raw_content:
Narrative:
assisted to brush their teeth on a daily basis due to not having a 1:1 staff to assist C1 with hygiene needs. Documents reviewed indicated that it was determined that C1 is to have a 1:1 staff. Confidential interviews also revealed that staff were reluctant to take C1 to the dentist due to aggressive behaviors, which was difficult for one staff to constrain. Based on confidential interviews and records reviewed, the preponderance of evidence standard has been met and the allegation that facility staff are not meeting minor's dental hygiene needs is substantiated. The Group Home facility is being cited for violation of Title 22, Division 6, Chapter 5, Continuing Requirements: 87072(d)(25) Personal Rights. An exit interview was conducted, appeal rights explained, and a copy of this report was reviewed with XXX. A copy of this report, LIC 811, and appeal rights was provided to the Administrator. information received, no identifying information of the staff member or a specific date given when the alleged incident occurred, the allegation could not be confirmed, or denied. Based on confidential interviews, that staff was smoking in the facility. may have occurred, however, is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained. A copy of this report, LIC 811, and appeal rights was provided to the Administrator.

Investigation Findings:
13On February 28, 2025, at 1: PM, Licensing Program Analyst (LPA) Guadalupe Munoz arrived unannounced at the facility and met with Administrator, Corazon Paison, to discuss the investigative finding for the allegation noted above. LPA conducted an inspection of the facility on 07/02/24 at 10: AM and no deficiencies were observed at this time. LPA Interviewed three Staff (S1-3) and Biological Parent. LPA interviewed one of three Clients (C2), LPA attempted to interview Client #1 (C1), however, C1 was unable to articulate words. During the investigation, the following documents were reviewed: staff schedule, special incident reports, medical and dental records and Needs and Services Plans for clients. On 06/26/2024, Community Care Licensing (CCL) received an allegation that facility staff are not meeting minor's dental hygiene needs. Specifically, it was reported "The child was observed having 'two very big cavities in the back and that the last dental appointment on record was on April 28, 2023. Confidential interviews confirmed that C1 had not attended a dentist appointment since 2023 and C1 has not been SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Guadalupe Munoz 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 22-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION ORANGE COUNTY RO, THE CITY DR., SUITE FACILITY NAME: CYNCO CHILD CARE IIFACILITY NUMBER: VISIT DATE: 02/28/2025

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

met_with: Corazon Paison


state: CA

facility_name: CYNCO CHILD CARE II

summary: Facility Evaluation

raw_content:
Narrative:
On February 16, 2022, at 09: AM, Licensing Program Analyst (LPA), Val Wilson, conducted an unannounced SB Psychotropic Medication Inspection. LPA was met at the door by Corazon Pasion, Licensee. LPA inspected the inside and outside of facility with the Licensee. LPA reviewed four of four child's records on site at the facility at 10: AM . LPA reviewed three of three staff personnel files on site at the facility at 12: PM. LPA interviewed two of three staff on site at 12: PM. LPA interviewed three of four children currently taking psychotropic medication at 1: PM, 1: PM, and 1: PM. LPA provided the Summary Report and LIC 811 to Corazon Pasion, Licensee, upon completion. No deficiencies or concerns were noted or observed throughout the inspection and interviews.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Corazon Pasion, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On November 3, 2022 at 11:27am, Licensing Program Analyst (LPA) Adrian Mendez arrived unannounced at the facility to conduct an Annual/Random inspection of the facility. The facility was inspected inside and out with Administrator Corazon Pasion, Direct Support Professional Juana Aranda, and Direct Support Professional Carol Enriquez. Bedrooms are arranged so that no more than two clients share a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. The hot water in one of the client bathrooms was measured at 116.0 degrees, which is within regulatory requirements. All hazardous items have been properly made inaccessible. The medications were stored and locked in a medication cabinet in the kitchen. Cleansers/chemicals are locked and stored in a locked cabinet in the garage. Sharp knives are inaccessible and stored in a lock box in the kitchen. The First Aid Kit is located in the medication cabinet and contained all required supplies. The facility's smoke/carbon monoxide detectors in the hallways and bedrooms were checked and were operable. There are no guns or weapons in the facility as stated by Direct Support Professional Carol Enriquez. The following required posted items were observed accessible to clients: Facility License, Grievance Procedures, Personal Rights, Visitation policies, Emergency Disaster Plan and current menu. The facility outside grounds was also inspected and it was observed to be clean and well maintained. There is a swimming pool located in the backyard of the facility which is made inaccessible with a fence. Emergency exits were free from obstruction. LPA discussed and reviewed the following inspection components; Emergency Disaster Preparedness. During the inspection, LPA reviewed 10 staff files and four client files. Cont. on 809-C A sample of four client files were reviewed during the inspection. All client files had the required documents per Title Regulations. LPA reviewed 10 staff files. All the staff have met the training and qualification requirements per regulation requirements. Per a review of the Community Care Licensing Information System (LIS), all staff met DOJ/FBI criminal record clearances and Child Abuse Index Check requirements. Due to time constraints and the need to complete client/staff interviews, this inspection will need to be continued at a later date. Based on the facility inspection, and files reviewed there are no deficiencies found at this time. An exit interview was conducted, and a copy of this report was explained to Direct Support Professional Carol Enriquez. Due to printer malfunction, this report will be emailed to Direct Support Professional Carol Enriquez and Administrator Corazon Pasion.

visit_type: Annual

met_with: Corazon Pasion


summary: Facility Evaluation

raw_content:
Narrative:
On December 8, 2022 at 3:22pm, Licensing Program Analyst (LPA) Adrian Mendez arrived unannounced at the facility to conduct an Annual Continuation inspection of the Annual/Random inspection that began on 11/03/2022. LPA met with Direct Support Professional (DSP) Carol Enriquez. During the inspection LPA conducted interviews with two facility staff, and two children. LPA discussed and reviewed the following inspection components; Operational Requirements, Emergency Intervention Plan, and Emergency Disaster Preparedness. Based on the facility inspection, interviews conducted, and files reviewed there are no deficiencies found at this time. An exit interview was conducted, and a copy of this report was explained to Direct Support Professional Carol Enriquez. Due to printer malfunction, this report will be emailed to Direct Support Professional Carol Enriquez.

met_with: Carol Enriquez


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Joon Choi on 11/07/2023 at 09: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the visit, LPA Choi met with Adminstrator Corazon Aranda Pasion and conducted a health and safety inspection of the facility. No immediate health or safety risks were observed. LPA reviewed 1 of child's records and 3 of staff personnel files on site at the facility. LPA reviewed 1 of child's psychotropic medications and medication records. LPA interviewed 2 of staff on site to discuss the facilities policies and procedures of operation. LPA will attempt an interview of 1 children currently prescribed psychotropic medication, at their assigned school after the facility visit. No deficiencies are being cited at this time. LPA conducted exit interview with Administrator Corazon Aranda Pasion and provided a copy of this licensing report.

met_with: Corazon Aranda Pasion, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On March 21,2024 at 10:00am, Licensing Program Analyst (LPA) Guadalupe Munoz and LPA Nicole Strickland arrived unannounced at the facility to conduct an Annual/Random inspection of the facility. The facility was inspected inside and out with Administrator Corazon Pasion, Direct Support Professional Juana Aranda, and Direct Support Professional Marie Noel. Bedrooms are arranged so that no more than two clients share a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. The hot water in one of the client bathrooms was measured at 116.0 degrees, which is within regulatory requirements. All hazardous items have been properly made inaccessible. The medications were stored and locked in a medication cabinet in the kitchen. Cleansers/chemicals are locked and stored in a locked cabinet in the garage. Sharp knives are inaccessible and stored in a locked drawer in the kitchen. The First Aid Kit is located in the medication cabinet and contained all required supplies. The facility's smoke/carbon monoxide detectors in the hallways and bedrooms were checked and were operable. There are no guns or weapons in the facility as stated by Administrator, Corazon Paison. The following required posted items were observed accessible to clients: Facility License, Grievance Procedures, Personal Rights, Visitation policies, Emergency Disaster Plan and current menu. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is a swimming pool located in the backyard of the facility which is made inaccessible with a fence, however the fence is broken and leaves a gap that makes it accessible to clients. This poses an immediate safety risk and therefore the facility is being cited for CCR 80087 (e)(1) Buildings and Grounds . LPA discussed and reviewed the following inspection components; Emergency Disaster Preparedness. During the inspection, LPA reviewed 10 staff files and four client files. Cont. on 809-C LPA discussed and reviewed the following inspection components; Emergency Disaster Preparedness. During the inspection, LPA reviewed 5 staff files and three client files. A sample of three client files were reviewed during the inspection. All client files had the required documents per Title Regulations. LPA reviewed 5 staff files. All the staff have not met the training and qualification requirements per regulation requirements. Therefore the facility is being cited for CCR 84065(I)(5) Personnel Requirements. Per a review of Guardian System, all staff met DOJ/FBI criminal record clearances and Child Abuse Index Check requirements. Based on the facility inspection, and files reviewed there are no deficiencies found at this time. An exit interview was conducted and a copy of this report and LIC 811 was provided to Administrator Corazon Pasion.


summary: Facility Evaluation

raw_content:
Narrative:
On November 14, 2024 at 09: AMA an unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Guadalupe Munoz and LPA Jacqueline Garcia. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the visit, LPA's met with Administrator Corazon Pasion and conducted a health and safety inspection of the facility. No immediate health or safety risks were observed. LPAs reviewed three staff personnel files on site at the facility. LPAs interviewed 2 of staff on site to discuss the facilities policies and procedures of operation. Facility did not have any clients that met the SB 484 inspection criteria, therefore LPAs did not review client files and did not conduct any client interviews. No deficiencies are being cited at this time. LPA conducted exit interview with Administrator Corazon Aranda Pasion and provided a copy of this licensing report and LIC 811 dated 11/14/24.


summary: Facility Evaluation

raw_content:
Narrative:
On 03/26/2025 at 9:00am, Licensing Program Analyst (LPA) Gilbert Marquez and arrived unannounced at the facility to conduct an annual inspection of the facility. The facility was inspected inside and out with Administrator Corazon Pasion and Administrator Marie Noel. The home is a one-story residence with a total of four bedrooms and two bathrooms. Bedrooms are arranged so that no more than two clients share a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. The hot water in one of the client bathrooms was measured at 117.0 degrees, which is within regulatory requirements. The medications were stored and locked in a medication cabinet in the kitchen. Cleansers/chemicals are locked and stored in a locked cabinet in the garage. Sharp knives are inaccessible and stored in a locked drawer in the kitchen. The First Aid Kit is in the medication cabinet and contained all required supplies. LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients as well. The facility's smoke/carbon monoxide detectors in the hallways and bedrooms were checked and were operable. The fire extinguishers were updated and showed proof of adequate maintenance. There are no guns or weapons in the facility as stated by Administrator, Corazon Pasion. The following required posted items were observed accessible to clients: Facility License, Grievance Procedures, Personal Rights, Visitation policies, Emergency Disaster Plan and current menu. **Continued on LIC809-C** **Continued from LIC809** The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is an in-ground swimming pool located in the backyard of the facility which is made inaccessible with a fence and two pool gates that swing away from the pool, self-close and have a self-latching device located no more than six inches from the top of the gate. The fence is constructed so that the fence does not obscure the pool from view. LPA noted that there is one vehicle in use to transport the clients in care. LPA reviewed the vehicle log, and the vehicle itself. The vehicle is brand new and only had 1,600 miles. LPA conducted two staff interviews (S1 and S2), and one client interview (C1). During the inspection, LPA reviewed two client files. All client files had the required documents per Title Regulations. LPA reviewed 5 staff files. All staff have training requirement. Per a review of Guardian System, all staff met DOJ/FBI criminal record clearances and Child Abuse Index Check requirements. Currently the facility is overdue on their licensing fees. Based on the facility inspection, and files reviewed, and interviews, there are no deficiencies found at this time. An exit interview was conducted, and this report was explained. A copy of this report and Confidential Names List LIC 811 were emailed to Administrator Corazon Pasion due to printer malfunction.

met_with: Corazon Pasion, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 07/11/25, at 1: PM, Licensing Program Analyst (LPA) Gilbert Marquez and Licensing Program Manager Ann Valenzuela met with Licensee Corazon Pasion for the purpose of conducting a case management inspection of the facility regarding criminal record clearances. The facility is licensed to serve four developmentally disabled clients ages 10-17 years old. The current census is two clients. LPA obtained the current LIC500 and that triggered a criminal record clearances check on Guardian. LPA found that four out of ten individuals (S2, S3, S4, S5- See Confidential Names List LIC811) did not have a completed background clearance listed on Guardian. LPA obtained the work schedule for the previous 30 days and found that all four individuals worked more than five shifts in the last month. LPA conducted two staff interviews (S1 and S6). Based on LPA observations, file reviews and interviews, the following type A deficiency is given today regarding the four staff who were not have clearance eligibility on Guardian (S2, S3, S4, S5) who were listed on the LIC500 as employees of this facility, and worked five shifts in the last month. This is not in compliance with Title Section 80019(e)(1): Criminal Record Clearance. Civil Penalties of $2,000 is being assessed today. Please see LIC809D and LIC421BG for full text of citation, how the civil penalty was calculated, and to review the plan of correction. **Continued LIC809C** **Continued from LIC809** An exit interview was conducted with the Licensee to explain this report, the LIC809D page, and a plan of correction. The appeal rights were discussed. A copy of this report, along with the LIC809D, LIC421BG, LIC811, and the appeal rights were given to Administrator, and additionally will be kept in the facility file.


facility_name: CYNTHIA'S CHILDREN'S HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
LPA requested the following documents for review: Annual required training logs, placement agreements/admission agreement, agency signed policies and procedures, and Client Information/Face Sheet, Needs and Services Plans/IPP, agency case notes regarding youth 1 (Y1), police reports, and LIC 500, employee staff schedule, and Staff 1 contact information. LPAs conducted an inspection of the agency. Confidential interviews were conducted with ten individuals, and attempted with 1 individual, during the period of October 23, 2024, to November 13, 2024. During the investigation of facility staff hit a minor and Facility staff scratched a minor, LPA Martinez and LPA Green toured the facility with William Riddle (house manager). On this inspection, LPA inspected the physical plant including but not limited to the kitchen, dining room, children bedrooms, children bathrooms, laundry room, activity room, and outside courtyards of the facility. LPA Martinez reviewed client 1's (C1) file, on October 23, 2024, and obtained documentation for the complaint investigation. Annual required training logs, placement agreements/admission agreement, agency signed policies and procedures, and Client Information/Face Sheet, Needs and Services Plans/IPP, agency case notes regarding youth 1 (Y1), police reports, and LIC 500, employee staff schedule, and Staff 1 contact information. LPA conducted interviews from October 23, 2024, to November 13, 2024. Five out of ten confidential interviewees reported they never witnessed staff 1 (S1) being aggressive towards the children or hitting them. The six out ten interviewees reported they had no concerns about S1 or the facility. One out of ten Interviewees reported an altercation did occur, and they were aggressive towards a staff and hit them. One out of ten interviewees reported they never fought with C1 and C1 did not hit them. One out of ten interviewees reported they were not able to corroborate C1's physical fight with a staff. Based on LPA's observations, interviews which were conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegations are found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No title 22 regulations were cited during today's inspection. An exit interview was conducted, and a copy of this report was left with William Riddle/house manager.

Investigation Findings:
13Licensing Program Analysts (LPAs) Avelina Martinez and Maie Soliman conducted an unannounced inspection to the facility on December 06, 2024 at 12: PM to deliver complaint allegation findings. LPA Martinez met with William Riddle and discussed the above allegations. On October 23, 2024, at 1: PM, Licensing Program Analysts (LPA) Kayla Green and Avelina Martinez arrived unannounced at the agency for the purpose of initiating a complaint investigation related to the above allegations. LPAs met with William Riddle and Etiana Jackson and explained the purpose of the visit. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Avelina Martinez 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: CYNTHIA'S CHILDREN'S HOMEFACILITY NUMBER: VISIT DATE: 12/06/2024

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

report_type: Complaint Investigation

met_with: William Riddle, House Manager

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, Ignacia Villapudua-Soto arrived at the above Group Home to conduct an announced Pre Licensing inspection of the facility on February 10, 2022 at 11: AM. LPA met with Administrator, Desiree Clifton to conduct the inspection LPA and Administrator conducted a joint inspection of the interior and exterior areas of the facility's physical plant. The front and back yards were free of clutter; and the passage ways and egress were unobstructed. No potentially hazardous items or areas were observed. The group home is requesting to be licensed for a capacity of 4 ambulatory clients, ages 7 and 17 years old. The clients are developmentally disabled. The home is a two story home. LPA observed near the front door, a single occupancy bedroom that had a single bed, bedding including mattress cover, fitted sheet, top sheet and blanket, dresser, night stand, lamp, chair and closet area. LPA observed Carbon Monoxide detectors and a gaming area is near the front entrance of the facility and has a couple of small gaming chairs and television. First level bathroom was observed and is equipped with a shower and tub with glass sliding doors and a shower curtain for privacy. LPA observed an activity area in the main seating and kitchen area of the facility and this activity area was equipped with computer, books, remote control cars, coloring pages with crayons, colored pencils, markers and sketch pads, card games and charades for kids game, puzzles and an extra table in the middle of the room that can be removed for other activities not requiring a table. LPA observed that the dining area is off of the kitchen and the table is set up for placement of four clients, however, the kitchen counter has four chairs for clients. LPA observed that there is a fire extinguisher in the dining area and upstairs. LPA observed that the kitchen area is located off the dining and living room area of the facility and that the kitchen area had the stove, microwave built in, refrigerator, double oven and pantry with no lock on the door. Inside the pantry, LPA observed plenty of non-perishable food items and snacks. LPA also observed perishable food items in the refrigerator. LPA observed that sharps are to be kept in a drawer in the kitchen and this drawer is secured by a magnetic locking system. Chemicals are to be stored under the kitchen sink and this lock is also the magnetic locking system. The facility has a working land line and cell phone. Menus and activity schedules are posted. LPA observed that the medications are stored in the closet by the front door, under the stair case leading to the second story of the facility. This closet has the first aid kit and other first aid supplies as well as cubbies to hold client medications. LPA also observed a small refrigerator in this closet that will also house medications that need refrigeration for clients in care. LPA observed that this closet has a locking door and will not be accessible to clients in care. Second story of the facility ,LPA observed that there is a laundry room in the landing area of the upstairs that is locked. The laundry room is located next to the bathroom for the clients and bedrooms for the clients. LPA observed that the three client bedrooms located on the second floor that are all single occupancy rooms equipped with the single beds in each room, bedding including mattress covers, fitted sheet, top sheet and blanket, dresser in each room, night stand in each room, lamp in each room, chair in each room and closet areas in each room as required. The bedrooms have fire detectors in each room and the Carbon Monoxide is placed in the hallway wall. LPA observed that the bathroom is equipped with a dual sink vanity and that the bathroom on the second level has a tub and shower area, no glass doors and a shower curtain. LPA toured the master bedroom on the second floor that is equipped with a bathroom for staff use; it also has extra hygiene items and beddings and the confidential staff files are locked in a cabinet. Administrator did advise that this room will be utilized for staff only and that no clients will be given access to this area. The home has a Disaster plan, Facility Sketch and Personal Rights. The facility was clean, safe, sanitary and in good repair. The facility is prepared for licensure pending a final review of the file and Licensing Program Manager's Approval. Exit interview was conducted with Administrator.

visit_type: Prelicensing

met_with: Desiree Clifton, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 2/8/ Licensing Program Analyst (LPA) Jean Stidman met with Desiree Clifton Administrator for the purpose of a Case Management Inspection. The facility had an incident that occurred when the client was not in their care on 01/12/2023 that should have been reported by 01/13/2023 but was not reported until 01/18/2023. Technical Assistance was given to the Administrator as well as Title 22 regulation 80061 on Reporting Requirements. The Administrator will ensure all incidents are reported as per required in regulations. A copy of this report was left with Desiree Clifton Administrator.

met_with: Desiree Clifton Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an unannounced Annual inspection on 6/22/23 at 10am. During the inspection LPA met with Desiree Clifton, Administrator who assisted with the inspection. LPA conducted a walk-through of the facility inside and out. Facility staff-client ratio at the beginning of inspection was one staff and one client, then three other clients and the administrator arrived during the inspection. LPA observed the home is a two story home with four bedrooms, three bathrooms and one staff office. LPA interviewed four clients and three staff. LPA inspected and/or reviewed the following: Physical Plant Posting of license_X_ Personal Rights_X__ Menu present and posted_ X__ Working telephone X Hot Water between 105-120 degree F _X_is 114 degrees F. Client Records LPA observed four client records contain the Regional Center Admission Agreement, LPA observed four out of four client records contain the medical assessment, examination for tuberculosis and immunization records. Disaster Preparedness Quarterly Drills conducted and documented_X__ Disaster preparedness supplies verified _X__ Emergency Intervention Review of manual restraint log __X__ The following items were reviewed for compliance in the regional office prior to the facility inspection: · Annual fees, Administrator Certificate for: Desiree Clifton, LIC 500, Waivers and Exceptions Facility citation violation of California Code of Regulations, Title 22, Division 6, regulation 84065(1) Personnel Requirements due to the facility does not have any staff trained to apply the Reasonable and Prudent Parent Standard. An exit interview was conducted a copy of this report was left with Desiree Clifton, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Kayla Green made an unannounced Annual inspection on 4/4/24 at 10am. During the inspection LPA met with Desiree Clifton, Administrator who assisted with the inspection. LPA conducted a walk-through of the facility inside and out. Two staff and three clients arrived during the inspection. LPA observed the home is a two story home with four bedrooms, three bathrooms and one staff office. LPA interviewed two clients and two staff. LPA inspected and/or reviewed the following: Physical Plant Posting of license_X_ Personal Rights_X__ Menu present and posted_ X__ Working telephone X Hot Water between 105-120 degree F _X_is 113 degrees F. Client Records LPA observed four client records contain the Regional Center Admission Agreement, LPA observed four out of four client records contain the medical assessment, examination for tuberculosis and immunization records. LPA observed Six staff files and criminal records were verified, first aid certificates verified, and training verified. Disaster Preparedness Quarterly Drills conducted and documented_X__ Disaster preparedness supplies verified _X__ The following items were reviewed for compliance in the regional office prior to the facility inspection: Annual fees, Administrator Certificate for: Desiree Clifton, LIC 500, Waivers and Exceptions An exit interview was conducted a copy of this report was left with Desiree Clifton, Administrator.

met_with: Desiree Clifton


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 4/16/2025 at 09:52AM Licensing Program Analyst (LPA) Angelique Hill arrived unannounced for the purpose of an annual inspection. During the inspection LPA met with Desiree Clifton, Administrator who assisted with the inspection. LPA conducted a walk-through of the facility inside and out. Two staff and three clients arrived during the inspection. LPA observed the home is a two story home with five bedrooms, three bathrooms and one staff office. LPA interviewed four staff. LPA inspected and/or reviewed the following: Physical Plant Posting of license_X_ Personal Rights_X__ Menu present and posted_ X__ Working telephone X Hot Water between 105-120 degree F _X_is 113 degrees F. Client Records LPA observed four client records contain the Regional Center Admission Agreement, LPA observed four out of four client records contain the medical assessment, examination for tuberculosis and immunization records. LPA observed four staff files and criminal records were verified, first aid certificates verified, and training verified. Disaster Preparedness Quarterly Drills conducted and documented _X__ Disaster preparedness supplies verified _X__ The following items were reviewed for compliance in the regional office prior to the facility inspection: Annual fees, Administrator Certificate for: Desiree Clifton, LIC 500, Waivers and Exceptions An exit interview was conducted a copy of this report was left with Desiree Clifton, Administrator.

Deficiencies:
84068.3(a): Modifications to Needs and Services Plan

(a) The needs and services plan specified in Section 84068.2 shall be updated at least every six months to determine the following


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an unannounced Post Licensing inspection on 6/16/23 at 12:45pm. During the inspection LPA met with Anne Cheryl Abenes, House Manager who assisted with the inspection. LPA conducted a walk-through of the facility inside and out. Facility staff-client ratio at the beginning of inspection was two staff, one client and one infant. LPA observed the home is a two story home with four bedrooms, three bathrooms and one staff office. LPA inspected and/or reviewed the following: I. Physical Plant Posting of license_Not posted in a prominent place_ Personal Rights_X__ Disinfectants/Cleaning solutions inaccessible_X_ Refrigerator Temperature at or below 45 degrees F X Freezer Temperature at or below 0 degrees X_ Nonperishable Foods one week and fresh perishable foods two days minimum_ X Menu present and posted_ X__ Working telephone X Carbon monoxide detectors _ X_Smoke Detector X First Aid Kit fully stocked_No _ Common Room available X Dining area (enough seating, furniture good condition, not broke or damaged) _ X Medication centrally stored, locked/inaccessible X Office (locked and privacy) _ X_ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F_No hot water is 130 degrees_ Fire Extinguishers were inspected April Toilets wash basin, bath and shower fixtures in good repair/no leaks _ X Soap and Paper towels _ X_ Laundry Facilities(available) X_ Bedrooms-required linen and furnishings X_ Motor Vehicle properly maintained, lights, tires, registration/insurance and working seat belts X Facility free of vermin X Locked Facilities (open locked storage area/building/sheds) _No the front door was unlocked and open from approximately 12:45pm-1:45pm while three clients were being dropped off from school. Bedroom (required bedding/furniture, furniture in good repair) _ X_ IV. Emergency Intervention LPA reviewed three staff files contain current MABPro restraint training V.Staffing/Volunteers Number of Staff files reviewed _three_Criminal record clearances verified _X_ First Aid Certificate_ X Certified Administrators certificate valid and current__ administrator has applied to renew their administrator's certificate that expired in April 2023. Job title/qualification verified _X_ VI. Client Records Number of Clients files reviewed four Needs and Services Plan X_ LPA observed four client records contain the Regional Center Admission Agreement, LPA observed one out four client records were missing the medical assessment, two out four client records were missing Ambulatory status, examination for tuberculosis and immunization records. LPA observed the facility license is not posted in a prominent place, the first aid kit is not fully stocked, the hot water temperature was 130 degrees Fahrenheit, the facility front door was left open from approximately 12:45pm-1:45pm with one client and two staff present while three other clients were being dropped off from school. LPA observed the Administrator has applied to renew their administrator's certificated that expired in April 2023. LPA observed one out four client records were missing the medical assessment, two out four client records were missing Ambulatory status, examination for tuberculosis and immunization records. Facility citation violation of California Code of Regulations, Title 22, Division 6, regulations 80088(e)(1) Fixtures, Furniture Equipment and Supplies, Client Medical Assessment and 80022(k) Plan of Operation. LPA was unable to complete this inspection and will return at a later date to complete the inspection. An exit interview was conducted and a copy of this report was left with Anne Cheryl Abenes, House Manager.

Deficiencies:
80069: 1
2
3
4
5
6
7

met_with: Anne Cheryl Abenes, House Manager

title:
1
2
3
4
5
6
780069 Client Medical Assessment. 80069(a) Client Medical Assessment. The licensee shall obtain a written medical assessment of the client prior to or within 30 calendar days following the acceptance of a client and 80069(c)(1) Client medical assessments shall include results of...tuberculosis..... This requirement is not met as evidenced by

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facility_name: DANROSE HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 11/17/25, Licensing Program Analyst (LPA) Mariah Hawkins met with Applicant Danrose Corporation on for the scheduled Component II face-to-face meeting. Representing the Applicant were CEO Vener Joshua Gano, Administrator Vincent Gano, Secretary/Director Jane Gano, Treasurer Venerando Gano. During the meeting, the following topics were discussed. Application Process Overview Goal/Purpose of the Facility Basic Services and Planned Activities Needs and Services Plans Care and Supervision Policies Emergency Intervention Policies Emergency Disaster Procedures Reporting Requirements Background Clearance/Guardian Process LPA and Applicant also discussed the pending application items, including the updated LIC 200, LIC 500, and revised program statement. The Applicant discussed potentially changing the served population to be all ambulatory and agreed to update LPA when that decision is finalized with Regional Center. The Component III was scheduled for 12/18/25 from 1PM-5PM. LPA thanked the Applicant representatives for attending the meeting. A copy of this report was provided to the Applicant representatives.

met_with: CEO Vener Joshua Gano; Administrator Vincent Gano; Secretary/Director Jane Gano; Treasurer/Director Venerando Gano


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday, March 25th 2026, Licensing Program Analyst (LPA) Mariah Hawkins conducted an announced prelicensing inspection that was scheduled in advance with the applicant. LPA met with Chief Executive Officer and Assistant Administrator Vener Joshua Gano, Vice President and Administrator Vincent Gano, Directors Venerando Gano, Jane Gano, Vito Jason Gano, and Facility Manager Leoraine Carandang. During the inspection, LPA toured the facility site and reviewed licensing procedures. LPA observed the facility to be a single-story house in a residential neighborhood. The facility and grounds were maintained in safe condition. The kitchen and bathrooms were sanitary. There are two refrigerators on site and kitchen cabinetry and backup pantry storage which contained cooking and eating utensils and a large supply of fresh foods and dry foods. Bedrooms, bathrooms, and living spaces were decorated and organized. There are four single-occupancy bedrooms with individual beds, individual linens including mattress pads, closets and drawers. Lights were observed to be functioning in all rooms. The outdoor space is free of obstructions. Activity supplies have been obtained and were stored neatly in the living room. Sharps were stored in a locked drawer. Chemicals were stored in a locked cabinet. Medications will be stored in a locked cabinet. A facility sketch, emergency disaster procedures, personal rights, disability rights, licensing agency complaint line, and facility grievance procedures were posted prominently in the living room. Continued -- See Lic 809-c Using the CARE inspection tool, LPA identified a few items to correct. LPA provided the regulatory language for applicant's reference. A) Obtain first aid scissors for the first aid kit. [80075(g)(1)(E)] B) Lower hot water to within permitted range of F to F. [80088(e)(1)-(2)] C) Include summary of emergency intervention procedures (intervention descriptions, time limits) provided in the CPI training within the emergency intervention plan (EIP) in the program statement (PS). [84322] D) Include discussion of monthly manual restraint log in the EIP in the PS. [84361(f)] LPA discussed the next steps in the application process and the anticipated timeline. The application is in Pending status and is pending completion of the items above and licensing management review and approval. An exit interview was conducted, and a copy of this report was provided to applicant representatives.

met_with: Vener Joshua Gano, Vincent Gano, Venerando Gano, Jane Gano, Vito Jason Gano, Leoraine Carandang


facility_name: DAYLEE JOY RESIDENTIAL

summary: Facility Evaluation

raw_content:
Narrative:
On July 23, 2024, at 9: AM, Component II of the application process for Daylee Joy Residential Group Home located Hobart Blvd. Los Angeles, Ca. 90047 was held at the El Segundo Children's Residential Regional Office in El Segundo. Attending Component II were the following individuals: Licensing Program Analyst (LPA), Charmetha White, and Administrator, Leah Hawkins. The purposes of this Component II meeting were to review the incomplete application and Program Statement and to resolve any outstanding concerns that may have existed. The following incomplete application forms were discussed at the meeting: Financial Information Release and Verification (LIC 404), Personnel Report (LIC 500), Group Home Orientation Certificate, CPR certificates, staff facility association and Group Home Hour Administrator certificate. Program Statement: Sections 1-29 was reviewed and discussed. Pre-Licensing Inspection will be conducted on July 26, 2024, at 9: AM. A copy of this report was issued to the Administrator, Leah Hawkins.

met_with: Administrator - Leah Hawkins


summary: Facility Evaluation

raw_content:
Narrative:
On July 26, 2024, at 9: AM, Licensing Program Analyst (LPA) C. White made an announced visit to the above location, for the purpose of conducting a Pre-Licensing Inspection for the pending licensure of Daylee Joy Residential Group Home. LPA met with Administrator, Leah Hawkins, who granted access to the home, and provided a tour of the interior and exterior physical plant. This home is seeking a license to provide care and supervision for five (5) developmentally disable children ages, 12-17 years old, ambulatory only, and non-minor dependents. Currently the census is zero (0). There is no pool or bodies of water on the premises. The Administrator confirmed that there are no firearms or dangerous weapons on the premises. LPA observed the following during the inspection: The facility is a three (3) bedroom, two (2) bathroom single family dwelling located in a residential neighborhood. The front porch is completely enclosed with a black iron gate and the home is set up as follows: Living room, Dining room, Kitchen, Office area, Laundry area, Backyard, detached garage, and detached office. Living room: has two (2) couches, a chair, a mounted TV, and a glass enclosed non-operational fireplace. Dining room: has table and four (4) chairs. Kitchen: has double door refrigerator/freezer, five (5) burner gas stove/oven (all burners were operational at time of this inspection), a microwave, dishwasher, ample plates, cups, and eating utensils. There is also a kitchen nook containing a small table with two (2) chairs, and a locked filed cabinet, which will be used to store medication. Laundry area: is located off the kitchen and has a stackable washer and dryer, there is also an exit door leading to the side of the home. Backyard: has ample space. LPA observed lose stones and a hole in walkway. Report continued on LIC 809C. (Page 1 of 3) Detached garage: Administrator informed LPA the garage is used for storage by property owner. LPA will return to view garage as administrator did not have access at the time of this inspection. Detached Office: LPA observed office is under construction; the outer exterior has unfinished walls, interior will be used as an office, and at the time of this inspection it is being used for storage. Bedrooms: Bedroom #1 and #3: have two (2) twin beds; Bedroom #2 has one (1) twin bed. Each room has closet space. There were no dressers in the bedrooms. All bedrooms have a mounted TV, a ceiling fan/working light, and security bars. The security bar emergency latches were not operational at the time of this inspection. Bathrooms: Bathroom #1 is located along the hallway, adjacent to bedroom #1 and has a toilet, tub, shower, and sink. Bathroom #2 is located off the kitchen near the laundry area and has a toilet and sink. Hot water was tested and measured within 105 - 120 degrees Fahrenheit. LPA observed the home to have a three (3) fully charged fire extinguisher. The smoke detectors were tested and found to be in working order. All posting requirements were met. The temperature of the facility is regulated by window mounted air conditioners throughout and electric floor heaters. LPA observe the facility to have a camera system that monitors the exterior of the home (front yard, both sides of the home, porch, and driveway) only. LPA reminded Administrator to ensure the following when children are in placement: Children are accorded personal rights. Children are to be supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. During the visit, LPA reiterated the importance of submitting Special Incident Reports, Law Enforcement contacts, and to report all changes within the home to Community Care Licensing and any other appropriate agency. Administrator acknowledges abuse reporting requirements. Report continued on LIC 809C (Page 2 of 3). Vehicle: Currently the facility does not have a vehicle to transport the clients. The administrator will provide information about the company vehicle later to be inspected. The following items need to be in the home prior to licensure: Perishable and Nonperishable food supply in the quantity per the regulations Drawers for clients' rooms Operational Security bar releases Carbon monoxide deter Extra linens Hygiene products for clients Cleaning/laundry supplies Locked storage for poisons/cleaning supplies First Aid kit complete with scissors, thermometer, tweezers Working facility telephone Locked storage cabinet for client & staff files An exit interview was conducted. A copy of this report was left with the Administrator. Application review will continue when the above items and all items discussed during the Component II (face-to-face office meeting) have been completed. (Page 3 of 3).


summary: Facility Evaluation

raw_content:
Narrative:
On September 19, 2024, at 9: AM, Licensing Program Analysts (LPA's) C. White and J. Armstrong made an announced visit to the above location, for the purpose of conducting a second Pre-Licensing Inspection for the pending licensure of Daylee Joy Residential Group Home. LPA's met with Administrator, Leah Hawkins, who granted access to the home, and provided a tour of the interior and exterior physical plant. This home is seeking a license to provide care and supervision for five (5) developmentally disable children ages, 12-17 years old, ambulatory only, and non-minor dependents. Currently the census is zero (0). LPA's observed the following during the inspection: The facility is a three (3) bedroom, two (2) bathroom single family dwelling located in a residential neighborhood. The front porch is enclosed with a black iron gate and the home is set up as follows: Living room, Dining room, Kitchen, Office area, Laundry area, Backyard, detached garage, and detached office. Living room: has two (2) couches, a chair, a mounted TV, a glass enclosed non-operational fireplace. LPA's observe the facility to have a camera system that monitors the exterior of the home (front yard, both sides of the home, porch, and driveway) only. Dining room: has a wooden table and six (6) chairs. Kitchen: has double door refrigerator/freezer, five (5) burner gas stove/oven (all burners were operational at time of this inspection), two (2) microwaves, a dishwasher, ample plates, cups, and eating utensils. There is also a kitchen nook containing a small table with two (2) chairs, and a locked filed cabinet, which will be used to store medication. Laundry area: located off the kitchen, has a stackable washer and dryer, an exit door leading to the side of the home, and a staff bathroom. Backyard: has ample space, with turf grass. Report continued on LIC 809C (page 1 of 3) Detached garage: LPA's observed the garage being used to store clothing, it also contains a small sink and a non-operational stove. Administrator informed LPA's items in the garage belong to the property owner. Detached Office: LPA's observed to office being used as storage. Bedrooms: Bedroom #1 and #3: have two (2) twin beds; Bedroom #2 has one (1) twin bed. Each room has ample closet space, two (2) drawers for each client, and working combination light/ceiling fans. All bedrooms have a mounted TV. LPA's observed partial security bars on bedroom windows which allow for emergency exiting. Bathrooms: Bathroom #1 is located along the hallway, adjacent to bedroom #1 and has a toilet, tub, and separate shower, and sink. Bathroom #2 is located off the kitchen near the laundry area and has a toilet and sink. Hot water was tested and measured within 105 - 120 degrees Fahrenheit. LPA's observed the home to have a three (3) fully charged fire extinguisher, one (1) in the kitchen, one (1) in the living room, and one (1) along the hallway. The smoke alarms and carbon monoxide detectors were tested and found to be in working order. All posting requirements were met. Temperature in the facility is regulated by window mounted air conditioners throughout and electric floor heaters. There is no pool or bodies of water on the premises. The Administrator confirmed that there are no firearms or dangerous weapons on the premises. LPA's observed the facility to be clean, safe, and sanitary. Passageways, stairways, inclines, ramps and open porches are unobstructed. The front and backyard were clean and free of debris. Vehicle: Facility will use a Dodge Caravan to transport the clients. LPA's inspected the interior and exterior of the vehicle. LPA's observed all seatbelts, the front lights, brake lights, back up lights, blinkers, and horn to be in working order. Vehicle registration is current through June 2025. Report continued on LIC C (page 2 of 3). LPA's reminded Administrator to ensure the following when children are in placement: Children are accorded personal rights and to ensure the corresponding form are placed in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. Administrator acknowledges abuse reporting requirements. During the inspection, LPA's reiterated the importance of submitting Special Incident Reports, Law Enforcement contacts, and to report all changes within the facility to Community Care Licensing and any other appropriate agency. LPA's informed Administrator that a Component III Tele-orientation will be scheduled per Community Care Licensing procedures. An exit interview was conducted. A copy of this report was left with the Administrator. (Page 3 of 3).


summary: Facility Evaluation

raw_content:
Narrative:
On March 28, at 9: AM, Licensing Program Analysts J. Armstrong and License Program Manager E. Hernandez made an announced visit to the above location, for the purpose of conducting a Post Licensing Inspection. LPA and LPM met with Administrator, Leah Hawkins, who granted access to the home, and provided a tour of the interior and exterior physical plant. This home is licensed to provide care and supervision for five (5) developmentally disable children ages, 12-17 years old, ambulatory only, and non-minor dependents. Currently the census is zero (0). LPA and LPM observed the following during the inspection: The facility is a three (3) bedroom, two (2) bathroom single family home located in a residential neighborhood. The front porch is enclosed with a black iron gate and the home is set up as follows: Living room, Dining room, Kitchen, Office area, Laundry area, Backyard, detached garage, and detached office. Living room: has two (2) couches, a chair, a mounted TV, a glass enclosed non-operational fireplace. LPA and LPM observe the facility to have a camera system that monitors the front yard. Dining room: has a wooden table and six (6) chairs. With the posting of Personal Rights, Facility Map, Emergency Contact list, and House Values/Expectations. Kitchen: has double door refrigerator/freezer, five (5) burner gas stove/oven (all burners were operational at time of this inspection), two (2) microwaves, a dishwasher, ample plates, cups, and eating utensils. There is also small office space in the kitchen containing a small table with two (2) chairs, and a locked filed cabinet, which will be used to store medication. Laundry area: located off the kitchen, has a stackable washer and dryer, an exit door leading to the side of the home, locked cabinets for storage and a staff bathroom. Report continued on LIC 809C (page 1 of 3) Backyard: has ample space, with turf grass. Detached garage: LPA and LPM was not able to see the garage due to Licensee not having the key, Licensee will get a copy of the key from the property owner. Licensee stated the garage is used for storage for the property owner. Detached Office: LPA's observed to office being used as storage. Bedrooms: Bedroom #1 and #3: have two (2) twin beds; Bedroom #2 has one (1) twin bed. Each room has ample closet space, two (2) drawers for each client, and working combination light/ceiling fans. All bedrooms have a mounted TV. LPA and LPM observed partial security bars on bedroom windows which allow for emergency exiting. Bathrooms: Bathroom #1 is located along the hallway, adjacent to bedroom #1 and has a toilet, tub, and separate shower, and sink. Bathroom #2 is located off the kitchen near the laundry area and has a toilet and sink. Hot water was tested and measured within 105 - 120 degrees Fahrenheit. LPA's observed the home to have a three (3) fully charged fire extinguisher, one (1) in the kitchen, one (1) in the living room, and one (1) along the hallway. The smoke alarms and carbon monoxide detectors were tested and found to be in working. All posting requirements were met. Temperature in the facility is regulated by window mounted air conditioners throughout and electric floor heaters. There is no pool or bodies of water on the premises. The Administrator confirmed that there are no firearms or dangerous weapons on the premises. LPA's observed the facility to be clean, safe, and sanitary. Passageways, stairways, inclines, ramps and open porches are unobstructed. The front and backyard were clean and free of debris. Vehicle: Facility will use a Dodge Caravan to transport the clients. LPA inspected the interior and exterior of the vehicle. LPA observed all seatbelts, the front lights, brake lights, back up lights, blinkers, and horn to be in working order. Vehicle registration is current through June 2025. Report continued on LIC C (page 2 of 3). LPA's reminded Administrator to ensure the following when children are in Place: To make sure to have non- perishable and perishable foods that is not expired, to clean the backyard to be free of debris, to retrieve a copy of the garage key from the property owner. During the inspection, LPA reiterated the importance of submitting Special Incident Reports, Law Enforcement contacts, and to report all changes within the facility to Community Care Licensing and any other appropriate agency. An exit interview was conducted. A copy of this report was left with the Administrator. (Page 3 of 3).

met_with: Leah Hawkins


summary: Facility Evaluation

raw_content:
Narrative:
On 12/30/2025, Licensing Program Analyst, C. White arrived at Daylee Joy Residential for the purpose of conducting an Annual/Required Inspection. LPA met with Facility Manager, Jason Watson who granted access to the facility and together toured the interior and exterior of the facility. The facility is licensed to provide care and supervision to five (5) children, ages 13-17 years old, ambulatory only. The current census is zero (0). The facility is a three (3) bedroom, two (2) bathroom single family home located in a residential neighborhood. The front porch is enclosed with a black iron gate, and the home is set up as follows: Living room, Dining room, Kitchen, Office area, Laundry area, Backyard, Detached Garage, and Detached Office. Living room: has one (1) couch, one (1) ottoman, a mounted TV, and a glass enclosed non-operational fireplace. Dining room: has a wooden table and eight (8) chairs. With the posting of Personal Rights, Facility Map, Emergency Contact list, and House Values/Expectations. Kitchen: a kitchen nook, double door refrigerator/freezer, five (5) burner gas stove/oven (all burners were operational at time of this inspection), two (2) microwaves, a dishwasher, ample plates, cups, and eating utensils, and a covered trash can. Office Area: is located in the kitchen nook. It contains a small table with two (2) chairs, and a locked filed cabinet, which will be used to store medication. Laundry area: located off the kitchen, has a stackable washer and dryer, an exit door leading to the side of the home, and a staff bathroom. Report continued on LIC 809C (Page 1 of 3) Backyard: has ample space, turf grass covers a portion of the area, and there is an additional cemented area. Detached garage: LPA was unable to view the interior due to Licensee not having the key. Facility Manager stated the garage is used for storage for the property owner. Detached Office: LPA observed to office being used for storage. Bedrooms: Bedroom #1 and #3: have two (2) twin beds; Bedroom #2 has one (1) twin bed. Each room has ample closet space, two (2) drawers for each client, and working combination light/ceiling fans. All bedrooms have a mounted TV. LPA observed partial security bars on bedroom windows which allow for emergency exiting. Bathrooms: Bathroom #1 is located along the hallway, adjacent to bedroom #1 and has a toilet, tub, and separate shower, and sink. Bathroom #2 is located off the kitchen near the laundry area and has a toilet and sink. Hot water was tested and measured within 105 - 120 degrees Fahrenheit. LPA observed the home to have a three (3) fully charged fire extinguisher. The carbon monoxide detector and smoke alarms were tested and found to be in working order. All posting requirements were met. Temperature in the facility is regulated by window mounted air conditioners throughout and space heaters. The Facility Manager confirmed that there are no firearms or dangerous weapons on the premises. LPA observed the facility to be clean, safe, and sanitary. Passageways, stairways, inclines, ramps and open porches are unobstructed. The front and backyard were clean and free of debris. LPA reminded Facility Manager to ensure the following when children are in placement: Children are accorded personal rights and to ensure the corresponding form are placed in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. Facility Manager acknowledges abuse reporting requirements. Report continued on LIC 809C (Page 2 of 3) During the inspection, LPA reiterated the importance of submitting Special Incident Reports, Law Enforcement contacts, and to report all changes within the facility to Community Care Licensing and any other appropriate agency. LPA did not review client or staff files as there are no clients in placement at this time. LPA informed Facility Manager, Jason Watson, that the facility would be cited. The following deficiency is being cited for violating of California Code of Regulations Title 22, Division Regulation Section 80023(a) Disaster and Mass Casualty Plan and Regulation Section 84087.2(a) Outdoor Activity Space. (see page D). An exit interview was conducted. A copy of this report was left with the Facility Manager. (Page 3 of 3).

met_with: Jason Watson - Facility Manager


facility_name: DELTA RESIDENTIAL - RIDGE CREST

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
inappropriate sexual incidents among residents, particularly during times when residents are still awake. While residents were upstairs to fall asleep, supervision should not lapse during night time, particularly at a time where it could be reasonably believed that not all residents are yet asleep, as was the case with this incident. Night staff should be present in the facility at a location where supervision can be provided to all residents and all activity can be clearly seen and heard to ensure appropriate intervention can be provided as needed. The preponderance of evidence standard has been met, and therefore the above allegation is found to be Substantiated. LPA is issuing a citation of California Code of Regulations, Title 22, Section 84065. Staff/Child Ratios. LPA also recommends that moving forward, the facility consider the history of and/or tendency for, within the served population, inappropriate sexual incidents and ensure that all residents have appropriate supervision when at the facility together, including those who do not have a specific requirement in their program plan for 24/7 supervision. An exit interview was conducted, appeal rights provided, and a copy of this report left with Facility Manager Liza Tagpis, whose signature on this form confirms receipt.

Investigation Findings:
SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

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

met_with: Facility Manager Liza Tagpis

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On 11/03/22, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility, which has transitioned to an adult facility, to deliver findings for the invesitgation of the above allegation. LPA met with Facility Manager Liza Tagpis and informed of the purpose of the visit. Based on confidential interviews and record review, the allegation pertains to an incident in which a staff member sent inappropriate messages to a then former resident. Based on interviews, it is not clear that any inappropriate messages or interactions occurred or were sent while the resident was in care at this facility. The staff member was immediately removed from the schedule and no longer works for the licensee, and based on interviews, no repeat or similar incident has occurred. Although the allegation may have happened or is valid, based on LPA's observations and interviews, there is not a preponderance of the evidence to prove the alleged violation did or did not occur. Therefore, the allegation is unsubstantiated. An exit interview was conducted, appeal rights provided, and a copy of this report was provided to Facility Manager Liza Tagpis, whose signature on this form confirms receipt. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3


summary: Facility Evaluation

raw_content:
Narrative:
On 4/7/22 at 1PM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility regarding the group home facility closure. LPA met with Supervisor Edwin Isip and Administrator Ryan Busalacchi informed of the purpose of the visit. Safety precautions were taken, including mask-wearing, entry screening, and pre-visit screening call. The facility has received an Adult Residential Facility (ARF) license on 12/14/21 and will be closing the group home facility. Closure letter, closure plan, and forfeited license have not yet been sent to Licensing. LPA requested these items when notified of the transition to ARF and surrender of group home license on 3/2/22. Today, LPA received the formal closure notice and closure plan from Administrator Ryan Busalacchi, as well as the ARF license, and LPA collected the forfeited group home license at visit. LPA issued a citation of Health and Safety Code, Section 1524. See attached LIC 809-D. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Supervisor Edwin Isip and Administrator Ryan Busalacchi, whose signature on this form confirms receipt.

met_with: Supervisor Edwin Isip, Administrator Ryan Busalacchi


summary: Facility Evaluation

raw_content:
Narrative:
On 11/03/22, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility, which has transitioned to an adult facility, to deliver a deficiency citation regarding an investigation at the facility. LPA met with Facility Manager Liza Tagpis and informed of the purpose of the visit. During an investigation at the facility, it was learned that an incident occurred involving a facility staff member sending inappropriate online messages to a former resident shortly after their move to a new placement. While the resident was no longer in care, their online information and/or identifying information to locate them online was secured due to the resident having been in care while the staff member was employed at the facility. The staff member did not ensure the resident was accorded dignity and respect. LPA is issuing a citation of California Code of Regulations, Title 22, Section 84072(d)(1). See attached LIC 809-D. An exit interview was conducted, appeal rights provided, and a copy of this report was provided to Facility Manager, whose signature on this form confirms receipt.


facility_name: DELTA RESIDENTIAL - STONY HILL

summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
... at the facility at between 6-6:30AM, the Facility Manager checked on the resident and then called 911. The resident was assessed by a doctor on the same day of the seizure, and a follow-up evaluation by a neurologist was scheduled. Due to the fact that the resident did not have seizures in their care plan, there was no seizure plan in place, so when the signs of a seizure were recognized, 911 should have been called immediately. The preponderance of evidence standard has been met, and therefore the above allegation is found to be substantiated. LPA is issuing a citation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 6, Section Health Related Services. See attached LIC 9099-D. An exit interview was conducted, appeal rights provided, and a copy of this report left with Supervisor Edwin Isip and Administrator Ryan Busalacchi, whose signature on this form confirms receipt.

Investigation Findings:
SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:


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

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

met_with: Edwin Isip, Facility Supervisor


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

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

met_with: Edwin Isip, Facility Manager


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

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


met_with: Edwin Isip, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 3/7/22 at 10:04AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a required annual inspection. LPA met with Supervisor Edwin Isip and House Manager Maria Tan and informed of the purpose of the visit. A screening call was conducted with Supervisor Edwin and Administrator Ryan Busalacchi prior to visit. Safety precautions taken including mask-wearing and social distancing. The CARES Inspection Tool was used to conduct this inspection. At 10:15AM, LPA toured the facility site. At 11AM, LPA inspected the facility and personnel records. At 2:55PM, LPA had completed the review of facility and personnel records but determined that a follow-up visit would be needed in order to complete the inspection of the resident records and to complete the visit report. LPA communicated the pending items that needed to be addressed and that the full report would be available during the follow-up visit. Supervisor and House Manager stated they agreed and understood. An exit interview was conducted, and a copy of this report was left with Supervisor Edwin Isip, whose signature on this form confirms receipt.

met_with: Supervisor Edwin Isip, House Manager Maria Tan


summary: Facility Evaluation

raw_content:
Narrative:
On 3/11/22 at 11:17AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a case management - annual continuation. LPA met with Supervisor Edwin Isip and House Manager Maria Tan and informed of the purpose of the visit. Safety precautions were taken, including mask-wearing, entry screening, and pre-visit screening call. During the initial inspection on 3/07/22, LPA inspected the facility and grounds and facility and personnel files using the CARES Inspection Tool. LPA continued with the tool to complete the inspection of resident records. At visit, LPA re-toured the facility and reviewed the resident records. At 4:30PM, LPA had completed the review of all records but determined that a follow-up visit would be needed in order to complete the visit report and supplemental pages. LPA communicated the deficiencies with Supervisor and House Manager and that the full report would be available during a follow-up visit. Supervisor and House Manager stated they agreed and understood. An exit interview was conducted, and a copy of this report was left with Supervisor Edwin Isip, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Alyssa Ng on 3/14/22 at 10:45AM. During the inspection, LPA Ng met with Maria Tan (Facility Manager) and inspected the facility inside and out. LPA reviewed 2 of child's records on site at the facility at 11: PM. At 12:30, LPA asked facility manager for staff files regarding training. The facility was given two technical violations during an annual inspection on 3/11/2022 for: CCR 84068.3(a): The needs and services plan specified in Section 84068.2 shall be updated at least every six months to determine the following. CCR 84066(b)(6): The licensee shall maintain the following personnel records: (6) A record of each work performance evaluation and any correspondence with the employee. Both plan of correction dates are on April 4th 2022. LPA reviewed 2 of child's psychotropic medications and records at 1: PM. Due to not having staff files ready for review and needs and service plans available, LPA was unable to review staff files but reviewed C1 and C2's 2020- ISP. LPA interviewed 2 of staff on site at 2: PM. ------ Cont. On Lic809-c------ LPA interviewed 0 clients currently taking psychotropic medication at 2: PM. C1 said waved Hi but was unable to answer questions. C1 seemed to be in good spirits. When counting one of the medications for C1, there was 18 pills extra. Facility Manager advised that C1 went to the hospital for those days and did not know if the hospital gave the medication to C1. LPA Ng advised to put it on a destruction log and properly dispose of the extra medication. LPA conducted exit interview with Maria Tan, Facility Manager at 3: PM. LPA provided the Summary Report to Maria Tan, Facility Manager upon completion. No deficiencies were cited today. LPA conducted exit interview with Maria Tan, Facility Manager at 3: PM.

met_with: Maria Tan


summary: Facility Evaluation - 4 deficiencies

raw_content:
Narrative:
On 3/18/22 at 9:48AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a case management - annual continuation. LPA met with Supervisor Edwin Isip, Facility Manager Maria Tan, and Administrator Ryan Busalacchi and informed of the purpose of the visit. Safety precautions were taken, including mask-wearing, entry screening, and pre-visit screening call. During the initial inspection on 3/07/22, LPA inspected the facility and grounds and facility and personnel files using the CARES Inspection Tool. LPA continued with the tool to complete the inspection of resident records on 3/11/22. Today's visit is to complete and the deliver the report. At visit, LPA re-toured the facility and updated observations of deficiencies listed below. The following was observed: The facility living and meal prep spaces are clean and sanitary; the facility's first aid kit was observed to be complete; personal rights were posted; facility license was posted; smoke detectors are in working condition; water and room temperature measured within permitted ranges. The following deficiencies were observed on 3/7/22 and/or 3/11/22 (See attached LIC 809-D pages): 1) Two (2) unsecured jugs of laundry detergent were observed on the floor in the corner of resident R2's (See attached LIC 811) bedroom. LPA issued a citation of California Code of Regulations (CCR) Section 80087(g). Laundry detergent jugs were immediately removed from the room and placed with locked chemicals. 2) Laundry detergent was stored among food items all accessible to resident R2 as they were stored unsecured in R2's bedroom. LPA issued a citation of CCR Section 80087(i). The laundry detergent jugs were removed, and R2 was moved out of this room by 3/18/22. 3) The storage loft in resident R2's bedroom has no full wall separating the spaces, so R2's bedroom is joint with staff "room" in the loft, meaning staff and resident shared a bedroom. LPA issued a citation of CCR Section 84087(b)(6). R2 was moved out of this room by 3/18/22. 4) More than 10 bottles of empty, expired, or discontinued medications were observed in a locked cabinet in the kitchen, including psychotropic medications, and at least one psychotropic that expired in November... ... 2021 and was filled in 2020. Supervisor and Facility Manager confirmed these should have been destroyed. LPA issued a citation of CCR Section 80075(I). 5) In the kitchen was a bulk stack of peanut butter each with an inch of separated oil and dated "Best before Oct 17 2020" as well as a large jug of chicken flavoring with real chicken in ingredients dated "Jan 29 22." LPA issued a citation of CCR Section 80076(a)(1). Peanut butter and chicken flavoring were removed immediately. 6) The facility uses only a rotation of planned menus and has no saved menus to reflect what was served in case it differed from the planned menu. LPA issued a citation of CCR Section 80076(a)(5). 7) The attached storage loft with low ceiling and accessed by narrow, ladder-like staircase in resident R2's bedroom was observed to be used as a staff bedroom for live-in staff member. The facility was previously cited and advised of the requirement to not use the storage space as a bedroom on 4/19/19. LPA issed a citation of CCR Section 84087(b)(4). R2 was moved out of this room by 3/18/22, and the storage space is no longer being used as a staff bedroom. 8) Facility Manager stated disaster drills are conducted twice a year and that two drills were conducted in 2020, one in 2021, and none so far in 2022. Logs were located for only 3/31/20, 12/17/20, and 9/3/21. LPA issued a citation of Health and Safety Code (HSC) Section 1565(c), which requires quarterly drills. 9) Supervisor and Facility Manager confirmed that restraints have been performed at the facility in the past 6 months but there was no log of manual restraints. LPA issued a citation of CCR Section 84361(f). 10) Staff files for S1, S3, S4, S5 (see LIC 811-C) were observed to have incomplete or missing initial training logs. LPA issued a citation of CCR Section 84065(i). 11) Staff files indicate that less than 20hrs of annual training was received in 2021 and no training record or training certificate for training in 2021 for staff S1, S2, S3, S4, S5 were observed in the files. LPA issued a citation of CCR Section 84065(j)(1). 12) The files for residents R2, R3, R5 were observed to be missing admission agreements, and Supervisor and Facility Manager were not able to locate all missing admission agreements. LPA issued a citation of CCR Section 80070(b)(6). 13) The files for residents R1, R3, R4, R5 were observed to be either missing needs and services and/or behaviorist/Regional Center treatment plans or having plans 2+ years old. LPA issued a citation of CCR Section 84070(b)(11). 14) The files for residents R1, R4, R5 were observed to be missing psychotropic medication consent documentation. LPA issued a citation of CCR Section 84070(b)(12). 15) The medication administration records (MARs) for residents R1, R4, R5 were observed to log... ... psychotropic and non-psychotropic medications jointly rather than psychotropic medications being logged separately on the (or version of) LIC 622B Psychotropic MAR (PMAR). LPA issued a citation of CCR Section 84070(b)(13). 16) Facility Manager stated that the facility keeps old medication bottles, removes the labels, and uses them to transfer medications to that container for residents' home visits. LPA issued a citation of CCR Section 80075(k)(6). 17) The files for residents R1, R5 were missing property/valuables inventory, and the inventories were not updated for 2021/2022 for R2, R3, R4. Facility Manager confirmed that items had since been removed or added, such as shoes or holiday gifts. LPA issued a citation of CCR Section 80026(h). 18) LPA observed that the licensee did not ensure that no bedroom was used as a general passageway to another room due to resident R2's bedroom being the only way to access a ladder-like staircase to the storage loft being used as a staff room for live-in staff member. LPA issued a citation of CCR Section 84087(b)(5). R2 was moved out of the room by 3/18/22, and the storage loft is no longer being used as a staff bedroom. 19) LPA observed that the licensee did not ensure the facility was clean and in good repair due to: smoke detector hanging by wires in the living room; hallway bathroom missing shower curtain and rod; resident R1's bedroom dirty with unsanitary floor, two dirty food containers and spoon on desk, crumbs on all furniture and in crevices, crumbs and wet and dried unknown substances on the floor from the doorway to the closet to the bed, candy wrapper, bowl of dried applesauce, plate with left over crust and residual oil/liquid on plate in the closet, 18 eaten yogurt cups in dresser drawer, two plates, spoon, and 2 hot dog buns in another drawer, cheese wrappers, empty Ensure drink bottle, empty jar of parmesan cheese in another drawer. Facility Manager stated the rooms are cleaned daily and that R1 makes this mess in one day. LPA issued a citation of CCR Section 80087(a). Shower curtain and rod replaced and R1's room cleaned by 3/11/22, and smoke detector secured by 3/18/22. LPA advised of the following deficiencies (See attached LIC9102 pages): 1) LPA observed that complaint procedures were not posted in the facility. LPA advised of this requirement, per CCR Section 84072.2(a)(3). Complaint procedures posted by 3/18/22. 2) LPA observed that emergency drills were not conducted quarterly as required and that documentation of drills was not available in the facility records. Facility Manager had to locate the logs from their computer and had difficulty locating them all. LPA advised, per CCR Section 80023(d)(2), that all logs be maintained at the facility site in either an electronic file accessible to licensing personnel during all visits or in the physical... ... facility files. 3) LPA observed that all staff files were missing work performance evaluations. Supervisor stated that performance evaluations are maintained in the confidential files at the administrative office. LPA advised, per CCR Section 84066(b)(6), that the facility maintain a record of work performance evaluations and also that per Section 80066(e)(1), the facility ensure all personnel records are accessible at/from the facility site. 4) During visit on 3/7/22, LPA observed that there were confidential client documents scattered and disorganized on a table in the garage. During visit on 3/11/22, LPA observed that staff left the laundry room open as well as the garage door while two residents were present and walking around the facility. Residents could have entered the garage and grabbed the documents, which LPA discussed with Facility Manager. Having the documents disorganized and outside of the proper secured file storage area does not encourage maintenance of confidentiality of documentation. LPA advises, per CCR Section 80070(c), that the facility ensure the garage door is kept closed and locked while residents are at the facility and that the facility remove and properly store the client documents currently in the garage. Garage was cleaned by 3/18/22. 5) LPA observed that residents R1 and R3 files were missing signed medical care consent forms. LPA advises, per CCR Section 84070(b)(10), that the facility ensure consent forms are signed by the authorized representative at admission. 6) LPA observed that needs and services and treatment plans were missing from the files and the plans that were in some of the residents' files were more than a year old, which was discussed with Facility Manager and Supervisor. LPA advises, per 84068.3(a), that needs and services should be maintained and should be updated at least every six months. 7) LPA observed that the facility did not maintain documentation of bedroom sharing arrangements. LPA advised, per CCR Section 84087(e), that the facility begin documenting bedroom sharing and that residents are compatible and maintain this documentation in the file of each child sharing a bedroom. An exit interview was conducted, and a copy of this report was left with Administrator Ryan , whose signature on this form confirms receipt.

Deficiencies:
84361(f): Documentation and Reporting Requirements

(f) The licensee must maintain a monthly log of each use of manual restraints. The log must include
84065(i): Personnel Requirements

(i) Notwithstanding Sections 80065(f)(1) through (6), new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16 hour training as specified in (1) and (2) below
80026(h): Safeguards for Cash Resources, Personal Property, and Valuables

(h) Each licensee shall maintain accurate records of accounts of cash resources, personal property, and valuables entrusted to his/her care, including, but not limited to the following
94066: Delta Residential - Stony Hillfacility Number: 075650106 Visit Date: 03/18/2022 Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32... 2021 and was filled in 2020.  Supervisor and Facility Manager confirmed these should have been destroyed.  LPA issued a citation of CCR Section 80075(I).
5) In the kitchen was a bulk stack of peanut butter each with an inch of separated oil and dated "Best before Oct 17 2020" as well as a large jug of chicken flavoring with real chicken in ingredients dated "Jan 29 22."  LPA issued a citation of CCR Section 80076(a)(1).  Peanut butter and chicken flavoring were removed immediately.
6)

met_with: Supervisor Edwin Isip, House Manager Maria Tan, Administrator Ryan Busalacchi

title: Facility Name


summary: Facility Evaluation

raw_content:
Narrative:
On 2/21/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a required annual inspection. LPA met with Administrator Ryan Busalacchi, Supervisor Edwin Isip, and Facility Manager Frances Nelson and informed of the purpose of the visit. The CARE Inspection Tool was used to conduct this inspection. During visit, LPA conducted two staff interviews and two resident observations. Residents returned from school around 4PM. At the end of visit, LPA encountered a system error that resulted in LPA's computer freezing and prevented the report from being completed and provided to licensee at visit. LPA completed report and provided to licensee on 2/22/23. During inspection, LPA observed the facility to have made significant improvements in compliance from the previous year's annual, including better file organization and implementation of staff training and resident activities. Food was within date, fresh, and stored correctly. One tub of expired sour cream that did not have visible mold was disposed of during visit. Hot water measured within permitted range, and the fridge was maintained at a temperature within permitted range. Planned menus and as served menus were maintained. Restraint log was maintained. Staff interviewed were knowledgeable of facility procedures and mandated reporting duties. Residents observed appeared dressed in clean, appropriate clothing and to be comfortable with staff present at the facility, evidenced by approaching and engaging with staff upon return from school. However, the following concerns require addressing. Two cigarette butts were observed with staff on the back patio near the rear sliding door. Construction items/supplies of a large nail on the ground and planks of wood with nails sticking out were observed in the side yard accessible to residents in care, with more planks in the other, gated-off side yard. The large nail was immediately removed by staff. Multiple areas of unknown brown substances were observed... ...on the wall of the kitchen by the table, on the wall and back door of the rear bedroom, and on the ceiling of the middle hallway bedroom. The word "crime" was graffitied on the dresser in the middle hallway bedroom, and curse words were graffitied on the door of the rear bedroom and on two walls in the dining room, the latter of which staff statements indicate were not in the last two weeks. Residents R2 and R3 (See LIC Confidential Names List) are prescribed levetiracetam and trazadone, respectively, and neither medication was logged on a separate log. Staff files contained missing or incomplete initial training logs for staff S1, S2, and S3 (See LIC 811), and all staff files reviewed were missing at least some certificates for trainings licensee confirmed staff attended. Activity supplies could not be located in the facility. LPA is issuing 2 citations of Buildings and Grounds, 2 citations of Fixtures, Furniture, Equipment, and Supplies, 1 citation of Children's Records, and 1 citation of Personnel Requirements. LPA is assessing two civil penalties of $250 each, $500 combined, for repeat violation of the same subsections of Sections 80087 and 84070, which were previously cited on 3/18/22. See LIC 809-Ds and LIC 421s. Additional advisories were provided, which are not citations. See LIC 9102s. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Supervisor Edwin Isip and Administrator Ryan Busalacchi, whose signature on this form confirms receipt.

met_with: Administrator Ryan Busalacchi, Supervisor Edwin Isip; Facility Manager Frances Nelson


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Shikya Belfield on 3/1/2023 at 10:40AM. During the inspection, LPA Belfield met with Edwin Isip, Supervisor and Ryan Busalacchi Licensee. The facility is licensed to serve 6 clients. Currently there are 5 clients residing in the facility. No clients were present at the start of this inspection. The facility has three verball clients and two verbal cleints who were at school during the inspection. LPA reviewed 3 of child's records, 2 staff files, interviewed one staff and observed facility files. A walk-through of the facility was conducted with supervisor Isip and Licensee Ryan B. Observed during this inspection, the facility was clean and free of obstructions, proper signs were posted such as personal rights poster, menus were observed, bedrooms were observed with proper storage. During a staff file review the training conducted for psychotropic medications did not include the information used for sufficient training. staff files were observed to have this training conducted in 2022 and not as apart of the initial and ongoing training in the California Code of regulations section 84065(k)(7). Facility issued Technical Assistance advisory for section 84065(k)(7) Personnel Requirements. LPA reviewed three clients ISP ( needs and service plans) and they were not signed by the clients social worker. It was discussed with licensee that that the request should be made to obtain signatures from the social workers. Licensee agrees to this as stipulated by signing this report. LPA also observed in one client file, the JV223 was expired. communication was observed with facility and social worker and the JV223 is currently still in process. Communication was observed buy this LPA that the reason for not having updated form on file is due to county social worker not completing the process at this time. Advisories issued. No citation for violation of California Code of Regulations, title 22, Division Six, were cited during this inspection. An exit interview was conducted a copy of this report will be sent to licensee Ryan Busalacchi.

met_with: Edwin Isip


summary: Facility Evaluation

raw_content:
Narrative:
On 2/29/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a required annual inspection. LPA met with Supervisor Edwin Isip and informed of the purpose of the visit. The CARE Inspection Tool was used to complete this inspection. LPA toured the facility site and grounds and reviewed facility, personnel, and resident records. LPA observed the facility to be free of hazards. Chemicals, medications, and sharp or potentially dangerous household items are stored where inaccessible to residents in care. Bedrooms are clean and organized and maintained in safe condition. During inspection, LPA observed the following which require follow-up: 1) Staff S5 (See LIC Confidential Names List dated 2/29/24) does not have a background clearance. LPA is issuing a citation of California Code of Regulations, Title 22, Section 80019(e) Criminal Record Clearance. See attached LIC 809-D. In addition, pursuant to Section 80019(g), LPA is assessing an immediate civil penalty of $100 per five days in violation for a total of $500. See LIC 421BG dated 2/29/24. 2) LPA observed food splattered on the kitchen walls as well as sticky substances on the interior and exterior of kitchen cabinets with dust stuck to the substances. LPA is issuing citations of California Code of Regulations, Title 22, Section Buildings and Grounds and Food Service. See attached LIC 809-D. LPA observed additional areas in which technical assistance can be beneficial. See LIC 9102s dated 2/29/24. A continuation visit will be required to complete this inspection. Licensee also agrees to submit a current LIC 500 to LPA by 3/1/24. An exit interview was conducted, appeal rights provided, and a copy of this report left with Supervisor Edwin Isip, whose signature on this form confirms receipt.

met_with: Supervisor Edwin Isip


summary: Facility Evaluation

raw_content:
Narrative:
On 3/11/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a continuation inspection for the required annual inspection conducted on 2/29/24. LPA met with Supervisor Edwin Isip and informed of the purpose of the visit. Using the CARE Inspection Tool, one additional deficiency was found. LPA observed that fire drill logs had not been maintained since December 2023 and the documentation for the October and November 2023 drills did not document the date of the drill. LPA is issuing a citation of California Code of Regulations, Title 22, Section 80023. See attached LIC 809-D. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Supervisor Edwin Isip, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 07/24/24, Licensing Program Analysts (LPAs) Kristin Pierotti and Celeste Aparicio conducted a visit to the facility for a case management inspection. LPAs met with the Facility Administrator and Facility Supervisor and informed on the purpose of the visit. During the inspection at the facility, LPAs became aware of an area in which technical support may be beneficial. LPAs observed two residents in care to be above the age of eighteen. Based on observation and records review, the Licensee does not have age exceptions in place for the two residents above the age of eighteen. LPAs discussed the process of requesting age exceptions with the Facility Administrator and the Facility Supervisor, who stated they will be submitting a request to the Department. LPA is issuing an advisory for the technical violation of California Code of Regulations, Title 22, Section 80024(a). An exit interview was conducted, and a copy of this report was left with the Facility Administrator, whose signature on this form confirms receipt.

met_with: Aaron Busalacchi


summary: Facility Evaluation

raw_content:
Narrative:
On 02/10/2025, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced Annual Inspection at listed facility. LPA met with Edwin Isip, Facility Manager and toured the facility inside and out. The Group Home is licensed to serve 6 clients. Present during the inspection were 1 staff and 0 clients. At 11:00am, LPA Pierotti reviewed client and staff files. Client files were complete and contained all necessary documents. Client Needs and Services Plans were reviewed and were current. Staff files were complete and contained all necessary documents. Staff training logs were reviewed and all staff have completed the necessary training. At 12:45pm, LPA Pierotti toured the facility. LPA Pierotti observed 3 bedrooms and 2 bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Pierotti tested the water temperature and found it to be 115.2 degrees which is in range. The thermostat read 68 degrees which is within range. Sharps were locked in the staff room and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored safely and in a locked cabinet in the kitchen. LPA reviewed client's medication logs and found them to be complete and up to date. The facility is in good repair and clean. At 1:00pm, LPA Pierotti toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. LPA Pierotti interviewed 1 staff and 0 clients. All clients were at school during the time of the inspection. The majority of the clients who reside in the home are non-verbal. LPA will attempt to conduct client interviews with the verbal clients at a later date. At this time there were no deficiencies found. An exit interview was conducted and a copy of this report was given to Facility Manager whose signature confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 03/10/25 at 1:40pm, Licensing Program Analyst (LPA) Kristin Pierotti conducted a Case Management inspection at the facility. LPA met with Rose Anne Clark, Staff who assisted in calling the Administrator and Facility Manager. LPA called Administrator and Facility Manager who did not answer. LPA waited 10 minutes at the facility for a response. LPA will return at a later date and time to conduct the inspection. An exit interview was conducted and a copy of this report was left with, Rose Anne Clark, whose signature confirms receipt.

met_with: Rose Anne Clark


summary: Facility Evaluation

raw_content:
Narrative:
On 03/14/25 at 12:50PM, Licensing Program Analysts (LPAs) Simran Nayyar, Hanako Primer, and Licensing Program Manger (LPM) Carolyn Flynn made an unannounced case management inspection to the facility. They met with Edwin Isip, Supervisor, and had Ryan Busalacchi, Licensee on the phone. The purpose of inspection was to deliver an immediate exclusion notice for staff member, Aura Orozco Martinez. The immediate exclusion of Ms.Martinez is a direct result of an investigation by the California Department of Social Services (CDSS), it has been determined that she engaged in inimical conduct while working as a staff at this licensed facility. As a result of this visit, there were no deficiency observed. Exit interview was conducted and a copy of this report was provided to Edwin Isip, Facility Manager whose signature confirms receipt of these documents. The report will also be emailed to delta@deltahomes.org.

met_with: Edwin Isip, Supervisor