summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, (LPA) Tana Kinder conducted a pre-licensing, Component II meeting with Cheryl Karran on 2/3/2022 to review revision requests to the program design. The meeting was conducted using the video conference platform, Microsoft Teams. Section 3: Every box was checked. Do you truly see this program serving every type of need identified on the list? Have you had experience and training with every population identified? Section 4: Page 2: Other descriptions, for example, behavioral and/or medical assessments? NSP & IPPs. Page 5, Line 9: remove comma after Regional Center Staff. Page 5: includes Long Beach Aquarium as a possible activity, please remove and identify specific options in your area- what is in your community? Give names and locations of dining places, parks, gyms; etc. Page 6: Note: and parent- check with them also. Line 31 the sentence starts with "Ways." Line 32 ...not limited to (should not have colon(:). Line 33 as support (insert regulations) to the person's needs. Line 36 codes and regulations. Line 39 ensuring. Page 7: Under dating line 5 physicals written 2# 5. Page 9: Please refer to local activities. Page 10: Are these optional? Aroma and meditation. Continued... Section 5: Lists services for San Joaquin and Solano county. Also make sure the programs listed are available to Regional Center clients-use examples of vendored services if applicable. Section 6: Page 15: top- will family or legal guardian also be informed and included? Page 15, Line 3: Individual(s) *Attach a copy of the appointment history tracking form to this section. Page 16: First Aid Kit-you list some specific items. Make sure you have everything required by regulations. Page 17, 2nd paragraph, line 5: Add PMAR with MAR. 2nd paragraph, last sentence: Be specific-where are you going to store? Have a designated area assigned. Page 20: Expired Medication Disposal- Change locations to local area. Section 7: Page 21, line 1: Define vigorous background check. 2nd sentence vigorous. *If you use volunteers add information here regarding driving policy. *Address potential use of car seats or car restraint systems for younger/smaller clients. Section 8: Individual move-in agreement: Page 23, Bullet 7: What age group? Be more specific. Page 26, Initial Screening: Will you take county referrals or only Regional Center? Later it says only Regional Centers. Clarifying would provide consistency. Page 28, Line 2: "individuals (who) are..." Under admission meeting documentation: please add Personal Rights will also be reviewed and a copy will be provided (unless I missed where you cover that). Page 29: Will you be taking CSEC clients? Continued... Section 9: Page 32, Bullet 2: remove the period (.) after the word following and perhaps use a colon (:) after "the plan of operation:" since you are listing the following information. Page 36, Line 1: remove the period (.) after "Individual Behavior. Supports..." Page 36: Who is responsible for completing the IBST? Section 10: Provide a detailed policy/procedure for removal of youth. Have a copy of the discharge plan/policy that would be signed by the parent/guardian in the child's record in this section. Section 11: When are visits allowed? Are the designated times/days visits happen or times they do not happen (during groups at the facility, etc.)? Section 12: Please address: Curfews, dress codes, dating policy, completing homework (?). Gambling and betting?? Why is Personal Hygiene addressed here? There is nothing that says anything about rules in the narrative. Maybe Section 9? Section 14: Page 44: Why is that first (very long) sentence in this section? What are you trying to convey? Maybe it should be rewritten and put in Section 3? Page 44, Line 8, last word: Avoid(s), remove (s). Line 14: "When an individual is safely (restrained) no restraint. Line 16: "simultaneously are restraint" should be "are simultaneously restrained." Page 45, paragraph 5, line 3: the last word, advise(d), paragraph 6, 1st sentence does not make sense. Already involved in Criminal Justice or preventing Criminal Justice involvement or additional Criminal Justice involvement? Continued... Section 15: Incident Report Section, Bullet 1: Individua(l)'s Section 16: Do you have a grievance form for the client's to access? Will you document the process if a client initiates a grievance? Where will this be kept? Section 17: Please edit the Policy and Procedures for Handling Children's Funds to reflect a minor. For example, remove the examples that do not apply to children; tax credits, renter credit, gambling winnings, etc. Include parents in this section as it applies. Page 56, Bullet 8: remove cigarettes and perhaps some of the other examples listed on page 56 and 57 as they do not pertain to minors. Please address allowance and how that will be handled. Section 18: Page 61, 2nd paragraph, line 3: sense (of) ownership. Are there paid chores? Section 19: Page 62, 2nd paragraph, line 2: Individuals is (are). Last ling page 63: fitting (fit). Page 64, Bullet 6: similar substance is (will). 2nd Bold/underlined section: "If at any point the dishwashing machines ... staff is (are). Section 20: Bullet 1, line 3: Rapidly change(s). Last bullet, line 1: "to be spend, (spent). Continued... Section 21: What is peer partner position? If you don't have it, do you want to eliminate? Otherwise, elaborate regarding the parameters for this position, including training, background check, etc. Should this be in Section 26? Section 22: QBMP/BCBA: "Several years of writing reports," be more specific; 2-3 years? 3-4 years? Page 72, line after paragraph 3: "The success(ful) candidate must..." Section 22, 23 and LIC 500: Be consistent with job titles: Administrator/Program Administrator, RN/RN Consultant, etc. Section 24: Where will you track and keep documentation for each employee's training. Add this information. Section 25: Don't see Appendix VII, specifically LIC 309. Section 26: Should Peer Partners be included here? Where will you keep track of volunteer training? Section 27: Provide a copy of the lease. Sections 28: Please identify where the Main Shutoff Valve is located. Section 29: Please provide Board of Directors information. Continued... Appendix II: Page 1, under Policy: "Upon admissions..." Page 1, last paragraph, line 4: "and so for(th)." Or so on?? Line 5: "developed by and DDS," Page 2, Line 6: regarding a restraint not lasting longer than 10 minutes: How was that timeframe determined? If the client is still escalated, how will you end the restraint? Page 2, line 8: "child is safely restraint (restrained)." Page 2, Multiple Emergency Interventions: How do you determine adequate number of staff? In the training handbook, is there a minimum number of staff that are required? Do you need to take the size of the client and staff into consideration? Maybe defer to the protocol of the technique you are using and document that here. Page 2, last paragraph, line1: "or a compliant (complaint)." Page 3, Debriefing, Bullet 1: "Child who was restraint (restrained). Bullet 9: "Determining where (if)..." Page 4, paragraph 2, line 1: "CCH will report to the Department..." is the Department DDS, DSS or both? CCL? Appendix III: Financial Policy Page 1, paragraph 4, line 4: individual(')s file Page 2: Where is the bonding documentation kept? *This appears to have been written for an adult client population. Please review and revise for minors and their parents and/or representatives like CPS. There is policy regarding loans, paycheck stubs, etc. Is any amount of $200 going to be returned to the client's parent or representative? Page 9: The list needs to reflect minors. Same with page 11 list of disallowed expenses.

met_with: Cheryl Karran


state: CA

facility_name: YAI DAVIS RD. COMMUNITY CRISIS HOME (CCH)

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPA) Tana Kinder conducted an announced pre licensing inspection with the Licensee, Cheryl Karran on 5/10/2022 at 11:15 am at the facility. LPA conducted the walk through of the facility with the Licensee and observed 4 bedrooms, 1 garage that was converted into an office area , 1 common area, 2 bathrooms a kitchen, laundry room, sensory room and a locked medication room. All spaces were clean, sanitary, free of insects, and had unobstructed pathways. LPA observed 7 days' worth of non-perishable, food for 4 potential clients. The refrigerator was 36 degrees and the freezer was 0 degrees. The hot water from the sink was 106.1 degrees. The facility does not utilized protective separation rooms. All the bedrooms are furnished with a bed, dresser, night stand, desk/chair, closet and is well-lit. The front yard and back yard are fenced in with accessible gates. The grounds have a recreation area with a basketball hoop and plenty of space for activities. No cameras are in use in the facility. The backup generator is secured with fencing. The water well is secured with fencing. The water sprinkler system is enclosed with a lock. There is a locked shed for storage. The backyard is fenced off with extra yard on the other side that is not accessible to the clients at this time. There is an open garage like structure on the other side of the fence that is not accessible without unlocking the gate to the extra backyard. There are 9 staff associated to the facility and 3 in process. The licensee and administrator are associated to the facility. There are currently no clients at the facility. continued... LPA has observed the following that need to be brought into compliance before issuance of the license. 1. The land line (2) phones need to be set-up. 2. Printer/Scanner has been ordered to upload all documentation for client and personnel electronic files. 3. Locked cabinet for any client or staff files that will be stored on site. 4. A posted copy of personal rights and 30 day menu. 5. Well water certificate needs to be kept at the facility and accessible at all times. 6. A facility vehicle will be rented by May 24th, 2022 until the leased vehicle arrives. LPA reviewed the following forms with the facility staff: An exit interview was conducted and copy for the report was provided.

report_type: Facility Evaluation

visit_type: Prelicensing

met_with: Regional Director


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, (LPA) Tana Kinder conducted a case management inspection related to the Incident report dated August 4th, 2022. LPA spoke with the Director of Residential Services to review the incident report, actions taken and to obtain a copy of an email and text messages detailing concerns that generated the incident report. No citations were issued. An exit interview was conducted and a copy of this report was provided.

visit_type: Case Management

met_with: Director of Residential Services


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, (LPA) Tana Kinder conducted an unannounced visit on 8/18/2022 to gather items left during the inspection conducted on 8/16/2022. No citations were issued. An exit interview was conducted and a copy of this report was provided.

met_with: DSP Staff


summary: Facility Evaluation

raw_content:
Narrative:
On October 11/3/2022 at 1215pm Licensing Program Analyst (LPA), Tana Kinder conducted an unannounced case management inspection regarding an incident report received by The Department on 11/25/22 regarding Personal Rights. LPA met with Lead RBT who assisted with the inspection. The facility consists of 4 bedrooms, 2 bathrooms, a sensory room, a kitchen/dining area and a common area for clients to socialize in. There is a locked medication room and the garage has been converted into an office area for staff. LPA conducted interviews with 3 staff and 2 clients and requested documentation from the facility. An exit interview was conducted and a copy of this report provided. This case management inspection needs further investigation.

met_with: Lead RBT


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, (LPA) Tana Kinder conducted a case management meeting on this date at 1pm for the purpose of discussing the internal review conducted by YAI regarding the incident report dated 10/25/22. The meeting took place using Microsoft Teams which was coordinated by YAI. After YAI interviewed staff and clients regarding the incident they determined their findings were inconclusive. Staff training occurred in order to reinforce the policy and expectations of YAI for individually interacting with each client, in a variety of settings. LPA stated their investigation had not concluded as additional interviews and review of documentation needed to occur. No citations were issued, further investigation is required. A copy of this report was provided.

met_with: Anthony Fogalia


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, (LPA) Tana Kinder conducted a case management meeting on 12/12/22 at 130pm for the purpose of following up with the case management inspection regarding the incident report dated 10/25/22. The meeting took place at the facility. LPA conducted interviews with staff and clients, reviewed the incident report and transportation protocol. Based on the interviews and information gathered, no citations were issued. An exit interview was conducted and a copy of this report was provided to the facility.

met_with: Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tana Kinder conducted a case management inspection on 3/6/23 at 10:30am and met with the Program Manager (See confidential names list dated 3/6/2023). LPA made the visit to inspect the facility; buildings and grounds since the evacuation from the facility on 12/31/22 due to significant property damage. LPA inspected the facility inside and outside. Trees that fell and/or had questionable integrity were cut down and removed. The water damage has been addressed, the well water has tested within normal limits and the sceptic system is fully functional based on an inspection that was done by a contractor with Brilliant Corners. Clients will be moving back into the facility today, 3/6/2023 after school. No citations were issued on this date. Exit interview was conducted and a copy of this report was provided to the facility.

met_with: Program Administrator


summary: Facility Evaluation

raw_content:
Narrative:
An annual required inspection was conducted by Licensing Program Analyst (LPA) Tana Kinder on 6/13/2023 with the facility administrator. Criminal record clearances were reviewed, and the facility is in compliance. Community Care Licensing file, incident reports, facility roster, facility profile and complaint history were reviewed prior to visit at the agency. The licensing fees are current. The Community Crisis Home has a capacity of 4 and currently 2 residents. There are 7 staff at the facility on this date. LPA reviewed 4 staff files. The files that were reviewed were complete and up to date. Staff files reviewed have required training hours, education, and fingerprint clearances. 2 child files were reviewed. The child's needs and services plan/Individual Program Plan, and quarterly reviews were complete and up to date. Immunization records were current. Medical consent forms were signed by authorized representative and are current. Additionally, the child's file had a record of personal rights. The menu, license, and emergency exit plan were posted prominently in the facility. The facility will have the personal rights posted. The facility has a copy of the DDS personal rights form posted. The facility was inspected jointly with the program administrator. There are 4 bedrooms and 2 bathrooms. Each client's bedroom has a firm mattress, with a bed cover, sheets, blanket, pillows and personal affects. The common area has couch and chairs to sit in, a TV and games for the clients. The facility is in good repair. Additional linen stored in the laundry room. Client and staff files are in a locked cabinet, in the garage/office area. The old client and staff files are also kept locked in the garage/office area in a locked cabinet. The passageway from the front to the back of the facility is unobstructed. LPA observed 1 locked shed in the backyard with supplies. The backyard has 1 piece of exercise equipment and a BBQ and a basketball hoop out front. LPA observed enough perishable/non-perishable food for 2 clients for 4 days/3 weeks. Smoke detectors and carbon monoxide monitor are in working order. There are 2 fully charged fire extinguishers. Continued... Disinfectants and cleaning solutions were in a locked cabinet in the laundry room and garage/office. Sharps were kept locked in a drawer in the kitchen. The kitchen was stocked with plates, utensils and drinking cups sufficient for 4 clients. The water temperature from the kitchen faucet was 106.2 degrees. Medication disbursement is logged and is cross reconciled with the bubble packs and the bottled medications are stored in a locked cabinet, in a locked room. The client's hygiene kits are stocked and kept in the garage. The first aid kit is kept in the medication cabinet and was missing scissors and tweezers. Exit interview conducted and discussed with the Program Administrator. Citations were discussed and issued, and a copy of the annual inspection report was provided.

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
A post licensing inspection was conducted by Licensing Program Analyst (LPA) Tana Kinder on 6/13/2023 with the facility administrator. Criminal record clearances were reviewed, and the facility is in compliance. Community Care Licensing file, incident reports, facility roster, facility profile and complaint history were reviewed prior to visit at the agency. The licensing fees are current. The Community Crisis Home has a capacity of 4 and currently 2 residents. There are 7 staff at the facility on this date. LPA reviewed 4 staff files. The files that were reviewed were complete and up to date. Staff files reviewed have required training hours, education, and fingerprint clearances. 2 child files were reviewed. The child's needs and services plan/Individual Program Plan, and quarterly reviews were complete and up to date. Immunization records were current. Medical consent forms were signed by authorized representative and are current. Additionally, the child's file had a record of personal rights. The menu, license, and emergency exit plan were posted prominently in the facility. The facility will have the personal rights posted. The facility has a copy of the DDS personal rights form posted. The facility was inspected jointly with the program administrator. There are 4 bedrooms and 2 bathrooms. Each client's bedroom has a firm mattress, with a bed cover, sheets, blanket, pillows and personal affects. The common area has couch and chairs to sit in, a TV and games for the clients. The facility is in good repair. Additional linen stored in the laundry room. Client and staff files are in a locked cabinet, in the garage/office area. The old client and staff files are also kept locked in the garage/office area in a locked cabinet. The passageway from the front to the back of the facility is unobstructed. LPA observed 1 locked shed in the backyard with supplies. The backyard has 1 piece of exercise equipment and a BBQ and a basketball hoop out front. LPA observed enough perishable/non-perishable food for 2 clients for 4 days/3 weeks. Smoke detectors and carbon monoxide monitor are in working order. There are 2 fully charged fire extinguishers. Continued... Disinfectants and cleaning solutions were in a locked cabinet in the laundry room and garage/office. Sharps were kept locked in a drawer in the kitchen. The kitchen was stocked with plates, utensils and drinking cups sufficient for 4 clients. The water temperature from the kitchen faucet was 106.2 degrees. Medication disbursement is logged and is cross reconciled with the bubble packs and the bottled medications are stored in a locked cabinet, in a locked room. The client's hygiene kits are stocked and kept in the garage. The first aid kit is kept in the medication cabinet and was missing scissors and tweezers. Exit interview conducted and discussed with the Program Administrator. A copy of the inspection report was provided.


summary: Facility Evaluation

raw_content:
Narrative:
On 8/17/23 about 12: PM, Licensing Program Analyst, (LPA) Uchenna Ajaero informed the licensee of the Immediate Exclusion of S1 (see LIC 811 - Confidential Names List dated August 16, 2023) issued on this date and confirmed that S1 is no longer employed by the Program Administrator.

met_with: Steven Toal, Program Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 10/4/23, Licensing Program Analyst (LPA) Stephanie Lor conducted an unannounced case management visit regarding an incident report submitted to Community Care Licensing. The incident report was regarding suspected mold in the water well. LPA spoke with the staff who indicated that maintenance was contacted and the water well was cleared during a test. LPA observed the water to be cleared with no particles or mold. The staff explained the plan they have been implementing since the incident. The facility will email LPA a copy of the document once received by the maintenance company. An exit interview was conducted with the Lead RBT and a copy of this report will be emailed to the facility. This case management investigation is closed.

met_with: Christian Thurman, Lead RBT


summary: Facility Evaluation

raw_content:
Narrative:
On January 26, 2024 at 11: AM, The Department met with Licensee for the purpose of an Informal Office Meeting to discuss areas of facility compliance. Attendees were: Licensing Program Analysts (LPAs), Farhaan Sarangi, Jacqueline Carmona, Sara Luman-Gonzalez, Licensing Program Manager (LPM), Rosa Rodriguez, Regional Manager (RM), Margo Castaneda, CDSS Staff Attorney, Erik Brunkal, Licensee, Cheryl Karran, HR Manager, Emily Ramos, Attorney Jake Reinhardt, Department of Developmental Services (DDS), Leah O'Meara, Catherine Knight and Angela Craven, Regional Center of the East Bay, Brooke Guerrero, Regional Manager at Regional Center of the East Bay, Jeff Nagafuji, Resource Developer with Regional Center for the East Bay, Heather Jacobs and DDS Angela Munoz. Areas of Concern: · Increase in number of complaints between both facilities (YAI East Tabor Rd and YAI Davis Rd.) primarily due to lack of staffing. Licensee acknowledges issues with staffing. The population that the facility serves requires a lot of attention. Licensee acknowledges that the clients they serve have a 2 to 1 ratio. HR Manager reports that there are four applicants going through the hiring process. Licensee reports that the house has been challenging regarding the culture in that home and the former facility staff. Licensee terminated previous employees that created a toxic work environment. Licensee has hired Prospective Administrator, Amber Palesi. Licensee reports having staff work double shifts. Licensee reports that the contingency plan put in place is sharing staff from other homes if staffing issues continue. New staff have been very good at picking up extra shifts. HR is adamant about visiting colleges, recruitment fairs and ongoing recruitment efforts. · Department of Developmental Services (DDS), Leah O'Meara advised that 80 hours of training is required for new staff and per diem staff that are new to YAI facilities. (Page 1 of 2) · Licensee was reminded of Reporting Requirements as it relates to submitting incident reports timely. · Required records availability-Licensing needs to have access to records as per Inspection Authority. Protocol for providing documentation to Licensing agency; ensuring records are readily available and easily accessible to CCL during business hours. LPA, Carmona advised that the Internet connectivity issues being a concern. Licensee acknowledges that there have been struggles with the internet connectivity. Licensee uses two different internet providers and is currently exploring other options to remedy this issue. · Staff do not feel that they are properly trained on medication dispensing. Staff issues with dispensing medication and the changes around medication dispensing. Licensee acknowledges their multiple medication errors and has since hired a Registered Nurse to train staff on medication procedures and review the MARS for both facilities. · No authorized staff members delegated at the facility to sign licensing reports. Licensee plan is to ensure an Administrator or lead staff is always in the home should Licensing arrive to the home. · General upkeep of physical plant: General Window discussion on replacing windows in a timely manner Window Screens need to be in place and inspected regularly. Heating and AC in facilities. Licensee reports that there have been multiple windows being broken. Licensee acknowledges the property destruction and physical plant concerns. Licensee reports of putting in a brand new screens. Licensee reports that the heating has been fixed in the facility. Licensee reports that they have hired two maintenance staff for both facilities. Licensee will put in procedure for submitting work orders when maintenance issues arise upon the departments request. · Accessibility to all parts of the facility. Licensee reports that it is a lactation room. Licensee reports that the leads have all the codes. Licensee will submit a new facility sketch to address the lactation room and will ensure that lead staff have access when CCL comes for unannounced inspections. Licensee has requested the Program Director to be contacted if a room is not accessible. Support & Resources: Licensee requested a Technical Support Program Referral (TSP). Referral to CDSS Technical Support Program pending. Exit interview was conducted and a copy of this report was emailed to the Licensee for signature.

met_with: Licensee, Cheryl Karran


summary: Facility Evaluation

raw_content:
Narrative:
On August 12, Licensing Program Analysts (LPAs) Sarina Buchannan and Tatyana Shulz arrive at the YAI Davis, Community Crisis Home. LPAs were greeted by Romer DeLa Cruz who granted LPAs access. LPA's conducted a tour of the inside and outside of the facility where LPA's observed the following deficiencies. Missing Screens in the sensory room, living room, and C2s bedroom. Work orders orders for the living room and sensory room were placed on 8/1/24. The work order for the C2s bedroom was placed on 8/11/24. LPA Buchanan received pictures from the facility on 8/12/24 showing that all windows now have proper screens placed in them. Part of the fence is sticking out exposing nails and creating a gap in the fence line. Work orders were placed on 8/7/24. LPA Buchannan received a picture from the facility on 8/12/24 informing that the nails on the fence were no longer exposed and gap had been closed. LPAs Buchannan and Shulz requested the work orders and dates the damages took place. This case management will remain open, until a follow up inspection is conducted in a week to ensure the facility is in full compliance. Exit interview conducted and a copy of this report was left with Romer DeLa Cruz.

met_with: Romer DeLa Cruz


summary: Facility Evaluation

raw_content:
Narrative:
On August 23, Licensing Program Analyst (LPA) Sarina Buchannan made an unannounced case management inspection at the above facility and met with DeMarcos Ayers, who assisted LPA with the inspection. CCL received an incident report dated August 18, 2024 in which a staff member was heard to be using profanity in front of clients and their parents. The facility itself has begun an internal investigation and also assigned training's regarding professionalism in the workplace. LPA requested the following documentation: client roster, staff roster, staff Professional in the Workplace training's, and staff schedule with contact information. LPA toured the facility and the facility was in full compliance. LPA conducted 3 interviews at the facility. This case management will remain open. Further investigation is need. Exit interview conducted and a copy of this report was provided to the licensee.

met_with: DeMarcos Ayers, Assistant Residential Director


summary: Facility Evaluation

raw_content:
Narrative:
On August 23, Licensing Program Analyst (LPA) Sarina Buchannan arrived at the YAI Davis, Community Crisis Home. LPA was greeted by DeMarcos Ayers, who granted LPA access. LPA conducted a tour of the inside and outside of the facility where LPA observed the following deficiencies. Missing Screens in the sensory room, living room, and C2s bedroom. Work orders orders for the living room and sensory room were placed on 8/1/24. The work order for the C2s bedroom was placed on 8/11/24. LPA Buchannan received pictures from the facility on 8/12/24 showing that all windows now have proper screens placed in them. On August 23, LPA observed screens in both the sensory room and living room had been repaired. LPA was informed that the window in C2's room was broken again following the pictures that were sent on 8/12/24. Part of the fence is sticking out exposing nails and creating a gap in the fence line. Work orders were placed on 8/7/24. LPA Buchannan received a picture from the facility on 8/12/24 informing them that the nails on the fence were no longer exposed and the gap had been closed. On August 23, LPA observed the fence has been repaired and is no longer exposing a gap or nails. LPA Buchannan requested the work orders and dates the damages took place. LPA also requested receipts for the screen that was ordered for C2's bedroom. This case management that was initially open on August 12, 2024 is now closed. The facility is in full compliance. Exit interview conducted and a copy of this report was left with DeMarcos Ayers.


summary: Facility Evaluation

raw_content:
Narrative:
On September 17, 2024 at 1: PM, Regional Manager, Margo Castaneda, Licensing Program Manager, (LPM) Rosa Rodriguez and Licensing Program Analysts, (LPAs) Sarina Buchannan, Tatyana Shulz and Zaria Turner conducted a virtual meeting via teams. Present from YAI Davis Rd. Community Crisis Home is Cheryl Karran, Senior Regional Director/Licensee, Steven Toal, Program Administrator, Erika Barrios Botello, Program Administrator, Melissa Koren, Qualified Behavioral Professional, Terrance Harris, and Romer DeLa Cruz, YAI Staff. Present from Department of Developmental Services is Sunni Polani, Behavior Specialist II and Catherine Knight, Assistant Deputy Director. Present from Valley Mountain Regional Center is Chris Pillsbury, Quality Assurance Liaison. Present from Disability Rights is Colleen Yoder, Clients Rights Advocate. The purpose of the meeting is to discuss CCL's concerns regarding issues related to clients personal rights and to collaborate and problem solve together for the success of the program. The primary areas of concern discussed, and outcomes provided include the following: Clients Personal Rights Staff training on Circles Curriculum Program Statement update o It was discussed that Administrators and facility staff were not properly trained on how to respond the behaviors that were occurring between clients in care. In order to mitigate the risks of violating clients personal rights and behaviors reoccurring; staff will be properly trained on sexuality, personal rights, and how to respond to client behaviors. In addition, administrators will assess prospective clients during intake to ensure the appropriateness of placement. Lastly, staff will be educated on the behaviors of new clients to maintain continuity of care throughout placement. (continued on LIC 809-C) o CCL confirmed that the facility has repurchased the Circles Curriculum on 8/29/2024 and is expected to begin implementation on 10/01/2024. Staff will be trained on the areas of the curriculum relevant to each clients needs. Administrators plan to develop a tool to assess staff competency after implementation. It was also confirmed that they will begin planning for the implementation process on 9/18/2024. o Facility Administration will work closely with CCL to review the program statement and determine if there are any additional updates needed or areas of noncompliance. Meeting was concluded. A copy of this report was emailed for signature to the provider.


summary: Facility Evaluation

raw_content:
Narrative:
On September 20, 2024 at approximately 11: AM Licensing Program Analyst (LPA) Sarina Buchannan made an unannounced case management inspection at the above facility and met with Romer John DeLa Cruz, who assisted LPA with the inspection. CCL received incident reports on August 20, 2024 and September 2, 2024 in which a staff member was heard to be using profanity in front of clients. On August 30, 2024 the facility conducted an internal investigation and also assigned training's regarding professionalism in the workplace. Based on internal interviews conducted by the provider, the staff in question has resigned even though additional training was provided. The staff member's resignation is effective as of September 19, 2024. This case management that was initially opened on August 23, 2024 is now closed. No further investigation is needed. Exit interview conducted and a copy of this report was provided to the licensee.

met_with: Romer John DeLa Cruz, Staff


summary: Facility Evaluation

raw_content:
Narrative:
On January 9, Licensing Program Analyst (LPA) Sarina Buchannan made an unannounced case management inspection at the above facility and met with Romer DeLa Cruz, who assisted LPA Buchannan with the inspection. CCL received an incident report dated December 12, 2024 in which a client had missed their medication during an Urgent Care visit. LPA requested the following documentation: Medication Log for December 11th, 2024, staff medication training's, staff roster with contact information. LPA toured the facility and the facility was in full compliance. LPA conducted 3 staff interviews and attempted 1 client interview. Facility stated that they will conduct training's with staff on medication's and how to ensure clients do not miss them in an emergency. Facility has hired a Nurse and will communicate the procedures with them and the facility will ensure the their Leads are aware of the new procedures. This case management will remain open. Further investigation is need. Exit interview conducted and a copy of this report was provided to the Romer DeLa Cruz, Lead RBT.

met_with: Romer DeLa Cruz, Lead RBT


summary: Facility Evaluation

raw_content:
Narrative:
On January 29, 2025 at 11: AM Licensing Program Analyst (LPA) Sarina Buchannan made an unannounced follow up Case Management inspection at the above facility and met with Romer DeLa Cruz, Facility Administrator, who assisted LPA with the inspection. CCL received an incident report dated December 12, 2024 in which a client had missed their medication during an Urgent Care visit. Based on interviews conducted and documentation obtained LPA confirmed that the client had missed one dose of their prescribed medication during an incident that took place on December 11, 2024. LPA Buchannan was informed that prior to the medication error, the client had been having a series of behaviors which resulted in a head injury. LPA was informed that staff was concerned about following concussion protocol and transported the client to the Urgent Care. This resulted in staff forgetting to check the Medication Administration Record (MAR) to determine if the client had any mid-day medications. Staff stated that the client usually does not take a mid-day medication and therefore they did not check the MAR and/or grab the medication. LPA confirmed through documentation that the client was taking this medication for a 7-day period and the date of the incident was the first day they had started taking it. Additionally, LPA did not observe the client to miss any other doses of prescribed medications for the month of December 2024. LPA confirmed the Lead staff working this shift was aware that it is their duty to check the MAR form but had forgotten during this incident due to concern for the injury. The facility confirmed that that all Lead staff are assigned to check client medication during emergency situations. The facility conducted training's on emergency medication procedures on January 22, 2025. Facility has also hired a Nurse and will ensure the procedures are communicated with them and any newly hired lead staff. (continued on LIC 809C) This case management that was initially open on January 9, 2025, is now closed. The facility is being issued a Technical Violation and not a citation this time due to the emergency incident taking place that day and for being an isolated incident. (See LIC TV) Exit interview conducted and a copy of this report was provided to the Romer DeLa Cruz, Facility Administrator.

met_with: Romer DeLa Cruz, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 1/29/2025 at 11: AM Licensing Program Analyst (LPA) Sarina Buchannan made an unannounced visit with the purpose of conducting an Annual inspection to the above facility using the Compliance and Regulatory Enforcement (CARE) tool. LPA met with Romer DeLa Cruz, Facility Administrator, and a walk through of the interior and exterior was completed. The facility serves up to 4 ambulatory female and male clients between the ages of 12-17 and 18-22 years old with an exception. Physical Plant Room 1 is a medication closet that has medical binders, posters for reporting Serious Incidents, and a locked cabinet with facility keys. Room 2 is a bathroom which has a toilet with a metal toilet tank cover, a working shower, and a trash can with a lid. Room 3 is a client bedroom with a full size mattress, 2 dressers, and a desk. Room 4 is a laundry room with a washer and dryer, and extra linens. Room 5 is a client bedroom with an Xbox, full mattress, and a dresser. Room 6 is the kitchen with a working stove, a food pantry, the facility phone, and chemicals locked under the sink. Room 7 is a living room with two tables, a couch, and a television. Room 8 is a bathroom which has a toilet with a metal toilet tank cover, a working shower, and a trash can with a lid. Room 9 is an activity room with board games, crayons, and 2 exercise balls. Room 10 is a client bedroom with a full size mattress, a play station 5, and a dresser. Room 11 is a staff office with client files, Davis Dollar store, staff refrigerator and freezer, sharps stored in a locked filing cabinet, and cleaning supplies. The 2 client bathrooms are located in the hallways and have water temperatures at 115 degrees Fahrenheit. The backyard is gated, has a shed, and is clear of debris. (continued on LIC 809C)(Page 1) The following required documents were posted, License and Personal Rights. Disinfectants/cleaning solutions inaccessible to children in care. Refrigerator Temperature at or below 45 degrees F. Nonperishable foods one week and fresh perishable foods two days minimum. Menu present and posted in the kitchen area on the fridge. Working telephone are available at the facility. Carbon monoxide and smoke detectors are in working order. First Aid Kit fully stocked. Medication centrally stored, locked/inaccessible to children. Hot Water between 105-120 degrees Fahrenheit. Fire Extinguisher up to date and in working order. Toilets wash basin, bath, and shower fixtures in good repair/no leaks/hot water temperature. Soap and Paper towels are available to clients. Bedrooms required linen and furnishings are fully stocked. Facility free of vermin. The following domains were also reviewed during today's inspection, Operations, Disaster Preparedness, Staffing, Emergency Intervention, and Client Records. A total of 7 staff files and 4 client files were reviewed. LPA also conducted 4 client interviews and 3 staff interviews. A review of the Licensing Information System indicates the facility is not up to date on their facility. The facility fees which are due in the amount of 681.00 were due on 06/17/24. All the staff were fingerprint cleared and associated to the facility. Based on confidential interviews conducted no concerns for follow up were noted. An exit interview was conducted with Romer DeLa Cruz, Facility Administrator, and a copy of this report, and the Appeal Rights were provided to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On April 18, 2025 at 2: PM Licensing Program Analyst (LPA) Sarina Buchannan arrived at the YAI Davis, Community Crisis Home. LPA was greeted by Zach O'Dell, Lead RBT who granted LPA access. LPA conducted a tour of the inside and outside of the facility where LPA observed the following deficiency. Part of the fence in the front yard is falling over falling over creating a gap in the fence line and exposing the neighbors property. Work orders were placed on 4/18/2025. LPA requested and obtained work orders and facility will repair fence by 4/25/2025. If facility is unable to complete repairs by this date, they will request and extension from LPA Buchannan. Exit interview conducted and a copy of this report was left with Zach O'Dell, Lead RBT.

met_with: Zach O'Dell, Lead RBT


summary: Facility Evaluation

raw_content:
Narrative:
On May 8, 2025 at 12: PM Licensing Program Analyst (LPA) Sarina Buchannan arrived at the YAI Davis, Community Crisis Home. LPA was greeted by Christian Thurman, Assistant Administrator, who granted LPA access. LPA conducted a tour of the inside and outside of the facility where LPA observed the following deficiency. Part of the fence in the front yard is falling over falling over creating a gap in the fence line and exposing the neighbors property. Work orders were placed on 4/18/2025. On May 8, LPA observed the fencing to be repaired and no longer exposing the neighbor property. This case management that was initially open on April 18, 2025 is now closed. The facility is in full compliance. Exit interview conducted and a copy of this report was left with Christian Thurman, Assistant Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On August 20, 2025 at approximately 2:41pm Licensing Program Analyst (LPA) Tatyana Shulz made an unannounced inspection to close a case management at the above facility. LPA was greeted by Yasmeen Sanghera, Lead Staff who granted LPA access. Prior to the meeting LPA Shulz conducted a tour of the inside and outside of the facility where LPA observed the following deficiency. The lower kitchen cabinet door would not remain closed staying open approximately one inch. LPA conducted a walk through of the facility and observed that the deficiency noted on the August 06, 2025 inspection has been fixed. The facility is in full compliance. An exit interview was conducted, and a copy of this report was left at the facility with Yasmeen Sanghera, Lead Staff.

met_with: Yasmeen Sanghera, Lead Staff


summary: Facility Evaluation

raw_content:
Narrative:
On September 18, 2025 at approximately 3:29pm Licensing Program Analyst (LPA) Tatyana Shulz made an unannounced case management inspection at the above facility and met with Emily Coley, Lead RBT who assisted LPA Shulz with the inspection. The purpose of the inspection is to follow up on Incident Reports that were received on 7/14/2025, 8/7/2025, 9/3/2025 and 9/12/2025 involving, sleeping staff, improper use of restraint, inappropriate communication with clients and inappropriate use of Ukeru pads. LPA conducted a tour of the inside and outside of the facility and no deficiencies were noted. LPA conducted 3 staff interviews during this inspection. This case management will remain open. Further investigation is need. Exit interview conducted and a copy of this report was left at the facility with Emily Coley, Lead RBT.

met_with: Emily Coley-Lead RBT


summary: Facility Evaluation

raw_content:
Narrative:
On November 25, 2025 at approximately 1:00pm Licensing Program Analyst (LPA) Tatyana Shulz made an unannounced case management inspection at the above facility and met with Romer John Dela Cruz, Administrator who assisted LPA Shulz with the inspection. The purpose of the inspection is to follow up on Incident Reports that were received by the Department on 10/8/2025, 10/9/2025 and 10/21/2025 involving lack of supervision and inappropriate staff conduct. LPA conducted a tour of the inside and outside of the facility and no deficiencies were noted. LPA conducted 1 staff interview during this inspection and obtained the following documents: Staff schedule for October 2025 and the most up to date staff contact list. This case management will remain open. Further investigation is need. Exit interview conducted and a copy of this report was sent to Romer John Dela Cruz, Administrator.

met_with: Romer John Dela Cruz- Administrator


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On August 6, 2025 at 1:54pm Licensing Program Analyst (LPA), Tatyana Shulz made an unannounced visit to conduct a case management regarding DDS Semi-Annual Review that took place at the facility on July 29, 2025. LPA met with Christian Thurman, Assistant Administrator who granted LPA access to the facility. Prior to the meeting DDS Behavior Specialist II, Sunni Polani conducted a tour of the inside and outside of the facility where the Specialist observed the following deficiencies: · The cabinet door under the kitchen sink and the box containing cleaning agents was observed to be unlocked and their contents readily accessible. · One lower kitchen cabinet door would not remain closed. After closing the cabinet door, the cabinet door would open approximately one inch. LPA Shulz conducted a walk through of the facility and observed that the accessible cleaning solutions noted on the July 29, 2025, inspection has been corrected. The facility placed a work order for the cabinet deficiency on August 6, 2025. An exit interview was conducted, and a copy of this report and the Appeal Rights were provided to Christian Thurman, Assistant Administrator. The facility has been cited for Buildings and Grounds on LIC809D. This case management will remain open until a follow up inspection has been conducted.

Deficiencies:
80087(g): 1
2
3
4
5
6
7

title:
1
2
3
4
5
6
780087 (g) Buildings and Grounds
Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.
This requirement is not met as evidenced by

description:
1
2
3
4
5
6
7


summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
On October 23, 2025 at 3:30pm Licensing Program Analyst (LPA), Tatyana Shulz made an unannounced inspection to conduct a case management regarding three incident reports received by the Department on 7/15/2025, 8/09/2025 and 9/04/2025 regarding lack of supervision and improper use of restraint. Client 1 and Client 2 assigned staff were witnessed to have fallen asleep during their shift on multiple occasions during the months of July and August. As well as improper use of restraint being conducted on C1 by staff when they grabbed the clients wrist during a behavior. LPA met with Romer John Dela Cruz, Administrator who granted LPA access to the facility. Based on interviews conducted with parties involved including facility staff, clients, administration and internal investigation documents, it was confirmed that these incidents did take place. The facility has been cited for Personnel Duties and Emergency Intervention Prohibition on LIC809D. The facility has since terminated several staff members and conducted additional training on the expectations of staff remaining awake while on shift as well as proper restraint techniques. The plan of correction has been cleared during today's inspection. LPA Shulz obtained the signed training material given to the staff and separation paperwork. An exit interview was conducted with and a copy of this report and the appeal rights were given to Romer John Dela Cruz, Administrator. This case management inspection is closed.

Deficiencies:
84065.2: Supervision, protection and care of children individually and in groups at all times.
84300.1(b): In addition to techniques specified in Section 84300.1(a), any emergency intervention technique not approved for use as part of the licensee's emergency intervention plan must not be used at any time.

1
2
3
4
5
6
7Licensee has provided training documents that were conducted on 9/15-9/16 and 10/6-10/7  highlighting proper restraint techniques.
8
9
10
11
12
13
14

title:
(b) (1) Personnel Duties
Child care staff shall perform the following duties

title:
1
2
3
4
5
6
784300.1 (b) Emergency Intervention Prohibition


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, (LPA) Tana Kinder conducted an unannounced inspection to conduct a case management related to the incident that occurred on 8/9/22. LPA reviewed the incident report, inspected the facility and conducted interviews with the staff. Based on the incident report and interviews, the facility was cited. An exit interview was conducted and a copy of the report and appeal process was provided.


summary: Facility Evaluation

raw_content:
Narrative:
On August 30, 2022 at 3pm, Licensing Program Analyst (LPA), Tana Kinder made an unannounced inspection to conduct a case management regarding an incident report received by The Department on 8/26/2022 regarding Medication Error. LPA met with Lead RBT. The community crisis home consists of 4 bedrooms, 2 bathrooms, a common area, kitchen, dining area, locked medication room, laundry room, garage converted into office space for staff and a sensory room. The incident which occurred on 8/24/2022 involving a staff not providing a client with their medication due to not having it available while taking the client to an appointment; resulting in a medication error. An exit interview was conducted at the facility with the Lead RBT and a copy of this report was provided.


summary: Facility Evaluation

raw_content:
Narrative:
On 3/6/ Licensing Program Analyst (LPA) Tana Kinder arrived at the above facility for the purpose of conducting a case management visit related to an incident report dated 3/5/2023 related to a medication issue. LPA met with the Program Administrator, reviewed the incident report and conducted interviews. LPA discussed a violation that was identified during the course investigation dated on 3/5/2023. The allegation is that a foster youth missed a medication due to facility not having the prescription filled. The incident report and staff confirm the youth missed one medication due to staff not having the prescription refilled. Due to the above, the allegation is SUBSTANTIATED, meaning that the allegation is valid because a preponderance of the evidence standard has been met. Facility will be cited for violations of the California Code of Regulations, Title Division 6, regulation 80075 (a) Health Related Services (a) The licensee shall ensure that each client receives necessary first aid and other needed medical or dental services, including arrangement for and/or provision of transportation to the nearest available services. A copy of this report was provided at the exit interview. Refer to 9099D for Title 22 deficiencies cited.


summary: Facility Evaluation

raw_content:
Narrative:
On 3/16/ Licensing Program Analyst (LPA) Stephanie Lor arrived at the above facility for the purpose of conducting a case management visit related to an incident report dated 3/7/23 regarding medication issue. LPA met with the Lead RBT. LPA discussed the incident report and gathered further information. LPA interviewed 2 staff during this case management. The incident report and staff confirm the youth missed one medication due to being on a family visit. Due to the above, the allegation is SUBSTANTIATED, meaning that the allegation is valid because a preponderance of the evidence standard has been met. Facility will be cited for violations of the California Code of Regulations, Title Division 6, regulation A copy of this report was provided at the exit interview. Refer to 9099D for Title 22 deficiencies cited.

met_with: Alexandria Tupas, Lead RBT


summary: Facility Evaluation

raw_content:
Narrative:
On 8/10/23, Licensing Program Analyst (LPA), Stephanie Lor made an unannounced visit to conduct a case management regarding an incident report received by Community Care Licensing for incidents that occurred on 8/2/23 and 8/3/23 regarding personal rights violation. LPA met with the Administrator. LPA conducted interviews with the Administrator and Quality Insurance Investigator. Based on interviews conducted and record reviews, the facility will be cited for personal rights violation. An exit interview was conducted with the Administrator and a copy of this report will be emailed to the facility. This case management is closed, and the facility has been cited under Welfare and Institutions Code section 16001.9. (see LIC 809D).

met_with: Steven Toal, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On December 11, 2023 at approximately 09: AM, Licensing Program Analyst (LPA), Farhaan Sarangi arrived unannounced at YAI Davis Rd. Community Crisis Home (CCH) for the purpose of conducting a Case Management-Deficiencies inspection. LPA was greeted at the door by RBT Lead, Christian Thurman, and was granted access into the facility. During a tour of the facility at approximately 09: AM, LPA observed a door that staff did not have access or the key. Facility Staff made multiple attempts to contact the Administrator, but was unsuccessful. LPA did not have access to the room during the Case Management-Deficiencies inspection. Deficiencies cited from the California Health and Safety Code. Appeal rights were given. Failure to correct the deficiency and/or repeat deficiencies within a 12-month period may result in civil penalties. Exit interview was conducted, and a copy of this report was signed and given to the RBT Lead.

met_with: RBT Lead, Christian Thurman


summary: Facility Evaluation

raw_content:
Narrative:
On May 7, 2024 at approximately 2: PM Licensing Program Analysts (LPAs), Farhaan Sarangi and Tatyana Shultz made an unannounced visit to conduct a Case Management-Incident Inspection regarding an incident report received by the Department on 3/20/24 regarding inappropriate staff language directed at a client and inappropriate conduct of vaping and drinking around a client. LPAs met with Administrator, Steven Toal who assisted with the inspection. Based on interviews conducted with all parties involved including, facility staff, client, Administrator, Regional Director, and internal investigation documents received, it was confirmed that the inappropriate language incident took place. As far as inappropriate conduct of vaping and drinking around a client, an internal investigation documents received could not be confirmed that the inappropriate conduct of vaping and drinking around a client took place. An exit interview was conducted with Administrator, Steven Toal, a copy of this report and the Appeal Rights were provided to Administrator, Steven Toal. The facility has been cited for Personal Rights on LIC809D. This case management inspection is closed.

met_with: Administrator, Steven Toal


summary: Facility Evaluation

raw_content:
Narrative:
On July 31, 2024 at 2:15pm Licensing Program Analysts (LPAs), Tatyana Shulz and Sarina Buchannan made an unannounced visit to conduct a case management regarding an incident report received by the Department on 7/02/24 regarding a HIPPA violation when staff misplaced a client's medical binder. LPAs met with Administrator, Steven Toal who assisted with the inspection. Based on interviews conducted with parties involved including, facility staff, Director of Quality, Compliance and Ethics, Regional Director, and internal investigation documents received, it was confirmed that the client's medical binder has been misplaced and is still missing. According to interviews conducted the medical grab and go binder was misplaced sometime during the night (NOC) shift and the AM shift on 5/17/2024 while accompanying the client during their stay in the hospital. The binder wasn't noticed to be missing until 6/18/2024 when the client had another upcoming medical appointment. The facility has since transitioned over to using tablets to store medical documents that are password protected and if misplaced can be cleared of all sensitive documents by the IT department. Plan of correction has been cleared during today's inspection. LPA Shulz obtained training logs of the new medical grab and go procedures. An exit interview was conducted, and a copy of this report and appeal rights were discussed and provided to the Administrator. This case management investigation is closed, and the facility has been cited for Personal Rights 84072 (d)(38) (See LIC 809D).

met_with: Steven Toal- Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On September 20, 2024 at approximately 11: AM, Licensing Program Analyst (LPA) Sarina Buchannan conducted an unannounced case management inspection to address the Circles Curriculum training at the above Community Crisis home and met with Romer John DeLa Cruz, who assisted LPA with the inspection. During the inspection at the facility on August 12, 2024 it was confirmed that the staff had no knowledge of the Circles Curriculum that was approved by CCL on the Program Statement. The department conducted a virtual meeting with the provider and it was confirmed by Cheryl Karran, Senior Regional Director that they have not been utilizing the circles curriculum due to it being misplaced. Community Care Licensing (CCL) confirmed that the facility has repurchased the Circles Curriculum on 8/29/2024 and is expected to begin implementation on 10/01/2024. Staff will be trained on the areas of the curriculum relevant to each clients needs. Administrators plan to develop a tool to assess staff competency after implementation. It was also confirmed that they will begin planning for the implementation process on 9/18/2024. Due to staff not being trained for a long period of time on Circles Curriculum, the facility is being cited for not following the Plan of Operation. (See LIC 809-D) Exit interview conducted. A copy of this report and the Appeal Rights were provided to the licensee.


facility_name: YAI ELECTRIC ST - CCH

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegations. LPA interviewed the administrator, staff persons who were involved, the regional director and C1. LPA also reviewed the incident report generated by the allegations and the Needs & Services Plan most recent to the allegations. LPA was unable to obtain a written police report. The two staff who were present during the incident denied that either of them hit the client, spoke to her harshly or injured her in anyway, The client herself declined to be interviewed, The incident report did not describe any injuries to C1. The administrato at the timer was not present during the incident and could only report what he had been told. Based on the available information and evidence, the above allegations are resolved as unsubstantiated. Unsubstantiated means that though an allegation may be true, there is not a preponderance of evidence to prove that it did or did not happen. 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

report_type: Complaint Investigation

met_with: Jennifer Prodiggalidad, Lead RBT on duty

complaint_status: unsubstantiated


raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward met with the administrator, Staff #1 and Staff #2 to discuss the allegations. LPA attempted to interview C1. However he was non-responsive. LPA was unable to interview the complainant due to anonymity. LPA also reviewed the two most recent weekly Individual Behavioral Support Plans for C1. Based on the obtainable information, it was not proven conclusively that staff #1 forced the client out of bed or forced him to shower against his will. All staff denied the allegations, but the client was not able to speak on them. Therefore the allegations were resolved as unsubstantiated. An unsubstantiated finding means that although an allegation may have occurred, there is not a preponderence of evidence that it did occur. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Adedapo Ajibade, Administrator


raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegations. LPA spoke to Staff #1, Staff #2 and Client #2. Client #1 was not available due to being detained by the Gardena Police Department and returned to his home county. LPA also reviewed Client #1's Individualized Behavioral Support Plan (IBSP) and a related incident report made to Client #1's Regional Center. There were no related reports found in the Department's data base related to this incident. Both staff members denied that staff speaks inappropriately to Client #1. They also deny that staff spreads false information about Client #1 to outside agencies. Client #2 did not remember anything about Client #1 other than his name. As stated previously, Client #1 could not be reached. LPA found no inappropriate information in the ISBP or the Special Incident Report that was submitted to the Regional Center. Based on the available information, the above findings are both resolved as unsubstantiated. Unsubstantiated means that although an allegation may have happened or is valid, there is not a preponderance of evidence that it did occur. 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


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegations by speaking to staff who were in witness to the incidents and reviewing relevant documentation such as C1's Individualized Behavior Support Plan (IBSP), the internal investigation report conducted by the licensee. LPA Jones-Steward also reviewed the Special Incident Report submitted to the Department on April 30, 2024. C1 is non-verbal and cannot be interviewed. During the internal investigation, the management of Young Adult Institute found that the allegations of personal rights violations were substantiated and Staff #1 was terminated. Witnesses confirmed that there was only one staff person assigned to supervise C1 during the time of the incident. Based on the information that this LPA was able to gather the allegations that client was confined to his room, that staff handled client in a rough manner and that C1 was inappropriately supervised are substantated. A substantiated finding means that there is a preponderance of evidence that an allegation did occur. The licensee was cited under Title Sections 84078(b) & 84072(d)(23) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 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: YAI ELECTRIC ST - CCHFACILITY NUMBER: 198209741

met_with: Jimmie Silvestri, QMBPS

complaint_status: SUBSTANTIATED


raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegation. LPA interviewed management staff, reviewed photographic evidence and reviewed the facility's HIPPA policies and the facilitiy's HIPPA training. The complainant stated that there was no other evidence to support her allegations. Staff #1 could be reached for comment. C1 declined to be interviewed. Based on a review of photographic evidence, staff interviews and facility policies, it was determined that staff did take photos of client which violated his HIPPA rights and the allegation was substantiated. The facility was cited under Title 22 84072(d)(1) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B This is an official report of an unannounced visit/investigation of a complaint received in our office on 02/22/2023 and conducted by Evaluator Connie Jones-Steward COMPLAINT CONTROL NUMBER: 34-CR- FACILITY NAME:YAI ELECTRIC ST - CCHFACILITY NUMBER: ADMINISTRATOR:MEAGAN CAMPANAFACILITY TYPE: ADDRESS: ELECTRIC STREETTELEPHONE: (510) 304- CITY:GARDENASTATE: CAZIP CODE: CAPACITY:4CENSUS: 3DATE: 09/13/ UNANNOUNCEDTIME BEGAN: 11: AM MET WITH:JImmy Sivestri, BCBATIME COMPLETED:12: PM Medications are being improperly handled The facility is chronically short staffed INVESTIGATION FINDINGS: 13Licensing Program Analyst Connie Jones-Steward investigated the above allegations. LPA interviewed management and Staff #2. LPA reviewed photographic evidence and medication records for C1, and employee schedules. Staff #2 denies that the allegations occured. Photographic evidence does not support the allegation that medication was handled or disposed of inappropriately. The medical Medical Authorization Records does not show that C1 missed his medication on the dates of the alleged mishandeling. Review of schedules show that the facility was properly staffed for the months in question. Based on lack of supporting evidence, the above allegations are resolved as unsubstantiated. Unsubstantiated means that even though an allegation may have happened, there is not a preponderance of evidence that it did happen. 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: 2 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: YAI ELECTRIC ST - CCHFACILITY NUMBER: 198209741

met_with: Jimmy Silvestrie, BCBA


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with John Smith and staff of YAI Electric to conduct the pre-licensing evaluation. The following was observed. This is a 4 bedroom, 2 bathroom home located in a residential area of the City of Gardena, CA. One of the bathrooms is ADA compliant. There are no bodies of water, no fireplaces and no firearms on the premises. There are no security bars on windows. There is a fire extinguisher near the front door. Smoke detectors and carbon monoxide detectors are working as required. There is a backup generator There is secure, locked space for medications, knives and household chemicals. There are complete first kits in the home and in the facility van. The facility van passed a visual check of headlights, brake lights, signal lights, windshield wipers, horn, seat belts and tires. The yard space is free of hazards There is space available for private visitations and client interviews. There is a back house that provides secured space for client and staff records,. Kitchen and bathroom fixtures are working as required. The stove and refrigerator are in good condition. The hot water temperature is within a safe range. The home is at a comfortable temperature. There are four bedrooms. Each bedroom has a twin bed with complete set of required linens and pillows. There is adequate closet space in each bedroom. All bedroom and household furniture is weighted for client safety. The following items are needed prior to license approval: Permanent or portable chests of drawers for each bedroom and window coverings for the bedroom windows.

met_with: John Smith, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with Behavioral Specialist Jimmy Silvestre to conduct the post-licensing evaluation. The following was observed. This is a four bedroom, two bathroom home located in the City of Gardena, CA. There is currently one client in placement. Client and employee files were locked by the administrator and there was no key available. In the kitchen, there is an electric range and refrigerator in good working condition. All knives, medications and household cleaners are securely stored. There is a complete first aid kit. There are no firearms in the home. There are no fireplaces or bodies of water. There are no security bars on windows. Smoke and carbon monoxide detectors are working, The floor plan is posted as required. Other current postings included the menu, employee schedule, activity schedule and notice of personal rights. The yard area was free of visible hazards. All bedrooms have one bed, along with the required linens and drawer space. Food supply was adequate except for lack of milk or non-dairy substitute. Bedrooms number one and three did not have window coverings however curtains were placed during the inspection. Bathroom equipment was in working order with covered waste cans. All waste and trash cans were covered. Staff was advised that client and employee records are to be available upon request. However due to lack of access to records by on-site staff, a follow-up visit will be made to review records. Citations were issued for Buildings and Grounds and Food Service. See case management visit dated 10/13/22

met_with: Jimmie Silvestre, BCBA


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with Administrator Adedapo Ajibade to conduct the Annual Required Inspection. The following was observed. This is a four bedroom, two bathroom home located in the City of Gardena, CA. There is currently one client in placement. In the kitchen, there is an electric range and refrigerator in good working condition. All knives, medications and household cleaners are securely stored. There are no fireplaces or bodies of water. There is a complete first aid kit on the premises Smoke and carbon monoxide detectors are working, The floor plan and Emergency Disaster Plan are posted as required. Other current postings included the menu, activity schedule and notice of personal rights. The employee work schedule was last updated 02/03/2023. The yard area was free of visible hazards. Bathroom equipment was in good working order with covered waste cans. All waste and trash cans were covered. All bedrooms have single beds and appropriate linens in good condition. All windows are operable with good screens and no security bars. All staff and client records were currently being reviewed by Regional Center personnel. LPA will return at a later date to review these items. There were no deficiencies cited as a result of this inspection.


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst Connie Jones-Steward met with the administrator to follow up on the report that the delayed egress system was not properly working when tested on 02/15/24 (SIR 0000236-FN). . Per the administrator, the system was never malfunctioning. The staff that tested it had entered the code incorrectly. LPA Jones-Steward observed as Mr. Ajibade entered the code on both the back and front delayed egress gates and the gates did indeed open. Mr. Ajibade reported that the regional center has already been out to verify operations. LPA requested that an addendum report be submitted to the Department.

met_with: Adedapo Ajibadie, administrator


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst Connie Jones-Steward met with Lead Registered Behavioral Therapist Jennifer Prodigalidad concerning a report that Staff #2 witnessed Staff #1 conducting an inappropriate restraint of Client #1. Per the RBT, Staff #1 is currently on leave pending the investigation and Staff #2 and the administrator are currently not on duty. Client #1 is non-verbal, thus cannot be interviewed. Ms. Prodigalidad stated that she is unaware of the status of the internal investigation. LPA Jones-Steward will contact the administrator regarding the incident. LPA is also requesting a status update on the internal investigation.

met_with: Jennifer Prodigalidad, Lead RBT


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with Administrator Adedapo Ajibade to conduct the Annual Required Inspection. The following was observed. This is a four bedroom, two bathroom home located in the City of Gardena, CA. There is currently one client in placement. In the kitchen, there is an electric range and refrigerator in good working condition. All knives, medications and household cleaners are securely stored. There are no fireplaces or bodies of water. There is a complete first aid kit on the premises Smoke and carbon monoxide detectors are working, The floor plan and Emergency Disaster Plan are posted as required. Other current postings include activity schedule and notice of personal rights. Disaster drills are conducted monthly. The yard area was free of visible hazards. Bathroom equipment was in good working order with covered waste cans. All waste and trash cans were covered. All bedrooms have single beds and appropriate linens in good condition. All windows are operable with good screens and no security bars. LPA reviewed client and staff records. The facility was cited under Title 22

met_with: Adedapo Ajibade, administrator


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst Connie Jones-Steward met with the assistant administrator Dana Boulden on this date to follow-up on a Special Incident Report 0001191-FN that alleges that Staff #1 hit Client #1 in retaliation. LPA went over the incident report with Ms. Boulden and interviewed three staff members. Administrator Ajibade stated via telephone that staff #1 is currently suspended pending an investigation that began Nov. 1, 2024. Westside Regional Center will be at the facility to interview the client on Nov. 11, 2024. LPA requested a copy of the final investigative report. LPA Jones-Steward will interview other staff members at a future date

met_with: Dana Boulden, Asst. Administrator


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst Connie Jones-Steward met with the administrator to discuss an incident (0001586-FN, involving hospitalization of a client and the use of an unauthorized hold. Per the administrator, the facility classifies any use of hands to restrain a client as unauthorized, LPA also discussed with the administrator the Department has no record that the incident was reported to our office as required. b The administrator stated that staff Dana Bolden is in charge of submitting SIRs. LPA will speak with the involved staff at a future date


summary: Facility Evaluation

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Narrative:
On September 5, 2025, at 8: AM, Licensing Program Analysts (LPA) Aimee Moratalla and Licensing Program Manager (LPM), Enrique Hernandez conducted an unannounced inspection, at the above-said facility for the purpose of conducting an Annual/Random. LPA met with Babatunde Deckon, Lead Staff (LS), who granted access into the facility and a tour was conducted together with the Lead Staff. LPA and LPM also met with Facility Administrator (FA), Dana Boulden. This is a single-story family home in a residential area with four bedrooms, two bathrooms, a sensory/activity room, living/kitchen room, an Administrator's office, garage/staff room, and a backyard. There is no pool or bodies of water. The home is license to care for four (4) children ages 12 to 17 years. The current census is three (3). LPA observed the following: Bedroom #1: Is unoccupied. There is a full-size bed, closet, dresser, and lighting. Bedroom is clean and in good repair. Bedroom #2: Is occupied by Client #1. There is one full-size bed, table, dresser, closet and lighting. The bedroom is clean and in good repair. Bedroom #3: Is occupied by Client #2. There is one full-size bed, table, dresser, closet and lighting. The bedroom is clean and in good repair. Page 1 of Bedroom #4: Is occupied by Client #3. There is one full-size bed, table, dresser, closet and lighting. The bedroom is clean and in good repair. Bathrooms (2): One is located inside the sensory room and the other one is located next to the laundry area. Laundry Area: Is in the living/kitchen room, secured with a lock door. It is equipped with a washer and dryer. Living/Kitchen room: Is equipped with chairs, a round table with four chairs, refrigerator, stove with four burners, oven, microwave, and a sink. Sensory room: Is equipped with a table, two chairs, a shelf and cabinets that contain art supplies. The medicine room is also located inside the sensory room. Garage/Staff room: is equipped with a desktop, chairs, refrigerator, cabinet with cleaning supplies, and pot. Administrative Office: Is equipped with copy machine, desktop, chairs, tables, and cabinets. Backyard: is equipped with a basketball stand, gazebo, and a grill. The home is clean, safe, sanitary, and in good repair. Medicines, disinfectants, and cleaning solutions are inaccessible to children stored locked in the laundry room. Facility has a smoke alarm/carbon monoxide detector that meets the statutory requirements. Smoke detectors were tested and operable at the time of inspection. LPAs observed fire extinguishers in the facility (living and staff room) that were operable at the time of inspection. There are no firearms or dangerous weapons in the home. Facility maintains age appropriate first aid supplies in the home. The facility operates within capacity and limitations of license. There are no more than two children sharing a bedroom. Adequate supervision is provided for clients in care; all clients currently have 2 to 1 staff per needs and services plan. Facility ensures three nutritious meals/day, snacks, and special diets. Children in care are accorded personal rights. The facility submits special incident reports as required. LPA reviewed the following sections with FA: Physical plant and interviewed three (3) staff. Page 2 of Due to time constraints, LPA shall return to complete the Annual/Required Inspection and review personnel and client's files to ensure they meet regulatory requirements. Also, clients and staff interviews will need to be conducted. An exit interview was conducted with the facility Administrator. A copy of this report will be emailed to FA.

met_with: Licensee, Dana Boulden


summary: Facility Evaluation

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Narrative:
On September 17, 2025, at 10: AM Licensing Program Analyst (LPA) Aimee Moratalla made an unannounced visit to the above facility for the purpose of conducting a Case Management - Annual Continuation inspection from the initial visit conducted on 9/5/2025. LPA was met by Stacy Rodriguez, Lead RBT (LRBT). LPA met with LRBT and informed her the purpose of the visit was to conduct and complete the Annual inspection. LPA inquired about the current census, requested the staff roster. LPA requested staff files and was informed that the Program Administrator (PA) has the key and will arrive in twenty minutes. LPA requested clients' files and was provided by LRBT. At the time of the visit the census is one (1). File reviews: LPA conducted 3 staff files and 2 client files. During the time of inspection, LPA completed the related Care Tools and addressed the following sections: Disaster Preparedness, Client records, and operations. The requested documents will be provided to the LPA no later than September 22, 2025. An exit interview was conducted, and the Program Administrator was informed that the Annual Inspection was completed. A copy of this report will be sent to the administrator via email.

met_with: Program Administrator, Dana Boulden


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with Behavioral Specialist Jimmy Silvestre to conduct the post-licensing evaluation. The following was observed. This is a four bedroom, two bathroom home located in the City of Gardena, CA. There is currently one client in placement. Client and employee files were locked by the administrator and there was no key available. In the kitchen, there is an electric range and refrigerator in good working condition. All knives, medications and household cleaners are securely stored. There is a complete first aid kit. There are no firearms in the home. There are no fireplaces or bodies of water. There are no security bars on windows. Smoke and carbon monoxide detectors are working, The floor plan is posted as required. Other current postings included the menu, employee schedule, activity schedule and notice of personal rights. The yard area was free of visible hazards. All bedrooms have one bed, along with the required linens and drawer space. Food supply was adequate except for lack of milk or non-dairy substitute. Bedrooms number one and three did not have window coverings however curtains were placed during the inspection. Bathroom equipment was in working order with covered waste cans. All waste and trash cans were covered. Staff was advised that client and employee records are to be available upon request. However due to lack of access to records by on-site staff, a follow-up visit will be made to review records. Citations were issued for Buildings and Grounds and Food Service.

met_with: Jimmy Silvestre, Behavioral Specialist


summary: Facility Evaluation

raw_content:
Narrative:
During a walk through of the home on 06/22/ LPA Connie Jones-Steward noticed that there was a missing sliding window in bedroom #3. Per Ms Simon and Mr. Silvestre, the missing window was used to replace the window in bedroom #2 after Client #1 broke the window during a behavioral incident over 06/20/23. LPA Jones-Steward explained to Mr. Silvestre that the missing window presents a health and safety hazard. Mr. Silvestre did provide a temporary fix to the window. The facility was advised to have the window permanently repaired within 30 days The facility was cited under Section 80087(a) Buildings and Grounds.

met_with: Dana Simon, Assistant Director of Residential Servic


summary: Facility Evaluation

raw_content:
Narrative:
During the course of investigating complaint # 34-CR-20230616113533, Licensing Program Analyst Connie Jones-Steward became aware of a series reportable incidents involving C1 that were not reported to Community Care Licensing. The first incident occurred on 05/13/2023 at a city park when C1 impersonated a police officer and tried to handcuff a child in the park. This happened due to lack of supervision by the two staff that were supposed to be supervising him. One staff was reportedly on his phone and the other was playing basketball. The second incident occurred on 05/15/2023 when the Gardena Police Department arrested C1 and charged him with assault, false imprisonment and impersonating an officer. After he was charged he was released to the facility. The third incident occurred on 06/15/2023 when C1 became violent, destroyed property and was placed on a psychiatric hold after being informed that he was being terminated from Young Adult Institute. The final incident occurred when C1 was picked up from the hospital by the Gardena Police Department and arrested for the incidents of 05/13/2023. C1 never returned to the facility. The judge ordered him returned home to Sacramento County. The facility was cited under 80061(b)(1)(E), 84061(i) and 84065.2(b)(1). The administrator was informed of the licensee's appeal rights. Administrator Adedapo Ajibade provided copies of the letters of disciplinary action that were issued to Staff #1 and Staff #2 for failure to properly supervise Client #1


summary: Facility Evaluation

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Narrative:
On January 28, 2026, Licensing Program Analyst (LPA), Aimee Moratalla made an unannounced visit to YAI Electric for the purpose of conducting a Follow up Case Management visit regarding a medication error. LPA met with Facility Administrator Dana Boulden to discuss the incident which was reported to the Department on 01/12/2026. The incident occurred on 01/07/2026. The incident stated a client was given a third dosage of Psychotropic medication when the prescription only stated to take one (1) tablet twice a day. Based on the information provided, and interviews conducted, it was confirmed that a medication error occurred on 01/07/2026. The Department has concluded, based on the preponderance of the evidence obtained, that staff administered a third dosage to the client contrary to the prescribed dosage. LPA informed Facility Administrator, Dana Boulden that the facility would be cited and the POC documents will submitted on 02/06/026. The following deficiency is being cited for violating California Code of Regulations Title 22, Division Regulation 80075(b)(5)(B) Health Related Services.

met_with: Facility Administrator, Dana Boulden


summary: Facility Evaluation

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Narrative:
On March 11, 2026, at 2: PM Licensing Program Analyst (LPA) Aimee Moratalla made an unannounced visit to YAI Electric, for the purpose of conducting a Case Management for Special Incident Report the department received on 03/09/2026. The incident occurred on 03/08/2026. The incident stated that the client left the facility unnoticed by the staff. LPA met with Program Administrator (PA), Dana Boulden and discussed the incident. LPA requested a copy of the LIC500 and LIC9020. Based on the information provided, and interview conducted, it was confirmed that a lack of supervision occurred on 03/08/2026 due to the facility being understaff. There should have been six (6) staff to effectively care for clients in care and there were only five (5) staff present during the incident and shift change. The Department has concluded, based on the preponderance of the evidence obtained, the facility did not provide adequate supervision for client/s in care. LPA informed Program Administrator, Dana Boulden, that the facility would be cited. The following deficiency is being cited for violating California Code of Regulations Title 22, Division Regulation 80075(a). An exit interview was completed, appeal rights issued, and a copy of this report will be emailed to the Program Administrator.

met_with: Dana Boulden, Program Administator


summary: Facility Evaluation

raw_content:
Narrative:
On March 11, 2026, at 9: AM, Licensing Program Analyst (LPA) Aimee Moratalla made an unannounced visit to YAI Electric, for the purpose of conducting a Case Management for Special Incident Report the department received on 03/04/2026. The incident occurred on 03/03/2026. The incident stated a client missed the morning dosage of the following prescriptions Clindamycin 300mg (3x/day), Mupirocin 2% (3x/day), and Flagyl 500mg (2x/day). LPA met with Program Administrator (PA), Dana Boulden and discussed the incident. LPA requested a copy of the LIC500, LIC9020, prescriptions, and medication log. Based on the information provided, and interviews conducted, it was confirmed that a medication error occurred. It was confirmed by the Director of Nursing that the morning dosages for 03/03/26, were not administered after conducting a medication count. The Department has concluded, based on the preponderance of the evidence obtained, that staff did not administer the prescribed medications to the client contrary to the prescribed dosage. LPA informed Program Administrator, Dana Boulden, that the facility would be cited. The following deficiency is being cited for violating California Code of Regulations Title 22, Division Regulation 80075(b)(5)(B). An exit interview was completed, appeal rights issued, and a copy of this report will be emailed to the Program Administrator.

met_with: Program Director, Dana Boulden


summary: Facility Evaluation

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Narrative:
On March 25, 2026, Licensing Program Analyst (LPA), Aimee Moratalla arrived at the facility to have an amended document of the original report LIC809-D dated 03/11/2026 signed by the Program Administrator, Dana Boulden.

met_with: Dana Boulden, Program Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On March 25, 2026, Licensing Program Analyst (LPA), Aimee Moratalla arrived at the facility and met by the Program Administrator (PA), Dana Boulden. During the visit, LPA observed one of the windows facing the street has a big crack on it. PA stated that it happened yesterday at 3: PM, when a client threw himself on the window. PA stated that she placed an order to have it repaired and the maintenance will be coming out today. Maintenance is coming from the headquarters in San Diego. LPA asked PA to board up the broken window from both sides. The window was boarded up before LPA left the facility. PA will send a picture of the repaired window at the end of today.


summary: Facility Evaluation

raw_content:
Narrative:
On March 24, 2026, at 8: AM Licensing Program Analyst (LPA) Aimee Moratalla made an unannounced visit to YAI Electric, for the purpose of conducting a Case Management for Special Incident Report the department received on 03/18/2026. The incident occurred on 03/17/2026. The report stated that the client began to cry when the request for strawberries was not given. The staff was unable to redirect the client's behavior that led to client unbuckling the seatbelt, pulling the steering wheel which caused the vehicle to go over the curb and off the road, striking and knocking down a signpost before coming to a complete stop. A police officer witnessed the incident and responded which led to an ambulance was called. The client was brough and examined at CHOC hospital in Orange and was discharged on the same day. LPA met with Program Administrator (PA), Dana Boulden and discussed the incident. LPA requested a copy of the LIC500 and LIC During this visit, LPA interviewed PA, but not the staff as the individuals were not available in the facility. Additional interviews will be conducted on a later date. Based on the interview and information gathered, this case management needs further investigation. Exit interview was conducted, and a copy of this report will be emailed to the Program Administrator.


raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the allegation that staff hit client. LPA reviewed medical reports, interviewed several staff members, reviewed the internal investigation and spoke to the mother of the client. LPA was not able to obtain a copy of the police report from the Gardena Police Department. . The medical report did indicate that C1 had a hematoma on his head. However, staff provided conflicting stories about what happened between C1 and S1 leading up to the bruise. C1 was unable to describe what happened. The internal investigation conducted by the group home was concluded as "unsubstantiated" regarding the allegationthat staff hit client but they did substantiate an unauthorized restraint Based on conflicting accounts of what happened, LPA resolved the allegation that staff hit client as "unsubstantiated". Unsubstantiated means that although an allegation may have happened or is valid, there is not enough evidence to prove that it did happen. 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 STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B This is an official report of an unannounced visit/investigation of a complaint received in our office on 08/22/2024 and conducted by Evaluator Connie Jones-Steward COMPLAINT CONTROL NUMBER: 34-CR- FACILITY NAME:YAI ELECTRIC ST - CCHFACILITY NUMBER: ADMINISTRATOR:ADEDAPO O. AJIBADEFACILITY TYPE: ADDRESS: ELECTRIC STREETTELEPHONE: (510) 304- CITY:GARDENASTATE: CAZIP CODE: CAPACITY:4CENSUS: 3DATE: 03/27/ UNANNOUNCEDTIME BEGAN: 10: AM MET WITH:Dana Boulden, AdministratorTIME COMPLETED:12: PM 9Emergency Intervention Staff Training -Clien's arm was hurt during a restraint INVESTIGATION FINDINGS: 13Licensing Program Analyst Connie Jones-Steward investigated the allegation that client's arm was hurt during a restraint. LPA reviewed the internal investigation conducted by YAI and it substantiated that an unauthorized restraint was used by S1 and S2 who used C1's arms to lead him to his bedroom. Per the investigation, it was recommended that staff be disciplined and retrained. LPA requested copies of the discplinary notices and proof that both staff were retrained in restraints. Based on the information in the internal report, the allegation that client's arm was hurt during a restraint was substantiated. The facility was cited under Title 22 84365(f). SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 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: YAI ELECTRIC ST - CCHFACILITY NUMBER: 198209741

met_with: Dana Boulden, Administratoe


facility_name: YAI EMPIRE AVENUE CCH

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13At 3:30pm on 08/15/2023, Licensing Program Analyst (LPA) Karmen Balhotra made an unannounced complaint inspection to the facility at N Davis Road, Lodi, California. The reason for the inspection is to deliver findings for the allegation listed above. LPA met with Christian Thurman, Lead Registered Behavior Technician, who helped with the inspection. Based on confidential interviews, it was confirmed that adequate supervision was not provided to C1 (LIC 811 dated 08/15/2023) while staff were cooking food for C1 using an oven in the kitchen and client independently grabbed the food from the oven and briefly burned themselves that resulted in no injuries to the client. Therefore, the allegation is substantiated. At this time, the facility is being cited under section 80078(a) of the California Code of Regulations, Title 22, Division 6. An exit interview was conducted and a copy of this report was left. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Karmen Balhotra LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: YAI EMPIRE AVENUE CCHFACILITY NUMBER: 075650161

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

met_with: Christian Thurman