerator/freezer. Applicant locked sharps and cleaning solutions under the sink to be inaccessible to clients in care. There is dinning counter with adequate seating. There is an adequate amount of cups, plates, bowls, and utensils. Applicant stocked fridge and freezer with and adequate amount of perishable and non-perishable food. The First Aid is in the kitchen and was checked to be complete with scissors, tweezers, thermometer, gauzes, bandages, and antiseptic solution. There is also a first aid manual and 2 emergency kits. There is a fire Extinguisher fully charged and available in the kitchen. Extra linens and towels are stored in the kitchen. There is water access from the fridge and bottled water. Client medication, client & staff files, facility plan of operation & program statement will be stored in a cabinet in the kitchen. Laundry Room: There is a laundry room next to the kitchen. There is a washer and dryer unit. There is a fully charged fire extinguisher. Bathroom #3: is a half bath located off next to the laundry room. It is clear of all cleaning solutions with a working toilet and sink. Water temp was measured to be 110 degrees F. Out Side: Front Yard: There is a front yard with adequate space for clients to hang out. Backyard: There is a back yard with a basketball court. There is a shaded area that will have outdoor seating. There is a side path that leads to the front yard. There is a separate unit in the back that applicants will use as an office and has been made inaccessible to clients. There is also a garage that applicants have made inaccessible. LPA observed facility vehicle to be in working order. The vehicle is up to date on insurance and insured by Berkshire-Hathaway specialty insurance. LPA and applicant discussed next step component three meeting. LPA will email applicants about meeting in person or having a scheduled zoom orientation. Exit interview was conducted and a copy of this report was given to the applicants.

visit_type: Prelicensing

met_with: Luther Waters & Pamela Dixon


summary: Facility Evaluation

raw_content:
Narrative:
On 3/2/25, Licensing Program Analyst (LPA) Reagan Cohen and LPM Lakescia Smith arrived at the above facility, for the purpose of conducting a Pre- licensing continuation inspection for a Group Home License. LPA/LPM met with applicant Luther Waters, who granted access into the home. The applicant and LPA toured the facility. Applicant is requesting to be licensed for 4 clients. The home was inspected and the following was observed: Back House: LPA and LPM toured the back house which has a separate address from the front house/main facility building. The back house is intended to be used as an office space for staff trainings/meetings. No clients will reside in the back house. The back hose includes 1 bedroom, a living room, storage area, and a kitchenette. There are no beds in the rooms, there is a stove and a refrigerator in the kitchenette, and a laundry unit in the storage area. Main House: LPA and LPM observed that bedroom #4 which has a sliding glass door is missing curtains to provide privacy. Applicant said they would add curtains, take a picture, and send it as proof to LPA. LPA and LPM also requested proof for audio chime alarm for exit doors. Applicant will send over a video of the chimes working as proof. LPA and LPM will inquirer about the lack of a dinning table and see in the kitchen counter is sufficient. LPA and LPM will also het back to applicant on if the back house because of its separate address will require its own fire clearance. Exit Interview Conducted a copy of this report was given to the applicant.

met_with: Luther Waters Applicant


facility_name: AUTISM ASHRAM AWAAZ

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA), Lidia Tinoco conducted an unannounced visit to the Autism Ashram Awaaz Group Home in order to deliver the findings of the above allegation and met with Assistant Administrator, Maria Brambila. On August 6, 2025, the above allegations were referred to Community Care Licensing for investigation. The investigation included an inspection of the Facility, confidential interviews, and review of records. Based on the investigation conducted the department found that there was not sufficient information to prove that staff engaged in inappropriate behaviors with a minor. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the allegations occurred. Therefore, the allegations are Unsubstantiated at this time. A copy of this report was provided at the conclusion of the inspection along with appeal rights. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Lidia Tinoco LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE This is an official report of an unannounced visit/investigation of a complaint received in our office on 08/06/2025 and conducted by Evaluator Lidia Tinoco COMPLAINT CONTROL NUMBER: 24-CR- FACILITY NAME:AUTISM ASHRAM AWAAZFACILITY NUMBER: ADMINISTRATOR:BRIAN FREITASFACILITY TYPE: ADDRESS: WEST LINWOOD AVENUETELEPHONE: (209) 552- CITY:TURLOCKSTATE: CAZIP CODE: CAPACITY:4CENSUS: 4DATE: 10/16/ UNANNOUNCEDTIME BEGAN: 10: AM MET WITH:Maria BrambilaTIME COMPLETED:12: PM 9Facility did not report incident timely INVESTIGATION FINDINGS: 13On the above date, Licensing Program Analyst (LPA), Lidia Tinoco conducted an unannounced visit to the Autism Ashram Awaaz Group Home in order to deliver the findings of the above allegation and met with Assistant Administrator, Maria Brambila. On August 6, 2025, the above allegations was referred to Community Care Licensing for investigation. The investigation included an inspection of the Facility, confidential interviews, and review of records. Based on the information obtained, there is a preponderance of the evidence to prove that the facility failed to report an incident timely, therefore these allegations are Substantiated. The Facility was cited for the California Code of Regulations (CCR), Chapter 1, Section 80061(b)(1)(E) Reporting Requirements. See LIC9099D. Plans of Corrections were reviewed and developed with Maria Brambila. A copy of this report and appeal rights were provided at the conclusion of the inspection. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Lidia Tinoco LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE FACILITY NAME: AUTISM ASHRAM AWAAZFACILITY NUMBER: 507207209

report_type: Complaint Investigation

met_with: Maria Brambila

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On the date above a pre licensing visit was conducted at Autism Ashram Awaz by Licensing Program analyst (LPA) Les Inouye. I was met by Administrator Brian Freitas and Licensee Anna Peri. A discussion on the required documents took place and all forms requested were received and reviewed. A review of the Physical Plant was conducted including the Indoor Activity Space, Fixtures Furniture Equipment and Supplies and Outdoor Activity Space. Kitchen was clean and non-perishable items were observed in the kitchen. Bedrooms were observed, 4 single occupancy for a capacity of four. Two client rooms down stairs sharing a common bathroom. Two single occupancy rooms upstairs. All rooms were appropriately furnished with storage area was observed. All chemicals and cleaning supplies were locked and secured. Smoke Alarms and Carbon Monoxide detectors were observed and operating. Hot water temperature was measured at 110 degrees. Back yard -there is no pool or hot tub, large yard consisted of a lawn area with covered patio area. Storage building was observed and shall be locked. No staff are hired at this time. The physical plant review was observed to be clean, safe, and free of hazards. Facility will secure doorway to the crawl space containing the hot water heater and AC unit. The upstairs storage area has a panel that shall be secured to keep the area free of nails and wires. At this time Regional Center Program Design is being reviewed. Applicant shall notify CCL when the crawl space and panel is secured. A final Review by CCL will be completed and LPA will notify Applicant of any updates or approval of license.

met_with: Brian Freitas and Anna Peri


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, LPA (Licensing Program Analyst) Lisa Slusher conducted a post licensing inspection. Met at the facility by Administrator Brian Freitas. An annual inspection is also conducted on this date. See LIC 809 on this date. The licensee is still in the vendorization process with Valley Mountain Regional Center and will keep LPA Leslie Inouye appraised of their progress toward completion. LPA received a copy of the current Administrator Certificate for Brian Freitas on this date.

met_with: Brian Freitas


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Lisa Slusher travelled to the facility listed above to conduct an annual inspection. Facility Inspection conducted. 1. Facility Grounds are free of hazard. 2. Adequate indoor and outdoor activity space and materials observed. 3. Chemicals appropriately locked. 4. Locked and centrally stored medications observed. Observed medication logs and discussed procedures for psychotropic medications. 5. First aid kit complete with appropriate manual observed. 6. Adequate storage space observed. 7. Individual beds in good repair observed. 8. The house has 4 bedrooms, single occupancy, located on two levels , all are equipped with required furnishings. The bedrooms on the first floor share a bathroom, and the licensee is aware that bathroom is only for the use of the youth who reside in those rooms. 9. Adequate food storage space observed. Menu is posted and accessible to youth. 11. Dining room equipped with large table and chairs accommodating of all clients. 12. Facility has two full restrooms in the house for client use, both are operable. 13.No firearms or weapons are allowed in the facility. The following items were discussed and reviewed by LPA during Inspection. Provisional license will be extended through the 18 month mark, due to the facility not having placement of youth during first 12 months. Updated Administrator Certification received during inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA), Lidia Tinoco arrived at the Autism Ashram AWAAZ Group Home for the purpose of conducting an Annual Inspection and met with Administrator, Brian Freitas and House Manager, Dalia Martinez and inspected the facility, inside and out. The facility currently has no clients in placement and has not had clients in placement since licensed. Facility has the ability to maintain Centrally stored medications in a locked cabinet. Sharps and Toxic chemicals are kept locked. The facility has a written emergency disaster plan. Facility smoke detectors were tested and appear to be in appropriate working order, fire extinguisher is properly charged. The house has 4 bedrooms, single occupancy, located on two levels, all are equipped with required furnishings. The bedrooms on the first floor share a bathroom, and the licensee is aware that bathroom is only for the use of the youth who reside in those rooms. Two cameras were observed outside of the facility. LPA Tinoco discussed and provided the PIN 24-09-CRP to the licensee. No firearms or weapons are allowed in the facility. Personnel Files will be maintained on-site. There were no deficiencies to be cited on this date. A copy of this report was provided at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA), Lidia Tinoco arrived at the Autism Ashram AWAAZ Group Home for the purpose of conducting an Annual Inspection and met with Administrator, Brian Freitas and House Manager, Maria Brambila and inspected the facility, inside and out. The facility currently has 4 clients in placement. LPA Reviewed 4 client files. Facility has the ability to maintain Centrally stored medications in a locked cabinet. Sharps and Toxic chemicals are kept locked. The facility has a written emergency disaster plan. Facility smoke detectors were tested and appear to be in appropriate working order, fire extinguisher is properly charged. The house has 4 bedrooms, single occupancy, located on two levels, all are equipped with required furnishings. The staff office is located down stairs and has a bathroom. LPA Tinoco and Administrator discussed the process for change of Administrator and LPA provided the requirements. LPA Tinoco also addressed C3 and C4's (See LIC Confidential Names List) placement plan as they turn 18. No firearms or weapons are allowed in the facility. 3 type B deficiencies were cited on this date. LPA Tinoco will complete this annual on a later date including Staff and Client interviews and the Staff file review. This report was provided and discussed at the conclusion of the inspection.


summary: Facility Evaluation - 3 deficiencies

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA), Lidia Tinoco arrived at the Autism Ashram AWAAZ Group Home for the purpose of conducting an Annual Continuation Inspection and met with Administrator, Brian Freitas. LPA Tinoco reviewed 5 staff files, interviewed available staff and interviewed 3 youth in care. On this date, LPA Tinoco observed that a deficiency cited on 05/30/25 had been addressed. As of todays date, POC are still pending for two deficiencies, POC due 06/06/25. LPA provided regulation section Reporting Requirements and Personnel Requirements. LPA also discussed supervision. LPA Tinoco issued Technical Assistance and 7 deficiencies on this date. Plans of correction were discussed and developed with Administrator Brian Freitas. A copy of this report was provided on this date along with appeal rights.

Deficiencies:
80066(a): Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information
84065(d): Personnel Requirements

(d) The licensee shall designate at least one facility manager to be present at the facility at all times when children are present
84065(i): Personnel Requirements

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

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA), Lidia Tinoco arrived at the Autism Ashram Awaaz Group Home for the purpose of conducting a Plan of Correction visit. LPA Tinoco met with Administrator, Brian Freitas. LPA Tinoco conducted a review of 5 staff files and Client file to verify for completeness. LPA cleared 8 deficiencies on today's visit. 2 plan of corrections are still pending as of today's date and will be submitted to LPA Tinoco via email no later than close of business day Friday, July 11, 2025. LPA provided clearance letters for deficiencies cleared on today's date. A copy of this report was provided at the conclusion of the inspection.


facility_name: AVANCARE GROUP HOMES-SUNSET

summary: Facility Evaluation

raw_content:
Narrative:
On Thursday 1/20/22 at 10:27AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a required annual inspection. Safety precautions were taken, including screening call, N95 masks and face coverings, and hand washing/sanitizing/gloves. LPA met with Facility Manager Cesar Redoloso and informed of the purpose of the visit. LPA used the CARE Inspection Tool to conduct the inspection. There are three residents in care, and all were at school during the visit. The facility is a house in a residential neighborhood and has three double-occupancy resident bedrooms and one staff room, two bathrooms, kitchen/dining/living space and outdoor activity space. Beds were observed to be in good condition and fitted with clean linens and mattress pads. The facility is clean and sanitary. There were no bodies of water or hazards, and per Facility Manager, there were no firearms on the premises. Room and hot water temperatures measured within permitted ranges, at F and 112. F, respectively. The first aid kit was observed to be complete. During the file review, LPA observed that staff S1, S2, S3, and S4 (See LIC Confidential Names) did not have 20 hours of annual training documented and maintained in the staff records. Per FM, in-house training is provided, but the facility was not aware that this training counted toward the training requirement as Regional Center had previously informed the facility that only outside training counted. LPA read the Title 22 regulations on the annual training requirement. LPA issued a citation of California Code of Regulations, Title 22, Section Personnel Requirements. See LIC9099-D attached. See attached (4) advisories issued for the following: (1) 80071: Register of Clients was not current with current residents, including one discharged resident and excluding one admitted resident 80071; (2) 84072.2: Complaint procedures were available in resident records but not visibly posted in facility; (3) 84070: Psychotropic medications for residents R2 and R3 (See LIC Confidential Names) were properly documented but not logged separately for the month of January 2022, while they were logged separately on the Psychotropic Medication Administration Record in December 2021; (4) 80070: Resident R2's file was missing an inventory of personal belongings. An exit interview was conducted, appeal rights provided, and a copy of this report provided to Facility Manager Cesar Redoloso, whose signature on this form confirms receipt.

met_with: Facility Manager Cesar Redoloso


summary: Facility Evaluation

raw_content:
Narrative:
On Thursday, February 17, 2022 (02/17/2022) at 11:30AM, a scheduled Office Tele-Meeting was conducted with the facility. In attendance were Licensing Program Manager (LPM) Helga Wong, Licensing Program Analyst (LPA) Mariah Hawkins, Licensee Filipina Cruz, and Facility Manager Cesar Redoloso. The purpose of the meeting was to discuss the facility's recent age exception requests and planned transition to an Adult Residential Facility (ARF). Licensee and Facility Manager confirmed that the residents in care will be turning 18 soon and that they will remain in care. Licensee agreed to submit a formal letter stating their intent to transition to an ARF. The letter is to include Licensee's plan for the submission of the ARF application and the date by which they will have submitted the application. This letter will be submitted to LPA Hawkins by Tuesday 2/22/22. A copy of this report was provided to Licensee Cruz and Facility Manager Redoloso, whose signature on this form confirms receipt.

met_with: Licensee Filipina Cruz, Facility Manager Cesar Redoloso


summary: Facility Evaluation

raw_content:
Narrative:
On 12-9-22 10:45AM, Licensing Program Analysts(LPA) George Karkazis and Alyssa Ng conducted an unannounced Annual/Random inspection at listed facility. LPA's met with Jose Solancho, Direct Care Support, and toured the facility inside and out. Safety precautions were taken including screening call and mask wearing. The Group Home is licensed to serve 3 clients. At 10: Cesar Redoloso, Facility Manager arrived. Present during the inspection were two staff and no clients. At 11:03AM, LPA Karkazis and Ng reviewed client and staff files. All of the necessary forms were present, all files were complete and in order. At 12:21PM, LPA Karkazis and Ng toured the facility. LPA Karkazis observed four bedrooms and two bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Karkazis tested the water temperature and found it to be 111.2 degrees which is in range. The thermostat read 68 degrees which is within range. Sharps were locked and safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked under the counter in a cabinet. The facility is in good repair and clean. LPA Karkazis interviewed two staff and no clients. At 1:39PM, LPA Karkazis and Ng toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. continued on LIC 809-C continued fro LIC At this time there were three citations and one Technical Advisory. California Code Of Regulations, Buildings and Grounds 84487(s)(3) LPA Karkazis witnessed two cans of disinfectant under the sink in a cabinet without a lock. California Code of Regulations 80087(g) Buildings and Grounds LPA Karkazis witnessed shaving clippers in client's room. California Code of Regulations 84072.2 (a)(3) Complaint Procedures- LPA Karkazis witnessed that Complaint Procedures were not posted in a visible area. Technical Advisory- 84470(b)- LPA witnessed weight record for client on the kitchen calendar, not in file. An exit interview was conducted, appeal rights discussed and a copy of this report was given to Cesar Redoloso, Facility Manager.

met_with: Jose Solancho, Direct Care Support


summary: Facility Evaluation

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Narrative:
On 1/25/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a case management visit regarding the facility closure. LPA met with Facility Manager Cesar Redoloso over the phone, facilitated by direct care staff, and informed of the purpose of the visit. A screening contact was prior to visit as well. The facility is transitioning from a group home facility to an adult residential facility. LPA confirmed at visit that the facility has completed their component 3 pre-licensing inspection but has not yet received licensure. Facility Manager agreed to notify LPA when the adult residential facility license is received so a follow-up inspection can be made. There are no deficiencies cited at this visit. An exit interview was conducted, and a copy of this report provided to Facility Manager Cesar Redoloso, whose signature on this form confirms receipt.


facility_name: A&A HEAVENLY HOMES LLC

summary: Facility Evaluation

raw_content:
Narrative:
On May 21, 2025, at 11:00am, Licensing Program Analyst (LPA) Toni Castillo and Licensing Program Manager (LPM) Cheraki Davis met with A & A Heavenly Homes applicant Irene Uribe and proposed Administrator Marshall Tunstalle to complete Component II of the Group Home application process, the face-to-face interview. The Applicant attended Component I, the group home orientation, on May 22, 2024. The purpose of the meeting was to review the group home application process with the applicant, review incomplete licensing (LIC) application forms, and resolve any questions or concerns to ensure that the applicant understands the process and can provide the services outlined in the Program Statement (PS) and Plan of Operation (POO) submitted. During the meeting, LPA informed the applicant that the A & B documents, PS and POO are incomplete and require revisions. LPA went over details of corrections and revisions with applicant and provided an outline of all forms and sections that require corrections/revisions. It was agreed upon that all revisions are to be submitted by June 11, 2025. Fingerprint clearances for applicant and proposed Administrator Marshall Tunstalle are currently pending/in process at this time. LPA advised applicant and Administrator that fingerprint clearances are required prior to being licensed. The following A & B documents are to be revised: (Continued on LIC 809C...) A & B documents: Section A: LIC Applicant Information- For Administrator No signature Part C marked yes and left blank LIC Monthly Operating Statement - Missing or revision on form #1, #6, #9, #14, #16, #17, #18, #23, #27, # LIC 401A Supplemental Financial Information- Blank LIC 403A Balance Sheet Supplemental Schedule- Missing the name of financial institution LIC Balance Sheet- Cash in financial institutions does not match what's on LIC 403A. LIC Application-Page Who's the second signature? Missing name of county and date signed LIC Applicant Info-For Administrator Education highest grade completed Missing college and date completed Missing financial references LIC Applicant Info -For Applicant Highest grade level completed Original signature Work experience on resume does not match what is on the LIC Page 2 part A is blank Page 2 part B is blank LIC Personnel Record-For Administrator Date of last TB test #2 hours working 72 hours a week? Is this reasonable? #2 salary? #2 name of supervisor #4 number of units completed Original signature LIC Personnel Record -For Applicant Date of last TB test #2 72 hours a week? Is this reasonable? #2 salary #3 does not match what is on LIC 215 work experience #4 education second page units completed Original signature LIC Health Screening Report-For Applicant and Administrator Marked to serve infants, application is for children 6-17 years of age. LIC 610C Emergency Disaster Plan- Identify utility shut off locations and dimensions of all rooms. Staff Bedroom? LIC 508D Criminal Record Statement-For Applicant and Administrator Part IV left blank Section B: Control of Property- Unofficial no signature or seal on documents B Verification of Social Work staff- Missing B Neighborhood Complaint Policy- Missing Page3- Ages 3-17 years old? boys and girls? Application is for 6-17 years of age. Page4-What is DSP? Spell it out. Ratio 2 staff to 1 consumer, on the LIC 500 you only have 2 staff listed for a capacity of 3. Page5-Indicates only males which contradicts boys/girls on page 3. Page5-How will it be determined and documented when a child can disperse their own medication? Page6-How often will training on medication by provide to staff? How will it be documented? State training will be provided prior to being allowed to dispense medication to children in care. Page8-What is the accordion file system that's being used for medical orders? Part V refills checked frequently, expand? What is frequently? More specific. Page9-(i) How will you ensure that the child takes medication? (k) Medication dropped and discarded how will that be documented? (e) Procedure? Call pharmacy for pickups? Provide timeline? Page10-VIII audits done how often? Page19-Not using prone containment. Last resort? Expand Page22-Complaint procedure should be in section 16. Where or how will CCL's contact info be made available to clients? Posted? States "only after successfully calling a Social Worker". Can be a violation of personal rights if a client wishes to contact CCL immediately. More developed policy and procedure. Page28-Cameras. Add if cameras are used in common areas Licensing has been notified, placement workers, children, and their authorized representatives are informed. Develop a procedure on how the facility will inform such parties upon admission.Program StatementSection Programs Services and Capabilities- Page 7 emergency shelter care is checked. Page 8 accepting blind/visual impairment and deaf/hearing impairment. Page 9 hardly any behaviors marked yet medical section describes facility psychotropic medication procedure. Page 10 staff ratio, 1:1 supervision only 2 staff on LIC 500, School? Psychotropic medication management? Page D1. Social Worker hours? D Needs & Service Plans? Development? Intake? E2 and E Blank F Blank F Need certification from department of Health Services Page Original signature Section Purpose, Methods and Goals- female & male? Under age 5? Application is for 6-17 years of age. IPP what does that stand for? Spell out. What type of treatment will be provided and how will results or outcomes be measured? how often? States what program will provide but does not state how it will be accomplished. Section Planned Activities/Use of Community Resources- 1.Describe the program's planned SOCIAL and RECREATIONAL activities. Include: - The plan for indoor and outdoor activities; - The plan for individual child activities and group interaction activities; - Which children are involved in the activities; 2.Describe the program's planned educational activities and services. Include: - Special education; - Use of public and/or private schools; - On grounds school; and- Tutoring, if applicable. 3. Provide a SAMPLE DAILY ACTIVITY SCHEDULE for one week, including weekends and holidays. The schedule must include social, recreational and educational activities. Section Special Services/Programs Offered 1. Describe any special services or programs which will be offered. 2. If the program provides vocational training, describe: - The skills taught; - Goals of the training program; Hands-on experience received; - Materials provided; - Number of hours per day/days per week training is provided; and How training is funded Section Medical/Dental 2. Describe procedures used to identify and handle medical, dental and psychiatric emergencies 3. Identify staff position(s) responsible for dispensing and destroying medications. Section Transportation 1. Describe arrangements for transporting children to and from school, activities provided outside the facility(ies) (including attendance at religious services) and medical/dental appointments. 2. Specify how the program will ensure that vehicles used to transport children are maintained in safe operating condition. 3. Specify how the program will ensure that vehicle registration and insurance will be maintained. 4. Specify how the program will ensure that only appropriately licensed program staff and volunteers will transport children. Section Admission/Intake 1.Describe the program's admission/intake procedures. Include: - Criteria for evaluating appropriateness of referrals for placement; Information required to assess referrals for placement; - Time frame for responding to referring agencies regarding acceptance or rejection of referral; - Staff position responsible for intake; and - Procedures for accepting emergency placement's on a time limited and/or trial basis. Section Needs and Service Plans/Assessment 1. Describe procedures for developing a needs and services plan which addresses each child's needs and the services required to meet such needs. 2. Describe procedures for review and evaluation of the needs and services plan. 3. Describe procedures for implementing and modifying the needs and services plan. 4. Describe the policy regarding participation of the child and his/her authorized representative in developing, updating and modifying the needs and services plan. Section Discharge and Removal 1. Describe procedures for planned discharge or removal. Include time lines. 2. Describe procedures for emergency discharge or removal. Include time lines. Section Visitation Rules and Policy -When and under what circumstances the child is permitted to have home visits with parents and/or relatives; -When and under what circumstances the child is permitted to have overnight visits with parents, relatives, family members and friends; and -When and under what circumstances other types of visits are or are not permitted. Section House Rules 1. Describe the program's policy of allowing children to be unsupervised away from the facility, including issuing passes to children. 2. Specify other house rules. Include: -Curfew hours on school nights, weekends and holidays; -Smoking; -Dating other children in placement; -Completing homework; -Cleaning bedrooms and other areas; Use of entertainment equipment (the child's and the facility's); -Dress code; -Laundry. -General prohibited behaviors -Describe your reward system (you may give examples) Section Discipline Policies 1. Describe the program's discipline policy. [Reference: Title CCR 80072(a)(3), (7) - (8), 84072, 84072.1] Include: -Type(s) of discipline used; -Conditions under which each type of discipline will be used; -Types of discipline not permitted (corporal punishment and violation of personal rights); -Provisions for contact with parents and/or placement representatives (conferences). Section Emergency Intervention Plan 1. Include a copy of your agency's approved Emergency Intervention Plan which must address the following areas: -Techniques of group and individual behavior management; -Methods for de-escalating volatile situations; -Alternative methods of handling aggressive and assaultive behavior; -Describe the physical techniques of applying manual restraints, if applicable; -Techniques for returning the child to planned activity following an emergency intervention; -A written test and evaluation criteria for the hands-on competency test; and 2. Include the name and qualifications of the individual who designed the Emergency Intervention Plan. * EIP is to be designed and approved on conjunction with licensee by a qualified behavior management consultant Section Runaway Plan 1. Describe the plan for responding to an incident of a child running away. Include: -Time frames for determining when a child is absent without permission; -Continuum of interventions; -Actions to locate the child; -Staff training plan; -Plan to involve law enforcement; and -Plan to notify the child's authorized representative. Section Children's Complaint/Grievance Procedures Describe procedures by which children or their authorized representatives are informed of their rights and permitted to file complaints. Include how children, their authorized representatives and staff receive copies of the written complaint/grievance procedures. Section Handling Children's Funds, Allowances and Salaries 1. Describe how the program accounts for and handles children's personal funds. 2. Describe the procedure for issuing allowances, including the amount. Section Chores Describe any chores children are required to perform as part of their regular routine. Section Nutrition/Sample Menu 1. Provide a SAMPLE MENU which includes: -One week's worth of planned meals, including snacks from the four basic food groups; -Portion sizes; and -Times meals are served. 2. Describe any provisions available for children with special dietary needs. Section Clothing and Incidentals 1. Describe how the program ensures that children have adequate clothing. Logs? Inventory ? 2. Describe how the program provides personal hygiene items (for example, shampoo and deodorant). Section Staff Schedule 1. Specify the number of hours the program administrator will be at each facility each week. Section Job Descriptions Social Work Staff from Regional Center? Reporting to Regional Center? Child Care staff listed in this section but not on your LIC 500 to be hired Section In-Service Training for Staff 1. Describe the plan for providing initial and annual training for child care staff. Include: - Position or person who will do the training and his/her qualifications; - Approximate length of training; - Initial and annual training curricula; and - How special training needs are identified and met Section Volunteers Describe how volunteers are utilized, screened and trained. Section Control of Property - Unofficial no signature or seal on documents - Provide a copy of the Deed(s) or Property Tax Bill(s) as proof of property ownership. Section Facility Sketch - Dimensions of all rooms and their designated use; - The number of children per bedroom; - Identify utility shut off locations and dimensions of all rooms. Staff Bedroom? An Exit Interview was conducted. LPA provided applicant a copy of the LIC 9106 group home program statement general instructions and the medications guide for group homes. A copy of this report and an outline of all revisions needed prior licensing was provided to applicant.

met_with: Irene Uribe, applicant


summary: Facility Evaluation

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Narrative:
On 9/05/ Licensing Program Analyst (LPA) Toni Castillo made an announced visit to A & A Heavenly Group Home for the purpose of conducting a prelicensing inspection. LPA met with applicant Irene Uribe and Administrator Marshall Tunstalle, who facilitated the inspection and the walk-through tour of the facility. A tour of the facility including outside and inside of the building was conducted. The group home is located in a residential neighborhood. This is a single story home which is 2,483 square feet. This home has 4 bedrooms and 2 restrooms. LPA observed the following: Visitors hours posted with visitors sign in/out log, medication closet which is locked containing client medication files, medication storage, and first aid kit, cleaning supplies are locked in a closet, a sufficient amount of linen supply in a hall closet, family room with seating area, side chairs and tables, a television and a fireplace which contains a screen. The kitchen area contains operable stove refrigerator, oven, microwave, and sink. LPA observed a pantry with food supply, a trash can with a proper lid, knives are stored in a locked cabinet, sufficient amount of cooking and eating utensils, dishware, pots and pans. Kitchen table with chairs for 6 to sit. Bedroom #1 is utilized as a staff office, which contains locked client files, desk, chair, computer and office supplies, Staff office has a bathroom which will be designated for staff and guest use only. Bedroom #2,#3 and #4 designated for one client in each bedroom. Bedroom #2, #3 and #4 each contain one bed, a chair, a night stand, a dresser, a closet, a television and a hamper. Each client beds has a mattress pad, fitted sheet, flat sheet, comforter and pillows. Bedrooms all contain adequate lighting. There are no locks on the bedroom doors. Windows are equipped with free of debris window screens. The clients' bedrooms were arranged so that no more than one client will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. ( for continuation 809-C) There is one client restroom designated for client use only. This is a full restroom with shower, tub, sink, toilet and counter space. LPA observed all restroom appliances in operable order, hot water temperature was tested and is within regulation temperature. Laundry room contains a washer and dryer. LPA observed laundry supplies. A safety assessment of the front and back yard was completed. There are no bodies of water in the front of back yard. LPA observed the front and back yard to be groomed and landscaped. There were no hazards items. Backyard is furnished with patio furniture for recreation. Smoke detectors are in operable working order. LPA observed recreational activities for client use such as books and games. This group home has a land line which will be used for clients as needed. All required items were posted in a visible area of the home. The following items were posted: personal rights, grievance procedures, food menu, emergency, evacuation and disaster plan An exit interview was conducted, and a copy of this report was provided to applicant Irene Uribe via email. The application will be forwarded to Licensing Program Manager Cheraki Davis once corrections in the program statement are submitted to LPA.


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Toni Castillo met face to face with applicants of A & A Heavenly Group Home, Applicant Irene Uribe and Administrator Marshall Tunstalle, to conduct a component III and follow up on corrections during the component II on May 21, 2025. During this visit LPA informed applicant the following revisions are still needed: * Section 2 page Social Work services * Section Handling of Children's Funds and Allowances is missing *Section 27 page 81 refers to program as an STRTP (short term residential therapeutic program) This is a group home application. During this visit LPA went through all component III information and slides. Applicant was provided a copy of approved slides, A copy of a blank LIC 624 unusual incident/injury report with the email address to submit all special incident reports was provided. LPA provided applicant with a copy of all forms which may be used in the operation of a group home. Applicant and Administrator are fingerprinted cleared and associated to this facility. LPA will package and submit application and program for approval once the stated above corrections have been submitted.


summary: Facility Evaluation

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Narrative:
On October 2, 2025, at 2: PM, Licensing Program Analyst (LPA) Cynthia Velasquez arrived A&A Heavenly Homes LLC, for an unannounced post-licensing inspection. There was no response at the facility and there was a pad-lock on the doorknob. A Ring camera was present at the front entrance and recorded LPA's visit, and a business card was left at the front door.

met_with: Attempt - No Response


facility_name: BAILARD HOUSE

raw_content:
Narrative:
There was no evidence that staff did not prevent inappropriate behaviors between minors. The name of the minor involved was not disclosed. Documentation provided did not show any boundary issues with other clients reported by facility staff or C1. There was no evidence that staff did not administer minors medication. LPA collected all medication distribution documents. No days of medication was missed. There was no evidence that staff did not refill minors medication in a timely manner. Medication is handled by an on site nurse and is ordered a week prior to running out. There was no evidence that staff did not seek medical attention for minor. It was documented that client saw the Doctor once a week while in care. There was no evidence that staff threatened minor or that staff did not provide a comfortable environment for minors. C1 was not available for comment. Clients interviewed stated that they got along well with staff. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that a violation occurred; therefore, the above allegation is Unsubstantiated. There are no deficiencies being cited at this time.

Investigation Findings:
13On September 8, 2023 at 1pm Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of delivering findings for the above complaint allegations. LPA met with Program Director, Dominique Baker and was allowed into the facility. During the course of investigation the allegations for staff did not prevent inappropriate behaviors between minors, staff did not administer minors medication, staff did not refill minors medication in a timely manner, staff did not seek medical attention for minor, staff threatened minor and staff did not provide a comfortable environment for minors, interviews were conducted and documents obtained. The interviews did not produce corroborating evidence to support said allegations. Interviews revealed inconsistent statements and no witnesses to suggest allegations occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: BAILARD HOUSEFACILITY NUMBER: VISIT DATE: 09/08/2023

met_with: Dominique Baker-Program Director


summary: Complaint Investigation - Unsubstantiated - 1 allegation

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Narrative:
Based on gathered information obtained and reviewed, the findings are determined Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There are no deficiencies per California Code of Regulations, Title 22, of at this time. Exit interview completed. Appeal Rights discussed and a copy of this report was provided to Facility Program Director.

Investigation Findings:
13On April 24, 2024, at 12: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection at BAILARD HOUSE to deliver findings concerning the above-mentioned allegation. LPA Martin met with Dominique Baker, Program Director to discuss the investigative outcome. On September 6, 2023, CCLD received a complaint alleging Neglect/ Lack of Supervision leading to sexual abuse, as a youth was reportedly sexually assaulted while in care. The investigation was conducted by Investigator Laura Garcia of the Community Care Licensing Division (CCLD) Investigations Branch. The investigation, including confidential interviews of former resident (alleged victim), three staff members, complainant, other associated parties, and review of facility file review history revealed former resident (Client #1) resided at the facility for approximately two months. Confidential statements obtained revealed a lack of evidence to support allegation as statements obtained produced denial of sexual abuse or neglect and further produced no witnesses or corroborating evidence to the alleged. (Continued on page LIC9099-C). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: BAILARD HOUSEFACILITY NUMBER: VISIT DATE: 04/24/2024

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

met_with: Dominique Baker, Program Director


raw_content:
Investigation Findings:
13LPA Jones-Steward investigated the allegations that there are pests and mold in the facility, that clients are not provided planned activities, staff ratios are not adhered to, and that therapy notes are falsified. LPA interviewed the executive director, the facility manager, one therapist and several clients. LPA reviewed the service notes from Orkin Pest Control, the program statement for stated ratios, and the schedule of activities. LPA also performed a facility walk through to inspect for pests and mold; none was seen inside the home. The LIC 500 for Feb. 2024 showed staff available to meet the staff:client ratios stated in the program statement The service notes from Orkin show that the company provides services on a regular schedule. Clients described their schedule of activities and indicated that they were happy with their options. Therapists and executive director explained how group therapy sessions are notated and denied any type of falsification. Based on the interviews and observations made by this LPA, the above allegations are resolved as unsubstantiated. An unsubstantiated finding means that although an allegation may be true, there is not a preponderance of evidence that it is true. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Eli Wayne, Executive Director


summary: Facility Evaluation

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Narrative:
On April 6, 2023 at 12pm Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting a Required Annual. LPA met with Program Director, Dominique Baker and was allowed into the facility, This facility is licensed for a capacity of 6 children, ages 12-17, ambulatory only. The Bailard House program is designed to accept private placement clients with a length of stay of 30-90 days. The inspection is as follows: First Floor: The first level of the home is comprised of a garage/recreation area that contains a pool and ping pong table, two storage closets and a locked laundry closet with a washer and dryer. Detergent is kept in their as well. As you enter the house, The hallway contains Bedrooms. Bedroom #1 and #2 are equip with a full sized bed and dressers for the clients clothing. Bedroom #1 also has a couch in the room. Bedroom #3 has a full sized bed dresser and an end table. Inside of bedroom #3 is a bathroom with a shower, sink and toilet all in good working condition. Bedroom #1 and #2 share the hall Bathroom. The hall bathroom has a shower, sink and toilet all in good working condition. There is a contraband closet at the beginning of the hallway. Second Floor: The kitchen which has a microwave, air fryer, toaster, coffee maker, stove, refrigerator and an island. The sharps are kept in a locked drawer and the key is kept with the Chef. The kitchen has 2 days of perishables and 7 days of non perishables. The nurse's office/medication storage area is in the hall outside of the kitchen. A nurse keeps track of the medication and the staff is also trained to administer medication. There is a first aid kit and ample supplies in case of an emergency. The clients medication is kept in a locked cabinet and in individual containers. The school area has a table an bookshelf. The common area has a large couch, a large seating area and a covered fireplace. There are two bathrooms on this floor in good working condition. There is a storage area where school supplies, laptops, and some cleaning supplies are kept. Cont 809-C The third level has one Bedroom, staff office and a large bathroom. The bedroom has two beds, two dressers and two desks. The bathroom is large. There is two sides of the bathroom which are identical. There is a shower, sink and toilet on both sides. There is a large jacuzzi tub which is inoperable. Throughout the home, several fire extinguishers were observed in good condition and fully charged until April of 2024. Smoke and carbon monoxide detectors are hard wired and are in working order. Outside: The shut off valves are in the back of the house and labeled. There is a basketball court and a large area that is being transformed into a garden. There were no hazards or obstructions at the time of the visit. The vehicle is a Chevy Suburban. The registration and insurance was in the vehicle and current until 2024. There is a first aid kit in the trunk and the lights and signals are in good working condition. LPA discussed with and advised the Licensee to ensure the following: Children are accorded personal rights and the corresponding form is in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency or Foster Care Ombudsperson, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. Licensee has received the Admissions Agreement, Needs & Services Plan and written authorization to obtain medical and dental care for the children and ensures these documents are maintained in individual client folders. Licensee acknowledges abuse reporting requirements. During the visit, LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. All posting requirements for Group Home Licensure and Emergency Plan were met. LPA reviewed Staff and Client files. LPA interviewed one staff and no clients. Clients were gone on an outing. No deficiencies were observed or cited during this inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On 07/15/2024, at 1pm, Licensing Program Analyst (LPA), Donald Martin made an unannounced visit to the above facility for the purpose of conducting a Case Management - Incident Inspection. LPA spoke with AM Lead, Stephanie Miller and was allowed into the facility. A health and safety assessment was conducted. On 07/1/2024, the department received an Incident Report dated 06/28/2024, indicating that Child 1 (C1) reported to Staff 2 (S2) that On 6/3/ S1, while on an outing to the park, walked C1 to the bathroom. While C1 was using the restroom, S1 made uncomfortable gestures adjusting his pants. LPA interviewed S2 and C2 and has concluded that further investigation is needed to determine findings for this Case Management investigation. There were no deficiencies cited at the time of the visit.

met_with: Stephanie Miller-Lead


summary: Facility Evaluation

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Narrative:
On August 26, 2024 at 1pm Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of conducting a Required Annual. LPA met with Program Director, Dominique Baker and was allowed into the facility, This facility is licensed for a capacity of 6 children, ages 12-17, ambulatory only. The Bailard House program is designed to accept private placement clients with a length of stay of 30-90 days. The inspection is as follows: First Floor: The first level of the home is comprised of a garage/recreation area that contains a pool table and ping pong table, two storage closets and a locked laundry closet with a washer and dryer. Detergent is kept in their as well. As you enter the house, The hallway contains Bedrooms. Bedroom #1 and #2 are equip with a full sized bed and dressers for the clients clothing. Bedroom #1 also has a couch in the room. Bedroom #3 has a full sized bed dresser and an end table. Inside of bedroom #3 is a bathroom with a shower, sink and toilet all in good working condition. Bedroom #1 and #2 share the hall Bathroom. The hall bathroom has a shower, sink and toilet all in good working condition. There is a contraband closet at the beginning of the hallway. Second Floor: The kitchen which has a microwave, air fryer, toaster, coffee maker, stove, refrigerator and an island. The sharps are kept in a locked drawer and the key is kept with the Chef. The kitchen has 2 days of perishables and 7 days of non perishables. The nurse's office/medication storage area is in the hall outside of the kitchen. Staff is trained to administer medication. There is a first aid kit and ample supplies in case of an emergency. The clients medication is kept in a locked cabinet and in individual containers. The school area has a table an bookshelf. The common area has a large couch, a large seating area and a covered fireplace. There are two bathrooms on this floor in good working condition. There is a storage area where school supplies, laptops, and some cleaning supplies are kept. Cont 809-C The third level has one Bedroom, staff office and a large bathroom. The bedroom has two beds, two dressers and two desks. The bathroom is large. There is two sides of the bathroom which are identical. There is a shower, sink and toilet on both sides. There is a large jacuzzi tub which is inoperable. Throughout the home, several fire extinguishers were observed in good condition and fully charged until April of 2025. Smoke and carbon monoxide detectors are hard wired and are in working order. Outside: The shut off valves are in the back of the house and labeled. There is a basketball court and a large area that is being transformed into a garden. There were no hazards or obstructions at the time of the visit. The vehicle is a Chevy Suburban. The registration and insurance was in the vehicle and current until 2025. There is a first aid kit in the trunk and the lights and signals are in good working condition. LPA discussed with and advised the Licensee to ensure the following: Children are accorded personal rights and the corresponding form is in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency or Foster Care Ombudsperson, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. Licensee has received the Admissions Agreement, Needs & Services Plan and written authorization to obtain medical and dental care for the children and ensures these documents are maintained in individual client folders. Licensee acknowledges abuse reporting requirements. During the visit, LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. All posting requirements for Group Home Licensure and Emergency Plan were met. Note: The disbursement of allowance has been discussed with the Program Director, Dominique Baker. LPA will review the program statement for clarity before making a determination on how to proceed. LPA reviewed Staff and Client files. No deficiencies were observed or cited during this inspection.


summary: Facility Evaluation

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Narrative:
On August 28, 2024 at 11:30am Licensing Program Analysty (LPA) Donald Martin arrived at the above facility for the purpose of conducting an Annual Inspection Continuation. LPA was met by Lead, Stephanie Miller and allowed into the facility. LPA will be conducting interviews for clients and Staff during todays visit. LPA interviewed 3 staff and 2 clients. No deficiencies were cited at the time of the visit.


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst Raymond Canal conducted a case management inspection on 6/24/25 at 11:12 am based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 5 out of Direct Care Staff and 6 out of 6 youth files were reviewed. 2 out of Direct Care Staff and 2 out of 6 youth were interviewed. (See the Confidential Names List, LIC 811, 6/24/25). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, youth case plans, and Trauma informed safety plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Canal observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Administrator Eli Wayne.

met_with: Eli Wayne, Administrator


summary: Facility Evaluation

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Narrative:
On April 29, 2026, Licensing Program Analyst (LPA) Andrea Aceves arrived at the above facility for the purpose of conducting a Annual/Random Inspection. LPA met with Administrator Eli Wayne who granted access to the facility. The facility is licensed to provide care and supervision for up to six children ages 12-17 years old, ambulatory only. Currently the census is (5). No pool on premises. This is a three-story home located in a residential neighborhood with an attached garage. First Floor: Therapy room: has a two couches, chair, coffee table. Bedrooms #1 and #2 are equipped with two queen-sized beds, dressers and plenty of closet space. Inside of bedroom #2 is a bathroom with a shower, sink and toilet all in good working condition. Hallway bathroom #1 has a shower, sink and toilet all in good working condition. There is a locked closet at the beginning of the hallway with client hygiene products. See Lic 809-c Second Floor: Kitchen/Dining Area: There is gas stove/oven with six (6) burners all working at the time of the inspection. There is a microwave, refrigerator/freezer, ice machine and kitchen island. The dining area is equipped with a wood dining table with ten (10) chairs. There is a lid covered trash can, dishes, eating and cooking utensils. Facility has adequate supply of food at the time of this inspection. LPA observed the weekly sample menu posted on the kitchen counter. Medication storage area: There is a first aid kit and ample supplies in case of an emergency. The client's medication are kept in a locked cabinet. There is a small refrigerator for Urine Analysis (UA) and another small refrigerator for cold storage medications. School Area: has a couple of desks and a large table with plenty of chairs. It has a whiteboard, additional chairs and a storage cabinet with school supplies. Living Room: has a large sectional couch, a seating area with three lounge chairs, end tables, two large coffee tables, a piano, a bookshelf with plenty of reading materials and a covered fireplace. The living room has sliding doors that lead to the patio. Second floor hallway: bathroom #2 and #3 are located on this floor and in good working condition. Administrator office has desk, computer, printer, couch and remains locked. Third Floor: Staff office: has a large desk and two chairs, computer, printer, small staff refrigerator, file drawer that's kept locked and a landline phone. There is a large bathroom with a shower, sinks and toilet all in good working condition. There is a large jacuzzi tub which is inoperable. Bedroom #3 has two queen-sized beds and two dressers. The bedroom also has three lounge chairs and a small table. It has an inoperable fireplace. See LIC809-C LPA observed the home to have six (6) fully charged fire extinguishers. Smoke and Carbon Monoxide combination detectors were tested and found to be in working order. The following posting requirements were observed and posted in public area: The Emergency Disaster Plan, Grievance Procedures, Personal Rights, the facility license, and the daily activity schedule. There is a working telephone readily accessible to clients. The home has central air and heat and the temperature maintained between 68-85 degrees (F). Outdoor Area: Upstairs patios by kitchen and living room: is a large area with plenty of patio furniture. Garage/Recreation Area- has 2 pool table and ping pong table, storage closets and a locked laundry closet with a washer and dryer. Detergent is kept in the locked laundry closet. The outdoor perimeter front yard, side yard and backyard were inspected and cleared of debris and hazards materials. The shut off valves are in the back of the house and labeled. Vehicle: Staff utilize a Chevy Suburban to transport clients. LPA observed the facility vehicle to have working seat belts, horn, and lights. Vehicle has current registration through March 10, 2027 and insurance with Berkley Regional which expires on August 1, 2026. LPA received copy of the Staff and Client Roster. LPA verified that all staff on the personnel roster have a criminal record clearance. LPA will return at a later date to review staff and client files. No deficiencies cited at this time. Exit interview was completed and a copy of this report was provided to the Administrator.

met_with: Administrator Eli Wayne


facility_name: BAUER RESIDENTIAL SANTA MARIA 3 GROUP HOME

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Investigation Findings:
13On August 25, 2021, at 7:10 am, Licensing Program Analyst (LPA) Enrique Hernandez made an unannounced visit to the above facility for the purpose of concluding the investigation on the above allegation and to deliver the findings. LPA met with facility administrator Jaime Stain, and together discussed the investigation details. Based on the confidential interviews conducted and file review the allegation cannot be substantiated. Facility staff denied having more than one client without clothes in the bathroom and the time the staff are in the bathroom with clients is to assist them while they are taking a shower. During the confidential interviews the Facility staff indicated that C3 does not need the assistance of staff while taking a shower. C3 confirmed that no one goes to the bathroom during the time C3 takes a shower. In addition, SW feels that C1 and C4 are happier now that they are in this facility and has no concern with the facility and knows that C1 and C4 need staff to be in the bathroom to assist the clients. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has decided that the allegation Personal Rights is unsubstantiated but if any additional information is received this complaint can be amended and findings can be changed. Per California Code of Regulations, Title Regulations, Division 6, Chapters 1 & 5, there are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Enrique M Hernandez 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

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

met_with: Administrator


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Narrative:
Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has decided that the above allegations are unsubstantiated, but if any additional information is received this complaint can be amended and findings can be changed. Per California Code of Regulations, Title Regulations, Division 6, Chapters 1 & 5, there are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was left at the facility.

Investigation Findings:
13On March 29, 2022, at 8:51 am, Licensing Program Analysts (LPAs) Enrique Hernandez and Nancy O'Connell made an unannounced visit to the above facility for the purpose of concluding the investigation on the above allegations and to deliver the findings. LPA met with Jaime Stain Facility Administrator, and together discussed the investigation details. On September 22, 2021 the Department received a complaint alleging Staff chemically restrained minor, Minor is being physically abused while in care, Minor sustained injuries while in care, Staff are not ensuring minor's health care needs are met and Facility is restricting visitation.The following information was obtained during the course of the investigation: During the confidential interviews there were no witnesses, and there is no supporting evidence that proves the allegations. LPA was unable to obtain statements from facility clients confirming or denying the allegations due to speech disability. Confidential interviews revealed that clients are happy at the facility and have not seen marks or bruises on the client's body. Confidential interviews also revealed that the facility takes all clients to their medical appointments. Continue on LIC9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Enrique M Hernandez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: BAUER RESIDENTIAL SANTA MARIA GROUP HOMEFACILITY NUMBER: VISIT DATE: 03/29/2022

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

met_with: Facility Administrator


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Investigation Findings:
13On 10/11/23 at 1:00pm, Licensing Program Analysts (LPA) Nancy O'Connell and Jhane Haynes made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation and deliver the finding.LPA spoke with S1 and together, discussed the investigative finding. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. Supporting evidence includes: interviews with formal supports attesting to client specific behaviors that would cause markings on C1's body. Further, record reviews indicate pressence of behavioral patterns that would account for discoloration on body. Documentation evidence was gathered from the facility to support policies that are in alignment with consistent supervision and "body checks." Lastly, photographic evidence was obtained that clearly shows markings on body that are inconsistent with signs of abuse. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Jaime Staine, S1


raw_content:
Investigation Findings:
13On 10/11/23 at 1:45pm, Licensing Program Analysts (LPA) Nancy O'Connell and Jhane Haynes made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation and deliver the finding.LPA spoke with S1 and together, discussed the investigative finding. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. Supporting evidence includes: interviews with staff and regional center representatives. LPA also conducted record reviews to review evidence. Records of the staff roster were reviewed and demosntrate that all staff are cleared to work within the facility. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was eailed to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13On 10/11/ Licensing Program Analyst (LPA) Nancy O'Connell and LPA Jhane Haynes made unannounced inspection to the above-listed facility for the purpose of concluding the investigation on the above allegation and deliver the finding. LPA O'Connell met with Jaime Staine, facility administrator (FA) and discussed the investigative findings. During the investigative process, LPA O'Connell conducted confidential interviews with all relevant parties and collected information on the above allegation. Supporting evidence includes: staff records produced by the facility administrator reflecting inaccuracies in staff schedules. Further, the facility administrator could not provide records confirming the staff schedule for S1, in order to confirm S1's presence within the facility during scheduled shifts. Based on LPAs observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations Title 22, Chapter 5, are being cited on the attached LIC 9099D. Exit Interview conducted, and a copy of this report was left at the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION WOODLAND HILLS S.Ro, Ventura Blvd., STE. WOODLAND HILLS, CA FACILITY NAME: BAUER RESIDENTIAL SANTA MARIA GROUP HOMEFACILITY NUMBER: 425801573

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

met_with: Jaimes Staine, Facility Administrator (FA)

complaint_status: SUBSTANTIATED


raw_content:
Investigation Findings:
13On 03/26/24 at 00:00PM Licensing Program Analyst (LPA) Jhane Haynes and Licensing Program Manager (LPM) Kevin Sauk arrived at the above facility for the purpose of concluding a complaint investigation. LPA met with Direct Care Staff (DCS) Cefarah Lewis who granted access and together discussed complaint findings. During the investigation LPA Haynes interviewed and accounted for all relevant parties. Based on interviews and records obtained, it was reported that clients in care attend medical appointments as scheduled. Interviews reveal staff do not shave or cut clients hair. The complaint findings were determined to be unsubstantiated.Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No deficiencies will be cited at this time. An exit interview was conducted, and a copy of this report was emailed to the facility administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Jhane Haynes LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Cefarah Lewis Direct Care Staff DCS


summary: Facility Evaluation

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Narrative:
On 8/25/ Licensing Program Analyst (LPA) Enrique Hernandez made an unannounced inspection of Bauer Group Home for the purpose of conducting a plan of correction (POC) visit to clear the deficiency dated 8/05/2021. LPA Hernandez met with administrator Jaime Stain, and together conducted a tour of kitchen to make sure all the chemicals were locked under the cabinet sink that could pose a danger to clients in care. The cabinet was lock and the chemicals are no longer accessible to clients in care. LPA Hernandez cleared the deficiency and provided the facility with a POC clearance letter. Exit interview was conducted and a copy of the report was left with the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 3/29/2022 at 8:50am Licensing Program Analysts (LPAs) Enrique Hernandez and Nancy O'Connell conducted a Case Management Annual/Required Inspection at the above facility. LPAs met with Jaime Staine Facility Administrator (FA) who granted access to the facility and toured the home in and out. This is a four-bedroom, two-bathroom, single story family residence that includes a living room, dining area, office area, kitchen, laundry area and an attached garage. LPA toured the entire facility and observed the following: Bedroom #1 is occupied by one male client, it has one twin size bed, adequate closet and drawer space. Wall behind bedroom door has a hole in the wall. Window screen needs repair. Wall outlet plug is cracked and needs to be replaced. Bedroom #2 is occupied by one male client, it has one queen size bed, adequate closet and drawer space. Window screen does not fit on window. Bedroom #3 is occupied by one male client, it has one twin size bed, and one full size bed adequate walking closet and drawer space bathroom was clean at the time of the inspection. [See LIC Confidential Names List form (LIC811), dated 03/29/2022, for names] LPA observed non-perishable foods for one week and perishable food for two days. Facility is clean and sanitary. Passageways, stairways, inclines, ramps, and open porches are unobstructed. Rules, regulations, licenses, emergency disaster plan and personal rights are posted at the facility. Menu is posted in the kitchen- an advisory notice will be given to direct facility to add date on menu. Outdoor space is free of debris and hazard. Bathroom #1 clean and sanitary. Water temperature was measured at 105 degrees. Continued on LIC 809C Hazardous and cleaning solutions, disinfectants, poisons, medication and sharp knives are inaccessible to the clients. Bathroom # Bathroom shower has mold in grout. Meds are locked and accessible only to employees supervising stored medications. Home has working smoke alarms, carbon monoxide detectors and working fire extinguishers at the time of this inspection. LPA advised FA to add another fire extinguisher in laundry room. The facility has a working telephone/landline. There is no bodies of water on the premises. Kitchen/Dining area: There was one (1) refrigerator, microwave, one (1) stove one (1) with four (4) burners, and back right knob on stove was missing. There was a large dining table with four (4) chairs. A trash can with a lid on was observed in the kitchen area. Laundry Room: There was a laundry room in the garage equipped with a sink, one (1) washer and one (1) dryer during the time of the inspection. Per California Code of Regulations, Title Regulations, Division 6, chapters 5, the following deficiencies were cited at the time of inspection: Wall outlet in BR#1 is broken Window screen in bedroom #1 is ripped on bottom of the screen Window screen in bedroom #2 is bent and does not fit in window frame Window screen in bedroom #3 is bent and does not fit in window frame Exit interview was conducted and a copy of this report will be emailed to the facility Administrator due to technical difficulties with LPA's printer.