raw_content:
Narrative:
Confidential interviews reported a bruise on the arm and a two-inch bruise on the leg of Client 1 (C1). Confidential interviews reported that these bruises resulted from C1 being physically pushed by another client (C2). Confidential interviews reported that this incident was witnessed by a facility staff member (unknown). Confidential interviews reported that the facility's Emergency Intervention Plan states that staff shall use verbal counseling, body positioning, and as a last resort, manual restraints when clients fight or engage in excessive physical horse-playing. Confidential interviews reported that C1 wasn't in a physical fight with C2. Confidential interviews reported that C2 pushed C1 while "horse-playing" in the bedroom. Confidential interviews reported that it was unknown if a staff member witnessed this incident. Confidential interviews reported that a review of the Facility's Special Incident Reports didn't have a record of a fight or horse-playing incident between C1 and C2 that resulted in bruising. Confidential interviews reported that a review of the facility's surveillance videos did not show any pushing or fighting incident between C1 and C2 within the time period addressed in the complaint in the common areas. Other confidential interviews reported no documented instances when staff failed to intervene properly when clients in the cottage engaged in horse-playing or fighting behaviors. Based on inconsistent confidential interviews, the allegation that staff failed to follow Emergency Intervention Plan resulting in a physical altercation between clients, may have occurred, however, is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted. A copy of this report, LIC 811 and appeal rights was explained and given to Quality Assurance Manager Amanda Bell.

Investigation Findings:
13On 03/13/2023 at 11: AM, Licensing Program Analyst (LPA) Joon Choi conducted an unannounced visit to ChildHelp Yvonne Fedderson and Sara O'Meara Short Term Residential Treatment Facility (STRTP) and met with Quality Assurance Manager Amanda Bell (QA), to deliver the investigative findings for the allegation listed above with. On 01/10/2023, LPA Sarah Lo and Licensing Program Manager (LPM) Cheraki Davis visited the facility, obtained pertinent paperwork, and conducted an initial health and safety inspection of Cottage 1A. No immediate health and safety hazards were observed. On 01/31/2023, LPA Choi conducted a follow-up visit to the facility and interviewed clients and staff. On 02/09/2023, LPA Choi made another follow-up visit to the facility and conducted a health and safety inspection of Cottage 1A. No immediate health and safety hazards were observed. LPA interviewed County Social Worker (CSW), clients (C1-C5) and staff (S1-S9). On 02/02/2023, Community Care Licensing received an allegation that staff (unknown) failed to follow Emergency Intervention Plan resulting in a physical altercation between clients (C1 and C2). CONTINUED ON THE NEXT PAGE UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Joon R Choi 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP-YVONNE FEDDERSON & SARA O'MEARAFACILITY NUMBER: VISIT DATE: 03/13/2023

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


state: CA

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Confidential interviews reported that a client (C1) was trying to exit their room by moving around S6. Confidential interviews reported that S6 pushed C1 to the ground as C1 was trying to walk past them. Confidential interviews reported that C1 got up and pushed S1 back after S1 pushed C1 onto their bed. Confidential interviews reported that a client disclosed to their authorized representative that S6 physically pushed C1 to the floor and to their bed, as C1 was trying to walk past S6. Confidential interviews reported that C1 wanted to move past S1 to fight another client (C6). Other confidential interviews reported that there were no incidents involving C1 or any other clients in the living unit, which involved staff physically pushing clients. Confidential interviews reported that there was no video surveillance footage or documents of Special Incident Reports that involved a staff member pushing a client. Confidential interviews reported that staff was unsure if the pushing occurred in the client's bedroom where there weren't video cameras or a possibility it could have happened in a blind spot where videos were not able to capture any recording. Community Care Licensing received another allegation that facility staff (S6) made inappropriate comments toward a minor (C1). Confidential interviews reported that a staff member (S6), told a client (C1), "I will f you up." Confidential interviews reported that S6 said this statement to C1 during the alleged pushing incident mentioned above. Confidential interviews also reported that when C1 was experiencing a difficult situation, staff members (S6, S7, S8, and S9) were taunting C1 and not utilizing professional language. Confidential interviews reported that a client disclosed to their authorized representatives that (S6-S9) were not using appropriate language to help C1 calm down when C1 was struggling with their behavior. Other confidential interviews reported that the staff members assigned to C1's living unit have never cursed at clients and always used a warm and professional approach when interacting with clients. Based on inconsistent confidential interviews, the allegations that facility staff pushed minor to the ground and on to a bed and facility staff made inappropriate comments toward minor, may have occurred, however, is not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted. A copy of this report, LIC 811, and appeal rights were explained and given to Quality Assurance Manager Amanda Bell.

Investigation Findings:
13On 03/21/2023 at 01: PM, Licensing Program Analyst (LPA) Joon Choi conducted an unannounced visit to ChildHelp Yvonne Fedderson and Sara O'Meara Short Term Residential Treatment Facility (STRTP) and met with Quality Assurance Manager Amanda Bell, to deliver the investigative findings for the allegations listed above. On 02/16/2023, LPA Joon Choi visited the facility, obtained pertinent documents, conducted an initial health and safety inspection of Cottage 1B, and interviewed three staff and two clients. No immediate health and safety hazards were observed. On 02/28/2023, LPA Choi made a follow-up visit to the facility, conducted a health and safety inspection of Cottage 1B, and interviewed an additional client and two staff. No immediate health and safety hazards were observed at the follow-up visit. LPA interviewed clients (C1-C7) and staff (S1-S5 and S7-S9). LPA attempted to interview S6 but was unsuccessful due to S6 no longer being an employee at the STRTP and not returning LPA's telephone calls. On 02/14/2023, Community Care Licensing received an allegation that facility staff (S6) pushed a minor (C1) to the ground and onto a bed. CONTINUED ON THE NEXT PAGE UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Joon R Choi 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP-YVONNE FEDDERSON & SARA O'MEARAFACILITY NUMBER: VISIT DATE: 03/21/2023

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

report_type: Complaint Investigation

met_with: Amanda Bell, Quality Assurance Manager

complaint_status: unsubstantiated


raw_content:
Narrative:
Confidential interviews reported that another client (C2) witnessed the incident. Other confidential interviews reported that C2 left the unit with C1 in the same incident. Confidential interviews reported that C2 also witnessed S4 kick C1. Confidential interviews reported that one of the other clients (C3) did not witness the incident. Confidential interviews reported that S4 did not kick C1 and that C1 and C2 eventually returned to the living unit after being visually supervised and redirected by S4 and S5. Other confidential interviews reported that the Special Incident Report (SIR) obtained does not mention any physical contact between S4 and C1. Confidential interviews reported that since this incident happened outside of the living unit, no surveillance cameras picked up any video evidence of this incident. Confidential interviews reported that S4 denies kicking or hitting C1. Based on inconsistent confidential interviews, the allegation that staff kicked minor, may have occurred, however, is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted. A copy of this report and appeals rights was explained and given to Executive Director Lawrence Story.

Investigation Findings:
13On 05/12/2023 at 10: AM, Licensing Program Analyst (LPA) Joon Choi conducted an unannounced visit to ChildHelp Yvonne Fedderson and Sara O'Meara Short Term Residential Treatment Facility (STRTP) and met with Executive Director Lawrence Story, to deliver the investigative finding for the allegation listed above. On 04/18/2023, LPA Choi made the initial visit to the facility, interviewed three staff (S1, S2, and S3), obtained pertinent paperwork, and conducted an initial health and safety inspection of Cottage 1B. No immediate health and safety hazards were observed. Client 1 (C1), Client 2 (C2), Client 3 (C3), Staff 4 (S4), Staff 5 (S5), and Staff 6 (S6) were interviewed at a later date. Client 4 (C4) was unable to be located. On 03/29/2023, Community Care Licensing received an allegation that staff (S4) kicked a minor (C1). Confidential interviews reported that C1 left their living unit without permission, and S4 was called to assist. Confidential interviews reported that S4 attempted to redirect C1 back to the living unit, but when C1 refused and walked away from S4, S4 kicked the back of C1's foot. CONTINUED ON THE NEXT PAGE UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Joon R Choi 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP-YVONNE FEDDERSON & SARA O'MEARAFACILITY NUMBER: VISIT DATE: 05/12/2023

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

met_with: Lawrence Story, Executive Director


facility_name: CHILDHELP-YVONNE FEDDERSON & SARA O'MEARA

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Toni Castillo met with Amanda Bell Manager of Quality, Lawrence Story Executive Director and Manuel Barragan Director of Support Services for the purpose of a pre-licensing visit for a short term residential treatment program ( STRTP) to be licensed with a capacity of 16 in order to meet department of health care services (DHCS) requirements for the Institute for Mental Health Diseases IMD program. During the visit LPA completed a health and safety assessment of the facility (site # Yvonne Fedderson site). This site is designated for females. During the assessment LPA observed the site has two wings each wing mirrors one another. Each wing has space for 8 placement's. Wing A: consists of 4 bedrooms, 2 twin beds, closet and dresser space, desks, ample lighting, hygiene supplies, mattress covers, fitted and flat sheets, comforters and pillows. Restroom with 4 sinks, 3 showers and 3 toilets. Kitchen area with a pantry for snacks. Dining room with tables and chairs for 8 clients. Smoke detectors and carbon monoxide were tested and are in operable working order, water temperature is no more then 120 degrees, there are no bodies of water. Family room with sofas and recreation space. Wing B: consists of 4 bedrooms, 2 twin beds, closet and dresser space, desks, ample lighting, hygiene supplies, mattress covers, fitted and flat sheets, comforters and pillows. Restroom with 4 sinks, 3 showers and 3 toilets. Kitchen area with a pantry for snacks. Dining room with tables and chairs for 8 clients. Smoke detectors and carbon monoxide were tested and are in operable working order, water temperature is no more then 120 degrees, there are no bodies of water. Family room with sofas and recreation space. Daily meals are prepared in a centralized kitchen and brought to each wing. Laundry and nursing office is in a centralized location, where all medication is stored and locked. Bulletin board with all required documents posted. Personal rights, grievance procedures, emergency and disaster plan. food menu, daily schedule and activity schedule. There are no corrections needed at this time. LPA observed the physical plant to be well maintained for a capacity of 16.

report_type: Facility Evaluation

visit_type: Prelicensing

met_with: Amanda Bell


summary: Facility Evaluation

raw_content:
Narrative:
LPA Toni Castillo conducted a meeting with applicant Childhelp-Yvonne Fedderson &Sara O'Meara. The purpose of the meeting was to complete Component II and III. Present at the meeting were Amanda Bell Manager of Quality, Lawrence Story Executive Director and Manuel Barragan Director of Support Services. During the meeting LPA discussed with Amanda Bell and the overall operation and services provided in the facility. This is a 16 bed short term residential treatment facility (STRTP) application. During the meeting the program statement, plan of operation including AWOL and emergency intervention was discussed. The application forms was also discussed. The following documents are needed for revision: -Updated LIC 200 (change to initial application (need original signatures) -A new LIC 610 emergency disaster form with correct pending license number and original signatures. -All staff need to be associated to this pending license number through Guardian system, Applicant can -submit a LIC 508 for CCL to associate staff. -Facility sketch in order to request a fire clearance. -Updated LIC Staff roster Exit Interview was conducted. It was discussed with facility representative that in the event of any other corrections be needed LPA will notify applicant.


facility_name: CHILDHELP - BAKER

summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Narrative:
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove C1 engaged in inappropriate online behavior while in care due to lack of supervision did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted with Arlene Martinez, Head of Service. A copy of this report and appeal rights were provided to Arlene Martinez, Head of Service.

Investigation Findings:
13On August 15, 2022, at 12: PM, Licensing Program Analyst (LPA) Eduardo Barragan conducted a complaint inspection at ChildHelp-Johnson and met with Arlene Martinez, Head of Service. The purpose of the inspection was to deliver the findings for the above complaint allegation. LPA Adrian Mendez conducted an inspection of the facility on October 28, 2021, and no deficiencies were noted. LPA interviewed two of two clients (C1, C2), three of three staff (S1, S2, S3), reviewed staff notes, Needs and Service reports, and Incident Report. The Department has investigated the complaint alleging C1 engaged in inappropriate online behavior while in care. Specifically, C1 was talking to an adult on the Internet. Confidential Interviews revealed that C1 did speak via Tiktok with an adult, and staff found out about it after reviewing the computer later that evening. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Eduardo Barragan 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 SO. Region Ac/res., 770 the City Dr., SUITE FACILITY NAME: CHILDHELP - BAKERFACILITY NUMBER: VISIT DATE: 08/15/2022

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

met_with: Arlene Martinez, Head of Service


raw_content:
Narrative:
Based on records reviewed, records indicated that the facility raised concerns with the placing agency regarding behaviors that would lead to C1's placement being terminated with the facility. Confidential interviews revealed that the facility issued a 14-day notice of terminating C1's placement to the placing county. Confidential interviews revealed that the facility did not give the placing agency the 14 days length of the notification. Confidential interviews resulted in conflicting information regarding the information surrounding the discharge of C1 from placement with the facility. Based on confidential interviews and records reviewed, the allegation that the facility abandoned C1 at the hospital, may have occurred, however is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. Exit interview was conducted and a copy of this report, along with appeal rights were explained to Administrator Carlee Kaczynski. Due to printer malfunction, this report will be emailed to Administrator Carlee Kaczynski.

Investigation Findings:
13On August 31, 2022, at 11:12am, Licensing Program Analyst (LPA) Adrian Mendez arrived unannounced to the facility and met with Administrator Carlee Kaczynski of Childhelp-Baker to discuss the investigative finding for the allegation noted above. LPA conducted an inspection with the facility on December 13, 2021, at 10:33am, no deficiencies were noted. During the investigation LPA interviewed one County Social Worker (CSW), and two facility staff (S1, S2). During the investigation, LPA reviewed one Needs and Services Plan (NSP)/Child Family Team (CFT) meeting notes, and facility written correspondence with county placing agency. On December 8, 2021, the Department received an allegation that the facility abandoned minor at hospital. It was reported that C1 was hospitalized and the facility closed C1's bed leaving C1 without a placement after being discharged from the hospital. It was also reported that the facility did not make any attempts at placement preservation and that the facility did not request an emergency CFT. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Adrian Mendez 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 CCLD Regional Office, THE CITY DR., SUITE FACILITY NAME: CHILDHELP - BAKERFACILITY NUMBER: VISIT DATE: 08/31/2022

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

met_with: Carlee Kaczynski


raw_content:
Narrative:
Based on confidential interviews, and records reviewed, the allegation that C1 is having sexually graphic conversations with adults is unsubstantiated. Meaning, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted and a copy of this report, along with the appeal rights were explained to Administrator Joseph Alvarado. Due to printer malfunction, this report will be emailed to Administrator Joseph Alvarado.

Investigation Findings:
13On January 12, 2023, at 10:27am, Licensing Program Analyst (LPA) Adrian Mendez arrived unannounced to the facility and met with Administrator Joseph Alvarado of Childhelp-Baker to discuss the investigative finding for the allegation noted above. LPA Lisi Leon conducted an inspection with the facility on January 27, 2022, at 11:45AM, no deficiencies were noted. During the investigation LPA interviewed five children (C1, C2, C3, C4, C5), and one facility staff (S1). During the investigation, LPA reviewed C1's Needs and Services Plan. On January 24, 2022, the Department received an allegation that a minor in care is having sexually graphic conversations with adults. It was reported that C1 was found to be exchanging graphic images and videos with adults via a social media application. Confidential interviews resulted in inconclusive information regarding how frequently staff check on or monitor the youth while using the internet or social media. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Adrian Mendez 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 CCLD Regional Office, THE CITY DR., SUITE FACILITY NAME: CHILDHELP - BAKERFACILITY NUMBER: VISIT DATE: 01/12/2023

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

met_with: Joseph Alvarado


raw_content:
Narrative:
Confidential interviews confirmed that on multiple occasions the facility ran out of food and household items for the minors in care. LPA Munoz observed during an unannounced visit conducted on 9/7/23 that there was approximately three days of non-perishable foods and only a half of a day of perishable foods not in the facility. In addition, the posted menu indicated that they were having steak and vegetables and LPA observed that the facility did not have the food items needed to prepare the meal. Confidential interviews revealed that in place of menu items clients have been served frozen convenient meals. LPA returned to the facility on 10/11/23 and made the same observation. Confidential interviews also confirmed that the facility would run out of toilet paper, paper towels, and trash bags. Based on confidential interviews, the preponderance of evidence standard has been met and the allegations that the staff do not serve minors nourishing meals and that staff do not maintain household items at the facility to meet minors' needs are substantiated. The STRTP facility is being cited for violations of Interim Licensing Standards (ILS), version 5, Article 6 continuing requirements, section 87076 (c ) (1) Food Service and ILS version Article 7 section 87088(c ) (3) Fixtures, Furniture, Equipment, and Supplies. 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.

Investigation Findings:
13On April 17, 2024, at 10: AM, Licensing Program Analyst (LPA) Guadalupe Munoz arrived unannounced at the facility and met with Brittnie Peluso, Program Director, to discuss the investigative finding for the allegations noted above. LPA obtained documents pertinent to the investigation. PA conducted an inspection of the facility on 09/07/2023 at 3:00 pm and no deficiencies were observed. LPA Interviewed three staff (S1-3) and interviewed three clients (C1-3). On 09/01/2023, Community Care Licensing (CCL) received an allegation that staff do not serve minors nourishing meals and that staff do not maintain household items at the facility to meet minors' needs. Specifically, it was reported that there wasn't enough food stored at the facility to serve minors a proper meal. Additionally, household items such as, toilet paper, paper towels and trash bags were unavailable as there was no back stock. 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: CHILDHELP - BAKERFACILITY NUMBER: VISIT DATE: 04/17/2024

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: Brittnie Peluso


raw_content:
Narrative:
Based on confidential interviews and documents reviewed, that staff speak inappropriately to minors in care, which may have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was reviewed with Program Director. A copy of this report, LIC 811, and appeal rights was provided to the Administrator. A copy of this report will be placed in the facility file.

Investigation Findings:
13On April 17, 2024, at 11: AM, Licensing Program Analyst (LPA) Guadalupe Munoz arrived unannounced at the facility and met with Brittnie Peluso, Program Director, to discuss the investigative finding for the allegation noted above. LPA conducted an inspection of the facility on 10/19/2023 and no deficiencies were observed. LPA Interviewed three staff (S1-3) and interviewed three clients (C1-3). On 10/16/2023, Community Care Licensing (CCL) received an allegation that staff speak inappropriately to minors in care. Specifically, it was reported that "staff provoke" minors in care be calling them "attention seekers" and "weak". Confidential interviews revealed conflicting statements, whether or not staff speak inappropriately to minors in care. It was revealed that staff was communicating information regarding clients verbally during shift change and it was also reported that on 9/16/ Program Director met with all staff and addressed them about not gossiping about youth cases and behavioral challenges. UnsubstantiatedEstimated 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: CHILDHELP - BAKERFACILITY NUMBER: VISIT DATE: 04/17/2024

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


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Latricia Rogers conducted a annual inspection. The facility converted from a Group Home to STRTP (Short Term Therapeutic Program) on November 16, 2020. LPA was met at the facility by Carlee Kaczynski, Facility Manager, Heather Michelson, Program Coordinator for quality and Mark Jones, Residential Program Manager. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment/toys/books/games were observed for children's recreation time. All facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. There was no food supply available in the facility as facility has been closed and without client placements since March 2021. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster. No Medications were reviewed as there are no current client placements in the facility since March 2021. Licensee has provisions for contraceptives to be held in individually locked containers by clients. Individual beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. The hot water in the client's bathroom was measured to be 117.9 degrees. Facility has no cameras in common areas of the facility. Per facility staff, no firearms or weapons are allowed in the facility. Facility appears to be meeting the terms and conditions of their license. Facility Manager, Carlee Kaczynski is present at the facility a minimum of 20 hours a week, as verified by staff schedule and interviews. Appropriate staff/client ratios were verified during this inspection. The facility employs Therapists, 1 facility managers and 12 direct care staff to begin when clients are placed at the facility. Licensee has Mental Health Certification since November 2020 with Orange County. Licensee has obtained National Accreditation through Council on Accrediation. The Accreditation is valid through October 2021. Licensing fee payments have been paid and there is currently a balance of 0. LPA discussed the following with the Administrator: Incident reporting, including incidents related to Assembly Bill 388 law enforcement contacts as well as incidents involving emergency interventions. LPA discussed procedures for Child and Family Team (CFT) meetings, including an overview of required Core Services and Supports. Based upon interviews with staff, the Licensee appears to be meeting CFT and Core Services/Supports requirements. Personnel files were reviewed to ensure they contained all required documentation per Title Regulations. Personnel Files are at the corporate office in Beaumont, California and all required information was faxed over to facility for review. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. Staff interviews were conducted and revealed no issues. No deficiencies were noted in the areas during time of inspection

visit_type: Annual

met_with: Carlee Kaczynski- Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Latricia Rogers & Licensing Program Manager Angela King conducted a case management inspection October 18, 2022 based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 6 out of Direct Care Staff and 5 out of 5 youth files were reviewed. 3 out of Direct Care Staff and 3 out of 5 youth were interviewed. (See the Confidential Names List, LIC 811, dated October 18, 2022). The Plan of Operation including policies and procedures were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, and crisis intervention plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Latricia Rogers observed documentation of completed training records showing staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Joseph Alvarado, Administrator.

visit_type: Case Management

met_with: Joseph Alvarado-Administrator


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On June 22, 2023 at 9: AM, Licensing Program Analyst (LPA) Joon Choi conducted an unannounced annual inspection at ChildHelp Baker Short Term Residential Therapeutic Program (STRTP). LPA was met by Teaching Family Specialist (TFS) Latoya Hollis. The facility is a four bedroom, 2 bathroom -one story home with a living room, dining room, kitchen, two car garage, and backyard with a patio. Please note, that one of the bedrooms is used as a therapy office and in the therapy office is a bathroom that is not used by clients. Also, the garage is used as a staff office. The facility's two registered vehicles are parked in the drive way full-time. LPA observed the following postings located in the front entry way and dining area: facility license, grievance procedures, Personal Rights, Foster Youth Bill of Rights, the (contact information for the California Foster Care Ombudsman is on the Foster Youth Bill of Rights poster), visitation policies, LPA began a physical plant inspection at 9: AM assisted by TFS. LPA inspected the facility's kitchen, dining area, refrigerator/freezers, food storage areas, garage, living room, staff office, therapy office, three client bedrooms (B1,B2,B3) and one client bathroom. The bedrooms were arranged so that no more than two clients are were assigned to a room, and there is one client per bed and a shared closet. Each client room had the appropriate linens, pillows, comforters, and mattresses are in good repair. Extra linens are stored in the hall closet. Additionally, each client was assigned a fully functional dresser drawer with adequate space for each client's belongings. The living room had two couches and a functional television. The dining room had a dining table with enough chairs for all the clients and some staff. Cleaning supplies such as chemicals, and cooking knives are inaccessible to clients. Cleaners and chemicals are locked in a cabinet in the garage. The cooking knives and cutlery are locked inside of a cabinet in the kitchen. Licensee maintains an adequate supply of food and a variety of snacks for clients. LPA observed a minimum seven day non-perishable and a two day perishable supply of food. and current menu. Board games are kept in the therapist office and books were observed to be in the shelves in the living room with no restrictions to access. There is adequate indoor and outdoor activity space; all exits, and walkways were free from obstruction. Per Administrator there are no guns or weapons on facility grounds. Continued on the Next Page The facility's outside grounds (front yard, backyard and sides) were also inspected and were found to be clean, well maintained, and free of observable hazards. The backyard has a bike rack with bicycles for clients and there were two locked storage sheds and a client garden. The facility has an operable carbon monoxide detector located in the hallway and smoke detectors are located throughout the facility. LPA observed the facility had three fire extinguishers, with one located in the kitchen, garage and therapy room. Each fire extinguisher was fully charged and inspected in May of 2023. The medications are centrally stored in the garage / staff office, in a loced cabinet. The First Aid Kit is complete and kept in the garage / staff office as well. The washer and dryer are located inside of the garage / staff office and are accessible to clients with staff supervision. The laundry detergents are kept locked in a cabinet. The Kitchen had a fully stocked refrigerator and the induction stove and dishwashing maching were operational. There were no cleaning supplies observed to be in the kitchen. The kitchen cabinets had plenty of pots, pans, plates and bowls for the clients to use. The hot water in the client bathroom measured within 109 degrees Fahrenheit (within the 105 to 120 range). LPA observed that each client's hygiene items such as shampoo, soap, lotion, deodorant and cosmetics were locked in a closet in the hallway. Facility staff explained that clients are given access to their hygiene prior to showering/bathing. LPA was also advised that clients are allowed to keep certain hygiene items in their room such as lotion. The facility has two vehicles used to transport clients to appointments and recreational activities. Each vehicle had no damage. The inside upholstery was intact for each vehicle. The brake lights and signals were operational. There was a fully stocked first aid kit in each vehicle as well as current registration and proof of insurance. At 10: AM, LPA observed that the outside window screens were missing for client bedroom 2 and 3, placing the facility out of compliance with CCR 80088(b)...all window screens shall be in good repair. LPA conducted three staff interviews (S1, S2, S3) and three client interviews (C1, C2, C3). At 12: PM LPA began review of five Staff Files and Operational Requirements, assisted by the Program Coordinator. All of the documentation pertaining to these areas of the inspection were provided, and no deficiencies were noted. Based on observations made during the inspection, see LIC 809D, a deficiency was cited. Due to time constraints, LPA will return to complete the inspection at a later date. An exit interview was conducted, and a copy of this report and appeal rights was provided to Program Coordinator Heather Michelson.

Deficiencies:
80088(b): Deficient Practice Statement
1
2
3
4Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in [count] out of [total count] [(objects) (persons)] [identifiers] which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/06/2023
Plan of Correction
1
2
3
4

met_with: Heather Michelson, Program Coordinator

title:
Fixtures, Furniture, Equipment and Supplies

(b) All window screens shall be in good repair and be free of insects, dirt and other debris.

This requirement is not met as evidenced by


facility_name: CHILDHELP MERV GRIFFIN VILLAGE

raw_content:
Narrative:
LPA Rogers learned during interviews that this isolated incident could not be remembered as C1 has so many incidents it's hard to pinpoint one. It was also disclosed that C1 does not remember any threats being made towards them from A1. During interviews with A1 it was reported that C1 was always confrontational. It was also reported that C1 was aggressive but never physical while attending behavioral therapy sessions. An additional allegation was received that staff spoke inappropriately towards minor while in care. It was alleged that C1 was told that nobody wants to speak with them and that C1 never acts right. During confidential interviews it was disclosed that there was never anything said inappropriate or mean to C1. It was also disclosed during confidential interviews that C1 visits with several different people but does not remember anyone making threatening comments. It was also reported during interviews that C1 would always apologize for threats made to staff after de-escalating. LPA Rogers also learned during interviews that if C1 was not cooperating during therapy visits the visits would be cut short. Based on interviews, the allegation that staff threatened C1 and staff spoke inappropriately to C1, may have occurred, however, is not supported by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted via video conference and a copy of this report, LIC 811, and appeal rights will be emailed to Jessie Jorrin, Director of Residential Programs for signature. Program Manager stated he would sign and return the document to CCL. Signed report will be placed in the facility file.

Investigation Findings:
13On Thursday, June 3, 2021 at 4: PM, an unannounced complaint inspection was conducted via video conference (FaceTime) by Licensing Program Analyst (LPA) Latricia Rogers. LPA Rogers met with Jessie Jorrin, Director of Residential Programs of ChildHelp Merv Griffin Village, for the purpose of issuing the investigative finding to the allegations listed above. During the course of the investigation, LPA Rogers interviewed County Social Worker (CSW), Client, Behavioral Therapist (A1) and Staff. The following documents were obtained: Visitation list, Needs & Services Plan On December 10, 2020, the Department received a complaint alleging that staff threatened a minor while in care. It was alleged that A1 threatened C1. During confidential interview, LPA Rogers was informed C1 was at a therapy session and was told to act right or therapy would end. Confidential interviews also revealed that A1 is very nice and treats C1 good. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Latricia Rogers 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 06/03/2021

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

met_with: Jessie Jorrin


raw_content:
Narrative:
Confidential interviews also reported that staff were notified when clients were touched, and staff separated the clients. During interviews with CSW it was disclosed that there were never any complaints from client regarding inappropriate touching at the facility. Interviews with A1 revealed that concerns regarding inappropriate touching between the girls in Cottage 3B were discussed during group sessions. A1 also disclosed during interviews that discussions regarding boundaries and respecting others were discussed. A1 also stated that girls were moved by staff to different cottages when complaints of inappropriate touching were reported. Staff also informed LPA Rogers that a memo was given to all cottages informing staff to be more watchful of inappropriate activities from the clients. Based on interviews, the allegation that staff did not prevent inappropriate sexual behaviors between minors, may have occurred, however, is not supported by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted and a copy of this report, and appeal rights were provided to Lawren Ramos.

Investigation Findings:
13On June 15, 2021, at 4: PM, an unannounced complaint inspection was conducted at the facility by Licensing Program Analyst (LPA) Lorena Valenzuela. LPA Valenzuela met with Executive Director Lawren Ramos, for the purpose of issuing the investigative finding to the allegation listed above. During the course of the investigation, LPA Latricia Rogers interviewed County Social Worker (CSW), County Social Worker- OCI (CSW2), Clients (C1-C4), Therapist (A1) and Staff. The following documents were obtained: Resident Roster, Staff Roster, Investigative Narrative. On December 07, 2020, the Department received a complaint alleging that staff did not prevent inappropriate sexual behaviors between minors in Cottage 3B. It was disclosed during confidential interviews that clients were humping each other in their room. It was also reported that clients were seen touching each other on the breast and private area on top of clothes. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Lorena Valenzuela 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 06/15/2021

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

met_with: Lawren Ramos, Executive Director


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
on the two residents. Confidential interviews report a second video of the incident was obtained and confirmed the assault including S1 hitting C1 and C2 several times before throwing them to the floor. Record review revealed additional observations of both videos noted S1 was seen to have been kicking both C1 and C2 as they were lying on the ground. Confidential interviews confirm S1 grabbed C1's head/neck. Confidential interviews report C1 and C2 where "play fighting" with one another and S1 became an active participate. An additional allegation was received by CCL on March 17, 2021 alleging Staff (Staff #2 (S2) and Staff #3 (S3) are not intervening when clients are assaulted. Specifically, it was reported an assault by Staff #1 (S1) on Child #1 (C1) and Child #2 (C2) occurred on January 1, 2021, which S2 and S3 did not attempt to intervene. Record review revealed observations of the two videos obtained of the incident show S2 and S3 were present during the assault and did not interject or try to stop the fight. Confidential interviews reported that S2 and S3 felt as the assault was a "horse play" and that intervening was not necessary. Based on confidential interviews, observation, and record review of facility documentation, the allegations allegation of Staff (Staff #1 (S1) are assaulting clients (Child #1 (C1) and Child #2 (C2) in care and Staff (Staff #2 (S2) and Staff #3 (S3) are not intervening when clients are assaulted are substantiated. The preponderance of evidence standard has been met. Facility is cited for violation of Interim Licensing Standards v.3.1, regulation 87072(d)(11) Personal Rights (11) To be free of physical, sexual, emotional, or other abuse...interference with the daily living functions of eating , sleeping, ...or aids to physical functioning and 87065.2(b)(8) Personnel Duties (b)(8) Direct care staff shall perform the following duties (8) Any other duties that may be necessary to ensure the health and safety of the children in the facility. A copy of the report was discussed and provided along with appeal rights to Childhelp Merv Griffin Quailty Assuarnce Coordinator, Marlo Felix

Investigation Findings:
13On June 21, 2021 at 10:15am Licensing Program Analyst (LPA), Nicole Strickland, met with Childhelp Merv Griffin Quailty Assuarnce Coordinator, Marlo Felix to deliver findings for the above stated allegations. LPA LaTonya Wilson conducted an inspection of the facility on March 26, 2020 at approximately 12:00pm no deficiencies were observed. The investigation was conducted by Community Care Licensing (CCL)'s Investigation Branch Special Investigator Lori Wood and included interviews with Riverside County Sheriff's Department, San Bernardino County Social Worker (CSW), two foster youth (Child #1 (C1) and Child #2 (C2), five staff members (Staff #1 (S1), Staff #2 (S2), Staff #3 (S3), Staff #4 (S4) and (Staff #5 (S5). In addition, county records and facility records were reviewed. On March 17, 2021, Community Care Licensing (CCL) received an allegation of Staff (Staff #1 (S1) are assaulting clients (Child #1 (C1) and Child #2 (C2) in care. Specifically, it was reported a video seen on social media of an incident occurring on January 1, 2021 of two children (C1 and C2) on the floor and S1 stomping SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Nicole Strickland 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 06/22/2021

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

met_with: Marlo Felix

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Confidential interviews revealed, that at least on one occasion in January 2021, Cottage 1B facility staff did not pass out the morning medications to Child #1 (C1), Child #2 (C2) and Child #3 (C3). It was revealed that on January 2021, Staff #1 (S1) who was trained to pass medications notified the facility S1 was going to come late to work. See the Confidential Names List, LIC 811, dated June 22, 2021. Additional information received indicated S1 made efforts to contact facility staff to ensure morning medications were passed out, however when S1 arrived at the cottage at 12 pm, S1 observed the morning medications were not passed out. Information received indicated that all children on medications had refused their medication in the morning, however, there was no documentation that supported this. Furthermore, witness statements indicated that there have been several times when staff was not able to pass out medications due to being short staffed. Based on interviews and records review conducted during the investigation, there is a preponderance of evidence to prove clients (C1, C2, C3) are not being given their medication(s) in a timely manner. The allegation is, therefore, found to be substantiated. The facility is cited for violation of Title 22, Division 6, Section 80075 (b)(5)(B) Health Related Services. An exit interview was conducted. A copy of this report, LIC 811, LIC 9099-D and Appeals Rights were provided to Executive Director Lawren Ramos.

Investigation Findings:
13On June 22, 2021, Licensing Program Analyst (LPA) Lorena Valenzuela met with Childhelp Merv Griffin Village Short-Term Residential Therapeutic Program (STRTP) Executive Director Lawren Ramos Jorrin to deliver the findings of the complaint investigation for the above allegation. The investigation included an inspection of the STRTP's Cottage 1B and a review of client and staff records on January 28, 2021. In addition, LPA interviewed five clients, eight direct care staff, facility Duty Officer and facility Administrator. On January 19, 2021, Community Care Licensing (CCL) received a complaint alleging clients are not being given their medication(s) in a timely manner. It was further reported that clients are not given their medication(s) at the appropriate time and at times clients are not given their medication(s) at all. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Lorena Valenzuela 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 06/22/2021

met_with: Lawren Ramos, Marlo Felix


raw_content:
Narrative:
A copy of the report was discussed and provided along with appeal rights to Childhelp Merv Griffin Quality Assurance Coordinator, Marlo Felix. physically abused child (Child #1 (C1) in care. Specifically, it was reported video footage from November 21, 2020 of cottage 4B showed S1 approaching C1 and forcefully picking C1 up and throwing C1 to the ground. Special Investigator (SI) and LPA Strickland were able to confirm the incident occurred by observation the video footage. Confidential interviews confirmed it was staff in video footage was S1 in the video as well as confirmed that the incident occurred as it appeared on the video. An additional allegation was received by CCL on December 11, 2020 alleging Staff (Staff #1 (S1) administered medication before the designated time. Specifically, it was reported that medications were given to residents of cottage 4B early in the morning of November 21, 2020, prior to 7:30 am which is outside the facilities designated time to provide residents with their medication. Confidential interviews confirmed S1 was seen on the video footage giving the residents of cottage 4B their medications shortly after 4:36 am. Confidential interviews confirm S1 gave medications to the residents early in the mornings. CCL received an additional allegation of Staff (Staff #1 (S1) interfered with client's (Child #1 (C1), Child #2 (C2), Child #3 (C3), Child #4 (C4), Child #5 (C5), Child # 6 (C6), Child #7 (C7) Child #8 (C8), Child #9 (C9), Child #10, (C10), Child #11 (C11), and Child #12 (C12)) nightly sleeping arrangements. Specifically, it was reported video footage from November 21, 2020 showed S1 waking the residents of cottage 4B up at 4:17 am by turning the lights on and going into the rooms and instructing the residents to wake up and go to the hallway. Special Investigator (SI) and LPA N. Strickland reviewed the video footage and confirmed the report. Confidential interviews confirmed the identity of S1 and as well as confirmed the incident occurred as it appeared on the video. Based on confidential interviews, observation, and record review of facility documentation, the allegations facility staff (Staff #1 (S1) physically abused child (Child #1 (C1) in care, Staff (Staff #1 (S1) administered medication before the designated time, and Staff (Staff #1 (S1) interfered with client's (Child #1 (C1), Child #2 (C2), Child #3 (C3), Child #4 (C4), Child #5 (C5), Child # 6 (C6), Child #7 (C7) Child #8 (C8), Child #9 (C9), Child #10, (C10), Child #11 (C11), and Child #12 (C12)) nightly sleeping arrangements are substantiated. The preponderance of evidence standard has been met. Facility is cited for violation of Interim Licensing Standards v.3.1, regulation 87072(d)(11) Personal Rights (11) To be free of physical, sexual, emotional, or other abuse...interference with the daily living functions of eating , sleeping, ...or aids to physical functioning and 87022.1(d) The facility shall operate in accordance with the terms specified in the plan of operation. ******

Investigation Findings:
13On June 21, 2021 at 9:23 am Licensing Program Analyst (LPA), Nicole Strickland, met with Childhelp Merv Griffin Quality Assurance Coordinator, Marlo Felix to deliver findings for the above stated allegations. LPAs LaTonya Wilson and De'Jon Lewis conducted an inspection of the facility on December 16, 2020 at approximately 2:00pm no deficiencies were observed. The investigation was conducted by Special Investigator Wilfred Vasquez and LPA N. Strickland and included interviews with five of twelve foster youth from Cottage 4B, (Child #1 (C1), Child #2 (C2), Child #3 (C3), Child #4 (C4), Child #5 (C5)), five staff members (Staff #1 (S1), Staff #2 (S2), Staff #3 (S3), Staff #4 (S4), and Staff #5 (S5), Department of Public Social Services (DPSS) Out of Homes Investigator (OHI), San Bernardino Department of Children and Family Services (DCFS) Open Case Investigator (OCI), and two County Social Workers (County Social Worker #1 (CSW1) and County Social Worker #2 (CSW2). In addition, county records and facility records were reviewed. On December 11, 2020, Community Care Licensing (CCL) received an allegation of facility staff (Staff #1 (S1) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Nicole Strickland 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 06/22/2021

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


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Witness interviews revealed S1 was alone in the room with C1 for 10 to 40 seconds and there were no indications that C1 had been grabbed by the neck in that timeframe. Witness statements indicated C1 was observed with redness on C1's neck, however the redness was not consistent with grab marks. Additional interviews revealed facility staff have not grabbed any of the children in care by the neck. Based on confidential interviews, the allegation that facility Staff #1 (S1) grabbed Child #1 (C1) by the neck while in care, may have occurred, however is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. A copy of this report, LIC 811 and Appeals Rights were provided to Quality Assurance Coordinator Marlo Felix.

Investigation Findings:
13On July 12, 2021, Licensing Program Analyst (LPA) Lorena Valenzuela met with Childhelp Merv Griffin Village Short-Term Residential Therapeutic Program (STRTP) Quality Assurance Coordinator Marlo Felix to deliver the finding of the complaint investigation for the above allegation. The investigation included a review of client and staff records and a review of a San Bernardino County Investigation Narrative. On April 9, 2021, LPA Valenzuela conducted a tele-inspection of the STRTP. In addition, LPA Valenzuela interviewed two direct care staff, Cottage Supervisor, two County Social Workers, and 11 of 11 clients in care. See the Confidential Names List, LIC 811, dated July 12, 2021. On April 8, 2021, Community Care Licensing (CCL) received a complaint alleging facility staff grabbed Child #1 (C1) by the neck. Confidential interviews revealed that on April 7, 2021, C1 became escalated and Staff #1 (S1) took C1 to C1's room in efforts to calm C1 down. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Lorena Valenzuela 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 07/12/2021

met_with: Marlo Felix, Quality Assurance Coordinator


raw_content:
Narrative:
On May 6, 2021, the Department received a complaint alleging that staff encouraged a minor to cause harm to another minor while in care. It was alleged that S1 told C2 to hit C1 for being bad. LPA was informed during confidential interviews that C1 took S1's purse and cellphone. S1 found C1 in possession of the cellphone and yelled "get him". It was further disclosed that C1 began to run and C2 caught C1 and hit him on the back. However, C1 did not remember how C1 obtained the cut to the lip. It was disclosed that C1 was acting up during the time of the incident and another child asked S1 if they could "get" C1 and S1 replied "yes". During interviews it was reported that staff did not remember C1 taking the cellphone or belongings of S1. S1 did not allow any child to hit or attack C1 and would not encourage a child to cause harm to another child. Interviews with CSW revealed that there was never a mention of this specific incident happening. CSW stated that C1 did not know the reason behind being hit. An additional allegation was received that a minor is being harmed by another minor while in care. It was alleged that C1 was hit by other children in the facility. LPA learned during confidential interviews that C1 was hit in the back by C2. Also, that there is always fighting in the cottage and that the "little kids" get punched in the face by the bigger kids. It was disclosed that children are told to separate when fighting and that no one remembers how or when C1 sustained the cut to C1 lip. CSW revealed that C1 did disclose that the other children in the facility were hitting C1. CSW also informed LPA that C1 was told to inform staff when being hit by the other children at the facility. CSW did inform LPA that C1 expressed feeling safe while at the facility. Based on interviews, the allegation that S1 told C2 to hit C1 for being bad and that C1 was hit by other children in the facility, may have occurred, however, is not supported by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted and a copy of this report, LIC 811, and appeal rights were given to Administrator Jesse Jorrin.

Investigation Findings:
13On July 19, 2021, at 3: PM, an unannounced complaint inspection was conducted by Licensing Program Analyst (LPA) Lorena Valenzuela who met with Administrator Jesse Jorrin and Quality Assurance Coordinator Marlo Felix, at the Short Term Residential Therapeutic Program (STRTP) Childhelp Merv Griffin Village, for the purpose of issuing the investigative finding to the allegations listed above. On May 14, 2021, at 1: PM, LPA Kendal Zirbes conducted a safety inspection, no immediate safety hazards were observed. During the course of the investigation, LPA Latricia Rogers interviewed County Social Worker (CSW), Clients (C1-C8) and Staff (S1-S3). The following documents were obtained from the Facility: Facility Incident Report Forms, Needs and Services Plan, Special Incident Report (SIR), Employee Roster, Client Roster and Staff Training History. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Lorena Valenzuela 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 07/19/2021

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

met_with: Administrator Jesse Jorrin, Marlo Felix


raw_content:
Narrative:
On May 5, 2021, the Department received a complaint alleging that staff pinched minor causing bruising. It was alleged that S1 pinched C1 causing bruising to the arm. During confidential interview, LPA Rogers was informed that C1 was making noises while eating a meal at which time S1 and C1 had a verbal exchange of words. Then, S1 went over to C1 and pinched C1 on the back of the arm. It was stated that S1 grabbed C1 by the arm, walked with C1 and tossed C1 in the "outcove". It was reported that S1 would often pinch clients when they were being bad or being rude. During interviews it was also stated that C1 was crying and yelled out that S1 was abusing C1. C1 further stated that C1 did not feel safe with S1 in the cottage. During interviews with CSW LPA learned that C1 is a very quiet child that never complains. It was also discussed during interviews with CSW that C1 will not talk about the incident any further but did nod his head yes when asked if S1 hurt him. Community Care Licensing also received an allegation that S1 made inappropriate comments to C1. LPA received information during confidential interviews that C1 was moaning while eating. It was reported that S1 asked C1 if C1 was "gay" and called him a "faggot". LPA was informed that S1 would be mean to the children in the cottage and call them names like "faggot" and "maggot" all the time. CSW informed LPA that C1 would not discuss if S1 made inappropriate comments. CSW also informed LPA while interviewing with C1 no words were spoken and only nods of the head to yes and no answers. Based on interviews, the preponderance of evidence standard has been met regarding the allegation that S1 pinched C1 causing bruising and that S1 made inappropriate comments to C1. Therefore, the allegations are substantiated. This poses an immediate health, safety or personal risk to children in care. The facility is cited for violation of the Interim Licensing Standards, Articles 9 & RFA Subchapter 1, Version 4.1, Section 87072(d)(11) Personal Rights and 87072(d)(10) Personal Rights. An exit interview was conducted, appeal rights were discussed, and civil penalty was assessed for repeating the same violation within 12 months for both allegations. A copy of this report was provided and explained to Administrator Jesse Jorrin.

Investigation Findings:
13On July 19, 2021, at 4:14 pm, Licensing Program Analyst (LPA) Lorena Valenzuela arrived at the Childhelp Merv Griffin Village Short Term Residential Therapeutic Program (STRTP) and met with Administrator Jesse Jorrin, and Quality Assurance Coordinator Marlo Felix to discuss the investigative finding of the allegations listed above. The allegations involved client (C1) as listed on the LIC 811, confidential names list dated July 19, 2021. On May 14, 2021, at 9: AM, LPA Kendal Zirbes conducted a safety inspection. No deficiencies were observed. During the course of the investigation, LPA Latricia Rogers interviewed County Social Worker (CSW), Clients (C1-C5), Staff (S1-S2) and Quality Assurance Coordinator (QA). The following documents were obtained from the Facility: Needs and Services Plan, Special Incident Report (SIR), Employee Roster, Client Roster, Staff Training History, Photos and Video Surveillance. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Christina Barnes LICENSING EVALUATOR NAME: Lorena Valenzuela 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CHILDHELP MERV GRIFFIN VILLAGEFACILITY NUMBER: VISIT DATE: 07/19/2021

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


raw_content:
Narrative:
STRTP ILS Version 3. Section 87072(d)(6)(B), and 87072(d)(11) PERSONAL RIGHTS are being cited on the attached LIC 9099-D. Due to technical difficulties the 9099, 9099D and Appeal Rights were emailed to the Director, and a hard copy was used to obtain signatures.

Investigation Findings:
13On 07/28/2021 at 10:30AM, Licensing Program Analyst (LPA) Robyn Word delivered the investigation finding for this complaint. LPA met with Matt Nomura- Residential Director. During the investigation, interviews were conducted by LPA Word with employees, County Social Workers, residents FC2, FC3, and FC4, LPA Stephannie Verna conducted an interview with FC1. The LPA reviewed training logs for all current staff, Needs and Services plans for residents, Serious Incident Reports, and the facility's policies and procedures. Residents FC2 and FC3 stated that they do not have any privacy in the home. Staff stated that the doors are removed when the residents refuse to keep them open. Staff stated that this is done to ensure residents do not self-harm, or smoke in the bedrooms. Residents FC2, FC3, and FC4 stated that this rule applies to all residents in the home regardless of self-harming behavior. On 7/28/ LPA Word observed FC1 ( see confidential name list dated 7/28/2021) door removed. Based on the LPA's observations; interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. (see continuation page 9099C) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Robyn Word 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 CCLD Regional Office, COHASSET RD., SUITE FACILITY NAME: CHILDREN'S HOME OF STOCKTON-ASPEN COMMUNITY HOMEFACILITY NUMBER: VISIT DATE: 07/28/2021

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

met_with: Matt Nomura- Residential Director


facility_name: CHILDREN'S HOME OF STOCKTON-ASPEN COMMUNITY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On August 17, Licensing Program Analyst (LPA) Stephannie Verna arrived at the above facility and met with Joelle Gomez, agency Administrator, for the purpose of conducting a required unannounced annual inspection. The facility is a licensed STRTP facility and is licensed for 6 clients, and currently has a census of 6. The facility is comprised of one cottage: Aspen. There is also a main building and office building on the campus which hold the main lobby, staff offices, Human Resources office, and training department. LPA Verna requested the current youth rosters for the cottage, current staff roster, the Emergency Disaster Plan, current Needs and Services plans, six client record's/client binders and all documents the facility has for the two newest client's, to review. LPA Verna began the client file review and reviewed six client files. LPA Verna was unable to complete the annual inspection on today's date. An inspection of the cottage was not conducted during today's visit and will be conducted at another date and time. Further inspection is needed to complete the annual. Licensing Program Analysts (LPA) Stephannie Verna completed an exit interview. A copy of this report, has been provided to Joelle Gomez, facility administrator.

met_with: Joelle Gomez, Agency Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On September 9, Licensing Program Analyst (LPA) Stephannie Verna arrived at the above facility and met with Matt Nomura, agency Administrator, for the purpose of conducting a required unannounced annual inspection. The facility is a licensed STRTP facility and is licensed for 6 clients, and currently has a census of 6. The facility is comprised of one cottage: Aspen. There is also a main building and office building on the campus which hold the main lobby, staff offices, Human Resources office, and training department. LPA Verna continued the client file review and reviewed six client files. Four staff interviews were conducted. LPA Verna was unable to complete the annual inspection on today's date. Further inspection is needed to complete the annual. Licensing Program Analysts (LPA) Stephannie Verna completed an exit interview. A copy of this report, has been provided to Matt Nomura, facility administrator.

met_with: Matt Nomura, Agency Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On September 10, 2021 at 10: AM, Licensing Program Analyst (LPA) Stephannie Verna arrived at the above facility and met with Matt Nomura, agency Administrator, for the purpose of conducting a required unannounced annual inspection. The facility is a licensed STRTP facility and is licensed for 6 clients, and currently has a census of 6. The facility is comprised of one cottage: Aspen. There is also a main building and office building on the campus which hold the main lobby, staff offices, Human Resources office, and training department. The facility also a locked garage with exercise equipment, storage items and a freezer. LPA Verna continued the annual inspection, and completed the inspection of the building and grounds. LPA observed that the facility license, and emergency exit plans were posted in a prominent place. LPA observed an expired fire clearance certificate. The facility is awaiting the certificate in the mail.. LPA observed working smoke alarms, with the exception to one smoke alarm in the foyer, the was missing and inoperable. Fire extinguishers are up-to-date, and first aid kits with required supplies. There is one week of perishable foods and two weeks of non-perishables for the clients in each cottage. Each client has an individual or shared bedroom (with no more than two to a room), with a bed, clean linens and pillow(s), and furniture to store their belongings, dressers and closets. The clients had hygiene supplies, laundry supplies, and cleaning supplies properly stored and provided for use. There is a locked pool on the premises, which has a life guard on duty, and has fences at least five-feet high and constructed so that the fence does not obscure the pool from view. Sharps are stored in locked container in the kitchen or staff offices. Prescribed psychotropic and other medications were present, locked, and MARs were documented thoroughly. The cottages were clean and in good condition with the exception of the bathroom showers and refrigerator, and hole(s) in bedroom walls. The bathroom showers require cleaning and the rubber seals are either broken or missing, and in need of repair. One out of two refrigerators is dirty with debris on the shelving inside, and does not have a functioning light bulb, and the inside seal is cracked and broken. Two out of three client bedrooms has holes in the walls and repairs that were pending or need to be requested. The cottage manager was able to provide documentation that shows maintenance orders were submitted to request repairs in one of the two bedrooms. No bugs were observed during the inspection. Additionally, LPA Verna observed that observed that three window screens were missing in three out of three client bedrooms. The screens for the other windows in the facility were present, in good condition and free of dirt, debris, and insects. LPA requested and reviewed fire clearance documentation, Board Meeting notes, vehicle insurance and registration. One staff interview was conducted. Five client interviews were conducted. LPA Verna was unable to complete the annual inspection on today's date. Further inspection is needed to complete the annual. The facility is being cited and assessed for a civil penalty for violations of the California Code of Regulations, Title 22, division 6, chapter 1, section 80020(a) Fire Clearance: All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection, or the State Fire Marshal. Licensing Program Analysts (LPA) Stephannie Verna completed an exit interview. A copy of this report and appeal rights has been provided to Matt Nomura, facility administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On September 24, 2021 at 12: PM, Licensing Program Analyst (LPA) Stephannie Verna arrived at the above facility and met with Matt Nomura, agency Administrator, for the purpose of conducting a required unannounced annual inspection. The facility is a licensed STRTP facility and is licensed for 6 clients, and currently has a census of 6. The facility is comprised of one cottage: Aspen. There is also a main building and office building on the campus which hold the main lobby, staff offices, Human Resources office, and training department. The facility also a locked garage with exercise equipment, storage items and a freezer. LPA reviewed 11 staff files. LPA requested a current staff roster, Mandated Reporting Training Certificates for 12 out of 11 staff, and CPR/First aid certificates for four out of 11 staff, medical and TB test results and clearance for all staff. LPA was provided current Mandated Reporting Training Certificates for seven staff, CPR/First aid certificates for two staff, and medical and TB test results and clearance for all staff. Upon the review of 11 staff files, LPA observed: One out of 11 staff files contained an expired Driver's License, One out of 11 staff files shows an outdated TB test result for one staff, Four out of 11 staff files did not contain a current Mandated Reported Training Certificate, and Two out of 11 client files did not contain a current CPR/First aid certificate, and was expired. Additionally, five out of 11 staff files reviewed did not contain criminal record clearance transfer requests for the facility that the staff is presently working in. Five out of 11 staff are associated to the incorrect facility license and one out of 11 staff files reviewed did not contain criminal record clearance for FBI/DOJ/CACI for one staff. Per the Guardian Background Check System the staff's fingerprints were not taken and the application was closed. The staff will need to complete the fingerprint process and cannot work at the facility until clearance is received. LPA Verna completed the annual inspection on today's date. The facility is being cited and assessed for an immediate civil penalty for violations of the California Code of Regulations, Title 22, division 6, chapter 1, section 80066(a)(12)(B): (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (12) For employees that are required to be fingerprinted pursuant to Section 80019: (B) Documentation of either a criminal record clearance or exemption as required by Section 80019(e). Licensing Program Analysts (LPA) Stephannie Verna completed an exit interview. A copy of this report and appeal rights has been provided to Matt Nomura, facility administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 5/16/22, Licensing Program Analyst (LPA) Jessica Caplinger and Licensing Program Manager (LPM) Dara Campos, conducted an unannounced inspection for the purpose of a Case Management to verify the closure of Children's Home of Stockton- Aspen Community Home. A walk through was conducted and no concerns were observed. An exit interview was conducted with Administrator Brown and this case management was left during inspection.

met_with: Joelida Brown, Administrator


facility_name: CHILDREN'S HOME OF STOCKTON TRI-PLEX

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Robyn Word conducted a follow-up complaint investigation. LPA met with Matt Nomura- Residential Director at 2:00PM. During the complaint investigation, LPA conducted a site inspection and reviewed staff and residents' files. Copies of pertinent documentation including: training records, needs and services plans, and case notes were obtained on 4/7/2021. During the investigation LPA Word conducted interviews with staff, FC1, FC2,FC3 (see LIC 811 dated 6/22/2021 for confidential names list). Due to inconsistent statements the LPA was unable to determine if minors are taking illegal drugs on the premises, if the facility staff failed to meet FC1 needs, if minors engaged in sexual activities with each other on the premises, and if the facility failed to prevent minors from AWOLing. The staff stated that FC1 had a history of frequently AWOLing and they followed AWOL protocol, and when FC1 would return back on grounds she was asked to empty pockets, and if she had any contraband on her. The residents stated that they are not participating in any sexual activities. As a result of the investigation and information obtained, the complaint finding is UNSUBSTANTIATED at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted, and a copy of the 9099 and appeal rights were given to the Director on 6/22/2021. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Robyn Word LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

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


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Robyn Word conducted a follow-up complaint investigation. LPA met with Matt Nomura- Residential Director at 2:00PM. During the complaint investigation, LPA conducted a site inspection and reviewed staff and residents' files. Copies of pertinent documentation including: training records, needs and services plans, and case notes were obtained on 4/7/2021. During the investigation LPA Word conducted interviews with staff, FC1, FC2,FC3 (see LIC 811 dated 6/22/2021 for confidential names list). Due to inconsistent statements the LPA was unable to determine if Staff did not adequately supervise residents. FC1 and FC2 stated that they engaged in sexual activity with each other during an AWOL. As a result of the investigation and information obtained, the complaint finding is UNSUBSTANTIATED at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted, and a copy of the 9099 and appeal rights were given to the Director on 6/22/2021. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Robyn Word LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

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


raw_content:
Investigation Findings:
13On 07/28/2021 at 10:30AM, Licensing Program Analyst (LPA) Robyn Word delivered the investigation finding for this complaint. LPA met with Matt Nomura- Residential Director. During the complaint investigation, LPA obtained copies of pertinent documentation including: training records, needs and services plans, AWOL policy and procedures, and incident reports. LPA Word conducted interviews with staff, FC2, FC3, and Program Manager, FC1 refused to be interviewed (see LIC 811 dated 7/28/2021 for confidential names list). Due to statements in interviews, and review of documentation the LPA was unable to determine if the staff are providing adequate supervision to youth. The staff stated that they follow the youth per AWOL protocol until the youth is out of sight, and they are no longer able to supervise. As a result of the investigation and information obtained, the complaint finding is UNSUBSTANTIATED at this time meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted, and a copy of the 9099 and appeal rights were emailed to the Residential Director due to technical difficulties. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Robyn Word LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

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

met_with: Matt Nomura- Residential Director.


raw_content:
Narrative:
During the course of the investigation, the following documents were gathered: Pest control invoice and contract Youth Face Sheet FC Incident Reports, 6/7, 6/13, 7/12, 7/ FC Law Enforcement Reports 07/12 and 07/ FC Problem Logs, May - July FC Behavior Management Plan, dated 06/16/ FC Needs and Service Plan Facility Program Statement Interviews were conducted with FC1, FC2, FC8, FC9, S1, S2, S3, S4, S6, S7, and CSW on 07/19/2021, 07/22/2021, 07/28/2021, 08/26/2021, 09/22/2021, and 10/05/2021, and 10/06/2021. On July 26, Licensing Program Analyst (LPA) Stephannie Verna conducted a pre-investigation review of the facility. LPA reviewed complaints for the last three years. The facility currently has multiple complaints open. The last 2- year inspection was conducted on 08/10/2021 and finalized on 09/01/2021. LPA reviewed the Complaint and Type A violation log. The facility had an allegation of: Facility has pests, substantiated on 08/27/2020, with no citations issued. No serious concerns noted. Interviews were consistent that staff do not and have not been observed yelling at youth. Staff do have different tones of voice, and some staff use a firm tone with youth when youth are aggressive to staff or peers or being unsafe, as an attempt to encourage the youth to not intimidate staff, stop unsafe behavior and to follow the rules. Interviews were consistent that the facility has had bugs on the premises, but not an infestation. The facility is located in Stockton, CA, a rural area, where bugs are present. The facility ensured that pest control was contacted and pest services were completed to treat for cockroaches and bed bugs at the facility and in a timely manner, and record review also showed proof of this. continued on 9099-c The department has conducted a complaint investigation regarding the allegations: Staff yell at minors, and Facility has an insect infestation. Based on LPA 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 allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted and a copy of this report was emailed to Matt Nomura, Agency Administrator. During the course of the investigation, the following documents were gathered: Pest control invoice and contract Youth Face Sheet FC Incident Reports, 6/7, 6/13, 7/12, 7/ FC Law Enforcement Reports 07/12 and 07/ FC Problem Logs, May - July FC Behavior Management Plan, dated 06/16/ FC Needs and Service Plan Facility Program Statement Interviews were conducted with FC1, FC2, FC8, FC9, S1, S2, S3, S4, S6, S7, and CSW on 07/19/2021, 07/22/2021, 07/28/2021, 08/26/2021, 09/22/2021, and 10/05/2021, and 10/06/2021. On July 26, Licensing Program Analyst (LPA) Stephannie Verna conducted a pre-investigation review of the facility. LPA reviewed complaints for the last three years. The facility currently has multiple complaints open. The last 2- year inspection was conducted on 08/10/2021 and finalized on 09/01/2021. LPA reviewed the Complaint and Type A violation log. No serious concerns noted. The department has conducted a complaint investigation regarding the allegations: Staff did not provide minor with adequate sleeping accommodations Minors in care are not afforded privacy Interviews were consistent that FC1 was made to sleep in the gym as a de-escalation strategy, which is not consistent with the facility's program statement. FC1 also slept on a cot, which is not allowed. FC1's bedroom door was removed due to safety concerns, however a youth's bedroom door cannot be removed and is a Personal Rights Violation. The facility has corrected this deficiency. There were no Incident Reports submitted to the Department referencing the removal of the door or requests for exceptions or waivers, submitted to the Department and/or requesting support with the safety concerns that resulted in the youth sleeping in the gym and/or youth's bedroom door being removed. continued on 9099-c Based on LPA observations, interviews which were conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. The facility is being cited for deficiencies of Interim Licensing Standards STRTP, Article 6, Section 87072(d)(11), which poses a potential Health, Safety, or Personal Rights risk to clients in care. An exit interview was conducted, appeal rights were reviewed and a copy of this report and appeal rights were provided to Matt Nomura, Agency Administrator.

Investigation Findings:
13Licensing Program Analyst (LPA) Stephannie Verna conducted an unannounced complaint inspection with the above agency on October 22, 2021 at 1: PM and met with Matt Nomura, Agency Administrator. The purpose of the inspection was to deliver complaint findings for the above allegations. On July 22, 2021 at 10: AM, Licensing Program Manager (LPM) Dara Campos, and Licensing Program Analyst, Stephannie Verna (LPA), initiated a complaint investigation regarding the above allegations and a tour of the facility was conducted. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Stephannie Verna 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 CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: CHILDREN'S HOME OF STOCKTON TRI-PLEXFACILITY NUMBER: VISIT DATE: 10/22/2021

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