summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday 6/16/21 at 9:33AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility to conduct a required annual inspection. A screening email and phone call were sent/attempted prior to the visit. Safety precautions were taken, including face masks, hand sanitizer, disinfectants, and social distancing. Additionally, LPA is vaccinated, tested negative for COVID-19 on Monday 6/14/21, and does not have any symptoms of COVID-19. LPA met with Dr. Linda LaBrie, Clinical Supervisor, and informed of the purpose of the visit. At 9:45AM, LPA conducted a tour of the facility and grounds. The facility is clean and free of debris. The grounds are free of obstructions and are well-maintained. The kitchen is stocked with food to meet the needs of the residents in care and meets the mandated 7-day non-perishable and 2-day perishable standard. Food items are in date and are labeled by date of purchase. Cleaners and sharps are kept in locked storage areas downstairs, and the laundry room (upstairs) is locked. There is a sign-in and screening table set up by the front entrance that includes a sign-in sheet, a thermometer, and hand sanitizer. At 10:05AM, LPA observed some kitchen cleaner in a high cabinet in the kitchen. Staff immediately moved these to the locked cleaning cabinet. At 10:22AM, LPA observed that the water temperature in the upstairs resident bathroom measured 125. F. LPA advises that, per California Code of Regulations, Title 22, Section 80088, hot water at vanity sinks should measure between 105 and F, and measurements above F require a hot water warning sign. Staff agreed to post a sign here until the hot water temperature can be lowered. At 10:35AM, LPA observed that there are cameras located in the following locations: facility entrance, front office, front living/dining area, back living room, classroom, and upstairs lounge. On 5/29/20, the facility was informed that a camera waiver is required before cameras can be used or fixed onto walls. LPA advises that the facility immediately deactivate the cameras and submit a waiver request for approval to use cameras. At 10:50AM, LPA reviewed the facility files that were accessible to present staff. Emergency documentation was stored for each resident in an emergency information binder in the staff office. Staff and resident records, such as admission agreement, consent forms, etc. are only accessible to director, who agreed to send LPA the requested documents. LPA requested the following: most current LIC Personnel Summary, LIC Emergency Plan, all staff qualifications (LIC 501), all staff training record for 2020-current, each resident's face sheet, needs and services, admission agreement, and treatment/medical consent forms. There are no citations and two advisories. A follow-up to review the facility files will be conducted. An exit interview was conducted, and a copy of this report was left with Dr. Linda LaBrie, whose signature on this form confirms receipt.

met_with: Clinical Supervisor Dr. Linda LaBrie


state: CA

facility_name: ADOLESCENT GROWTH, INC.

summary: Facility Evaluation

raw_content:
Narrative:
On November 8th, 2022 at 3: PM Licensing Program Analyst (LPA) Alyssa Ng conducted an unannounced case management inspection. The purpose of the inspection was to confirm that the above address ( Vista Ridge Court, Concord, CA 94518) is no longer operating as a Children's Residential Facility and has no children in placement. On 10/11/21, LPA Mariah Hawkins learned in staff interviews (Please refer to complaint # 14-CR-20210716093941) that the facility was temporarily closed. LPA confirmed this with the administrator. No formal notice of closure was sent to the Licensing agency. LPA Ng made multiple attempts to get in contact with the Administrator/Licensee. LPA Ng left voicemail's and email correspondence regarding the overdue of fees and to get an update on the facility. There were no cars outside. During inspection, it was confirmed that the above address has no residents living inside. Adolescent growth is officially closed.

report_type: Facility Evaluation

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On 06/20/24 at 1:15 p.m., Licensing Program Analyst (LPA) Brenda Rodriguez conducted an unannounced visit to the above facility. The purpose of this visit was to complete the required annual inspection. LPA Rodriguez met with Medical Assistant Emani Burks, at the above facility to conduct the required annual inspection. LPA Rodriguez used the CARE Inspection Tool. LPA Rodriguez conducted the physical plant inspection. Personnel Files are maintained safely online. LPA Rodriguez reviewed one (1) client file. LPA Rodriguez discussed the following with Emani Burks, Medical Assistant: client files and the physical plant inspection. Two technical assistances were cited at this time. At this time, the inspection is not complete. LPA Rodriguez will be back at a later day to complete the required annual inspection. LPA Rodriguez conducted an exit interview, and a copy of this document was given to Medical Assistant Emani Burks.

met_with: Emani Burks, Medical Assistant


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 07/29/24 at 12:20 p.m., Licensing Program Analyst (LPA) Brenda Rodriguez conducted an unannounced visit to the above facility. The purpose of this visit was to complete the required annual inspection. LPA Rodriguez met with Medical Assistant Emani Burks, at the above facility to conduct the required annual inspection. LPA Rodriguez used the CARE Inspection Tool. LPA Rodriguez conducted one confidential staff interview. The clients present at the time did not want to get interviewed. Three deficiencies (CCR 80023(a), CCR 84365(d), and CCR 80066(a)) and two technical violations (CCR 84009(a) and CCR 84072(a)) were cited at this time (see more on LIC 809Ds). Appeal rights were discussed and provided. The required annual inspection is complete. LPA Rodriguez conducted an exit interview, and a copy of this document was emailed to Administrator Joy Lewis and Medical Assistant Emani Burks whose signature on this form confirms receipt.

Deficiencies:
80066(a): Personnel Records

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


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13On September 15, 2022 at 9: AM, Licensing Program Analysts (LPA) C. White conducted an unannounced visit to Adolescent Growth for the purpose of delivering findings on the above allegations. LPA met with Facility Chef, Brian Constantino and discussed the complaint findings. During the course of this investigation, LPA interviewed pertinent parties and reviewed records. Confidential interviews and records did not produce corroborating evidence to support the allegations. Staff provided inconsistent statements regarding client's blood pressuing not being taken. Staff denied not having client medication and not have anyone to cook for the clients. Staff stated food is purchased weekly and facility bathrooms are cleaned multiple times a day per COVID requirements. Client interviews revealed facility bathrooms are cleaned multiple times a day and staff cook 3 times a day. Client interviews did not reveal issues with medications. Based on information obtained, the allegations are found to be unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violations did or did not occur. No deficiencies cited. Exit interview completed and a copy of this report was left with facility staff. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Charmetha White 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:

report_type: Complaint Investigation

met_with: Facility Chef, Brian Constantino

complaint_status: unsubstantiated


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13On September 15, 2022 at 9: AM, Licensing Program Analysts (LPA) C. White conducted an unannounced visit to Adolescent Growth for the purpose of delivering findings on the above allegations. LPA met with Facility Chef, Brian Constantino and discussed the complaint findings. During the course of this investigation, LPA interviewed pertinent parties and reviewed records. Confidential interviews and records produced corroborating evidence to support the allegation. Staff confirmed the facility/program manager is not always present at the facility. Client interviews revealed there is one program manager that works in the facility. Based on interviews and information obtained, the department has determined the preponderance of evidence standard has been met, therefore the allegation is found to be Substantiated per California Code of Regulations Title Division Chapter 5. Facility cited for violation of California Code of Regulations, Title Division 6, regulation: 84065(d) Personnel Requirements. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Charmetha White LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290b El Segundo, CA Facility Name: Adolescent Growth, INC.FACILITY NUMBER: 198206911

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

complaint_status: SUBSTANTIATED


raw_content:
Narrative:
On December 16, 2021, Investigator Hector met with licensees, requested additional information and issued a 10-Day Complaint Notification. The investigation continued consisting of, confidential interviews and contacts with, five former residents, five staff members, Facility Administrator, Facility Director, and other associated parties. The investigation further included review of related client and staff files, facility file history, facility records, and review of related Los Angeles Police (LAPD) report and LAPD associated records. On October 28, 2020, LAPD responded to Adolescent Growth, Inc. concerning an alleged sexual assault between Y1 and Youth #2 (Y2) reportedly occurring on October 27, 2020, for which Y2 was subsequently arrested. Records reviewed found that the facility failed to report the incident occurring between Y1 and Y2 to CCL and further failed to report the incident concerning Y2's related arrest. The investigation revealed a pattern of inappropriate behavior of youths in the facility occurring prior to the incident on October 27, 2020, yet measures were not taken to stop that behavior. Information obtained revealed staff failed to conduct room checks every 15 minutes in the evening and staff was usually working solely in the evenings. Staff on duty during the incident involving Y1 and Y2, had reported needing more support, including more staff and/or training resources, in order to effectively perform their job duties. Request for more help during the night shifts was not supported as Administration did not provide staff's request. A review of records found multiple incidents including, but not limited to, youth's absence without permission occurring in October 2020, in which local law enforcement was called and responded to the facility, that were never reported to Community Care Licensing. Statements obtained indicate incidents were submitted to facility administration; however, Investigator's request for these incident reports were not produced. (Continued on page LIC9099-C) Based on information from record review and confidential interviews, the preponderance of the evidence standard has been met. The Department has determined substantiated findings for neglect/lack of supervision contributing to inappropriate sexual activity between Y2 and Y1; Failure to Report incidents and failure to allow CCL staff entrance into the facility during initial complaint notification. The above-mentioned concerns pose an immediate and potential health, safety and personal rights risk of harm to youth placed in care. The following citations are issued in accordance with California Code of Regulations, Title 22, Division 6, Chapter 5; 84065. Personnel Duties; Reporting Requirements and Inspection Authority. [See page LIC9099-D for cited deficiencies]. An exit interview was conducted, and appeal rights were discussed. A copy of this report, Confidential Names List and appeal rights were provided to Facility Administrator.

Investigation Findings:
13On October 11, 2022 at 11:00, Licensing Program Analyst (LPA) Regina Martin met with licensees to issue investigative findings concerning the above-mentioned allegations. On December 8, 2021, Community Care Licensing (CCL) received a complaint alleging neglect/lack of supervision as Youth #1 (Y1) was reportedly sexually assaulted by another youth resident while in care (see LIC811, dated October 11, 2022). The allegation was investigated by Licensing Special Investigator Edward Hector of CCL Investigations Bureau. On December 14, 2021, Investigator Hector attempted to conduct an unannounced visit at the facility (Adolescent Growth, Inc.) to initiate the investigation into reported claims; however, after Investigator Hector arrived at the facility, identified himself with a State business card, an official State badge and photo identification positively confirming Investigator's employment with the State of California, Investigator Hector was refused access into the facility by facility staff member and further denied entry by facility supervisor to no avail. When Investigator Hector asked the facility supervisor for their name, they replied that their name was "Program Manager" and refused to further identify themselves. (Continued on page 9099-C) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290b El Segundo, CA Facility Name: Adolescent Growth, INC.FACILITY NUMBER: VISIT DATE: 10/11/2022

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

met_with: Joilyn Lewis and John Lewis


summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On November 9, 2022, Licensing Program Analysts (LPA) C. White conducted an unannounced visit to the facility for the purpose of delivering findings on the above allegations. LPA met with Facility Manager, April Barnes and discussed the complaint findings. During the course of this investigation LPA conducted confidential interviews and reviewed records. Staff denied speaking inappropriately towards minors. Staff stated they would never provoke minors to act inappropriately towards each other. Staff stated retalition against minors is not allowed. Staff stated minors are not denied the use of restrooms. Staff denied failing to provide client records to authorized representatives. Client interviewed stated staff would get upset when clients would speak up for each other. Client interview did not reveal that staff provoked inappropriate behaviors between minors nor prevented minors from using the restroom. The information obtained did not produce corroborating evidence to support the allegations. Thus, the allegations are found to be unsubstantiated, meaning although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violations did or did not occur. No deficiencies cited. Exit interview completed and a copy of this report was left with facility staff. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Charmetha White LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

met_with: Facility Manager - April Barnes


raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegations. LPA interviewed Staff 1 and Staff 2. LPA attempted to interview Staff 3 but she was on jury duty and then on indefinite leave. LPA could not reach Staff 3. Likewise LPA could not reach C1 and C2 as they have been returned to their parents. None of the current clients were in residence when the alleged incidents took place, Due to inability to interview the involved clients or all involved staff, the above allegations are resolved as "unsubstantiated". Unsubstantiated means that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Sushma Nagisetty, primary therapist


raw_content:
Investigation Findings:
13On Nov. 16, 2023, Licensing Program Analyst Connie Jones-Steward investigated the allegations that licensee did not properly address a bedbug infestation, staff did not ensure that a client received timely medical attention, clients are not transported to their medical appointments, and medical staff are not adequately trained, LPA interviewed one licensee and one medical associate. None of the clients named in the complaint were still residing in the facility therefore no clients were interviewed, LPA Jones-Steward inspected all bedrooms and reviewed staff personnel files. There was no sign of infestation at the time of the inspection, although it was confirmed that a client had insect bites on their body and the beds and frames were replaced out of caution. Personnel files indicate that staff education and training meet Title 22 requirements and that staff who transport clients have driver's licenses. Mr, & Mrs Lewis stated although the facility van is in the repair shop, they have an alternate vehicle to transport clients to medical and other appointments and sometimes clients are transported in employee vehicles. LPA Jones-Steward was not able to confirm nor negate the validity of the allegations. Therefore they all resolved as inconlusive. An inconclusive finding means that although an allegation my be true or valid, there inadequate information to find conclusively that it did happen UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Laura Meza, John Lewis, Joy Lewis


raw_content:
Investigation Findings:
13On Nov. 16, 2023, Licensing Program Analyst Connie Jones-Steward and LPM Lakescia Smith investigated the allegations that staff are not administering minor's medications as prescribed,staff do not have access to minor's records, staff do not provide minors with activities and facility washer is in disrepair. LPA interviewed one licensee and one medical associate. None of the clients named in the complaint were still residing in the facility therefore no clients were interviewed, LPA Jones-Steward and LPM Smith inspected the medical control logs and all doses were accounted for. The staff that was present was able to demonstrate that she had access to the client's computerized records. The administrator provided an activity calendar that listed many activites. However LPA was unable to determine if clients had supplies for art projects. LPA and LPM observed on the date of inspection, that the washer and dryer were working, but were unable to determine if clients had washed clothes by hand due to non-working washing machine and dryer LPA Jones-Steward was not able to confirm nor negate the validity of the allegations. Therefore they all resolved as inconlusive. An inconclusive finding means that although an allegation my be true or valid, there inadequate information to find conclusively that it did happen UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: John Lewis, Joy Lewis, Laura Meza


summary: Facility Evaluation

raw_content:
Narrative:
On November 9, 2021 at 11: AM, Licensing Program Analyst (LPA) Charmetha White arrived at ( ) for the purpose of conducting an Annual Random Inspection. LPA met with the Facility Manager, who granted access to the location and together a tour of the entire facility was conducted both inside and out. The facility is licensed to provide care and supervision services for six (6) children, ages 12-17 years old, ambulatory only. The census today is four (4). The program only accepts Private Placement Clients. The facility is set up as follows: This is a two-story home with 3 bedrooms, 2 full bathrooms and 2 half bathrooms, staffing offices, a therapy room, living room, dining room, kitchen, classroom, laundry area, conference room, a nursing office, and a backyard. Living room/community area: has ample seating, and a non working fire place. Dining room: is equipped with a table and seating for 6 people. Kitchen: is equipped with two (2) freezers/refrigerators, an oven, stove top with four (4) functional burners, dishwasher, and ample cabinet/storage space. Sharp objects and chemicals are kept in locked cabinets. Classroom: is located next to the kitchen. It is equipped with a multiple tables and seating, and lockers for children in care. The room contains two doors, one leading outside to the right of the home and the other leading to the garage both doors remain locked. Laundry Area: is located in a closet inside the classroom and has a stackable washer/dryer combination. Staffing offices: Three (3) staffing offices are located on the first floor. Therapy room: is located to the right of the entry way along a hallway at the front of the home. It is equipped with two desk and three chairs. Nursing Office: is located to the right of the entry way along a hallway next to the therapy room. It is equipped with a double locked cabinet that contains medications and the First Aid Kit. Conference room: is located on the second floor and is used for meetings. The room is equipped with a TV, a table, and seating for more than 8 people. Report continued on LIC 809C. Bedrooms: All bedrooms are located on the first floor to the left of the entry way. Each bedroom is equipped with two twin beds, ample closet and drawer space. Bedrooms #1 and #2 both have sliding glass doors leading to the left side of the house. Bedroom #3 contains a bathroom and an exit door leading to the backyard. Bathrooms: Bathroom #1 and a ½ bathroom are located on the first floor along the hallway to the left of the entry way. Bedroom #3 contains Bathroom #2 and there is a ½ bathroom located on the second floor next to the conference room. All bathrooms were observed to be in good repair and working order. The hot water temperature was tested and found to be between 105-120 degrees (F). LPA observed four (4) fire extinguishers throughout the home and all were found to be in good condition. The smoke and carbon monoxide detectors were tested and found to be in working order. Medications are stored in a locked cabinet located in the nursing room and made inaccessible to children in care. All doors and exits are attached to an alarm system that alerts staff when doors are opened. There is a working telephone readily accessible. LPA observed the home to be clean, safe, and sanitary. Passageways, stairways, inclines, ramps and open porches are unobstructed. The front and backyard were clean and free of debris. There are no firearms or dangerous weapons in the facility. There was no swimming pool, hot tub, spas, nor similar bodies of water located at the facility. LPA reminded Licensee to ensure the following: Children are accorded personal rights and the corresponding form is in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. Licensee acknowledges abuse reporting requirements. During the visit, LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. All posting requirements for Group Home Licensure and Emergency Plan were met. The Program has a total of six Staff. LPA interviewed all six Staff members and all Children in care. LPA will return on a later date to review client and staff files. There were no deficiencies noted on this date. An exit interview was conducted, and a copy of this report was signed and left with the Facility Manager.

visit_type: Annual

met_with: Facility Manager - Azadeh Ebrahimi


facility_name: AIM GROUP HOME

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Vaishali Singh-Sood conducted an unannounced inspection at the facility for the purpose of conducting an Annual/Required inspection. LPA Singh-Sood met with Administrator, Florietto Alano and both toured the facility, inside and out at 12: PM. The Group Home is licensed to serve six clients, ages 7-18 years. Currently, there are five clients in placement. This facility is a one story house, consists of 5 client bedrooms and 3 client bath. Staff files and client files were reviewed and are kept locked to ensure confidentiality. Hot water temperature was checked and was observed to be 113 degrees Fahrenheit. First aid kit was observed. Food supply, linens and fire extinguisher were observed. There is sufficient perishable food for two days and nonperishable food for 7 days. Smoke detectors were observed and operational. Medication storage and procedures were reviewed. There is no pool or firearms on the premises. The following documents are posted in the facility: facility license, emergency disaster plan, facility sketch, menu, activity calendar and personal rights. Fingerprint clearances were reviewed using a Facility Personnel Report Summary dated 4/29/22. All facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances and/or exemptions. There were no Title 22 deficiencies observed during this visit. Appeal Rights were provided and discussed. Exit interview was conducted with Mr. Alano, and a copy of this report was issued.

met_with: Florietto Alano


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Vaishali Singh-Sood conducted an unannounced inspection at the facility for the purpose of conducting an Annual/Required inspection at 9: AM. LPA Singh-Sood met with House Manager, Nonet Alano, and both toured the facility, inside and out. During the time of the inspection, 1 client, and 3 staff were present. It is noted the client was non-verbal and an interview could not be conducted. Ms. Alano also informed this LPA that they will be submitting an application to convert the home into an adult home by the beginning of November. The Group Home is licensed to serve six clients, ages 7-18 years. Currently, there are five clients in placement. This facility is a one story house, consists of 5 client bedrooms and 3 client bath. Staff files and client files were reviewed and are kept locked to ensure confidentiality. Hot water temperature was checked and was observed to be 111 degrees Fahrenheit. First aid kit was observed. Food supply, linens and fire extinguisher were observed. There is sufficient perishable food for two days and nonperishable food for 7 days. Smoke detectors were observed and operational. Medication storage and procedures were reviewed. There is no pool or firearms on the premises. The following documents are posted in the facility: facility license, emergency disaster plan, facility sketch, menu, activity calendar and personal rights. Fingerprint clearances were reviewed using a Facility Personnel Report Summary dated 10/17/23. All facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index clearances and/or exemptions. There were no Title 22 deficiencies observed during this visit. Appeal Rights were provided and discussed. Exit interview was conducted with Ms. Alano at 2: PM, and a copy of this report was issued.

met_with: Nonet Alano


facility_name: AIR GROUP HOME

summary: Facility Evaluation

raw_content:
Narrative:
On February 18, 2025 at 9: AM, Licensing Program Analyst (LPA) Pamela Silva conducted a virtual Component II session via Teams with applicant, Air Group Home. Present at the meeting from Air Group Home was Kedra Creer, President. During the meeting, the following items were discussed: 1. All requested revisions in the application documents (LICs) have been submitted by applicant and will be reviewed by LPA Silva. 2. Staff Associations - Ms. Creer stated that she has associated herself and the Administrator to Air Group Home on Guardian. 3. Emergency Disaster Plan 4. Use of Video Cameras - Ms. Creer will add the Use of Video Cameras to their Program Statement per PIN 24-09-CRP. LPA asked questions on the facility's Program Statement/Plan of Operation regarding population to be served, client age range and source of placement. Ms. Creer was informed that the Program Statement is currently being reviewed and that all revisions/corrections requested should be submitted to LPA Silva for review. An exit interview was conducted, and a copy of this report was provided to Ms. Creer.

met_with: Kedra Creer


facility_name: ALLYJIRI HOMES

summary: Facility Evaluation

raw_content:
Narrative:
On 8/27/2025 at 10: AM, Licensing Program Analyst (LPA) Shikya Belfield and LPA Omar Sawyer met with Allyjiri Homes Licensee, Alex Omoko, at the San Jose Regional Office. The purpose of this meeting is to discuss the Plan of Operation and Program Statement for the Group Home Application that was submitted to the department on 7/21/2025 and the Revisions that were submitted to the department on 8/18/2025. Based on two reviews of the application submitted, there are several parts of the application that need clarification, signatures, and updates to reflect the population served. The following was discussed. Population to be served Program policies around the specific population. Application documents Financial information regarding the facility. LPA Belfield went over the above topics with the licensee, LPA provided copies of LIC401A, LIC309, LIC500, and a copy of the third letter of revisions request for the program statement. LPA will provide the link for the regulations home page for Licensee to reference. LPA Belfield and LPA Sawyer discussed any questions that Licensee had. The meeting was concluded.

met_with: Alex Omoko


summary: Facility Evaluation

raw_content:
Narrative:
On 12/30/2025 at 11: AM, Licensing Program Analyst (LPA) Shikya Belfield and LPA Omar Sawyer met with Allyjiri Homes Licensee / Administrator, Alex Omoko and Co-Licensee Ajiri Alex Omoko, at the San Jose Regional Office. The purpose of this meeting is to conduct the component II of the licensing process. The following was discussed: LPA's went over missing information needed for Board of directors. LPA's observed that the requested changes for LIC308 were updated. Administrative responsibilities were discussed as well as staffing ratios. Staff training and requirements were discussed including topics and requirements of trainers, information to be found in the California Code of Regulations. LPA discussed with the Mr. Omoko the need for the program statement to reflect how the program will accomplish its purpose and goals as some of the methods are not clear. LPA discussed client money management. LPA's answered all questions presented by Licensee's at this time. All information discussed will be included in the revision information that will be sent to Mr. Omoko no later than January 2, 2026. Meeting was concluded.


summary: Facility Evaluation

raw_content:
Narrative:
On March 16, 2026, at 12: PM Licensing Program Analysts (LPA) Shikya Belfield conducted a scheduled pre-licensing inspection at the above facility. LPA met with Alex Omoko, Licensee / Administrator and Ajiri Alex Omoko. There are no clients currently placed at the facility. LPA conducted a tour of the facility, reviewed operating requirements with applicant representatives, and discussed the pending items to be completed prior to licensure. Facility was clean and in good repair. LPA inspected 4 bedrooms and 3 bathrooms. One bedroom is dedicated as an office space for staff. Bedrooms were observed to have storage space and beds with proper linens, with extra linens/towels located in each bedroom. Lights were functioning. LPA observed a week supply of nonperishable foods. There are kitchen utensils, silverware, and dishes in the kitchen cabinets and drawers. The trash cans have tight-fitting lids. The backyard is clean and free of obstruction and hazards. LPA observed client rights posted, proper templates posted for menus and activities. There are locked storage areas for medications, sharps, and toxic substances. Cleaning compounds were stored separately from food supplies. Client files and staff files will be stores in the staff office. The following items need to be completed prior to licensure. - More activity supplies and educational supplies will be purchased. - more linens will be purchased to meet the needs of the number of clients requested to be served. - Grievance / complaint policy will be posted in the facility as it was not observed today. - facility sketch / emergency disaster forms need to be posted in the facility. - Applicant will submit all requested documentation as proof prior to becoming licensed. An exit interview was conducted and a copy of this report was left with Applicant Alex Omoko whose signature confirms receipt.

visit_type: Prelicensing


facility_name: ALPHA CONNECTION-ANOKA RANCH, THE

raw_content:
Narrative:
Confidential interviews confirmed an altercation did occur in the facility and the whereabouts of staff during the altercation was unknown. Record review revealed a second video was observed by SI and noted an additional altercation between C3 and C4 occurred on the basketball court at the facility where again no staff supervision was observed. Confidential interviews confirmed the second altercation occurred and the whereabouts of staff during the altercation was unknown. Based on confidential interviews and observation of video footage the allegation lack of supervision resulting in minors (C1, C2, and C3) getting into an altercation with another minor in the home is substantiated. The preponderance of evidence standard has been met. Facility is cited for violation of California Code of Regulations regulation 80078(a) Responsibility for providing care and supervision (a) The licensee shall provide care and supervision as necessary to meet the client's needs. An Enhanced Civil Penalty (ECP) determination is pending. If an ECP is assessed a Community Care Licensing (CCL) representative will return to the facility to deliver the penalty assessment. A copy of the report was discussed and provided along with appeal rights to Alpha Connection - Anoka Ranch, Administrator Evonnda Hull.

Investigation Findings:
13On July 29, 2021 at 11:20am Licensing Program Analyst (LPA), Nicole Strickland, met with Alpha Connection - Anoka Ranch, Administrator Evonnda Hull to deliver the findings for the above stated allegation. The investigation was conducted Community Care Licensing (CCL) Investigation Branch Special Investigator (SI) Marlon Williams and LPA Kendal Zirbes. The investigation included interviews with Program Director (PDir), Administrator (ADM), County Social Worker (CSW), three of six residents (Child #1 [C1], Child #2 [C2], Child #3 [C3]), two staff members (Staff #1 [S1], Staff #2 [S2]). In addition, county records and facility records were reviewed. On March 5, 2021, CCL received an allegation alleging lack of supervision resulting in minors (C1, C2, and C3) getting into an altercation with another minor in the home. Specifically, it was reported a video sent by an anonymous party showed five minors stomping on the head of another minor. Record review of SI's observation of the video noted an altercation did occur in the facility and no staff members were observed. 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: ALPHA CONNECTION-ANOKA RANCH, THEFACILITY NUMBER: VISIT DATE: 07/29/2021

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

met_with: Administrator Evonnda Hull


raw_content:
Narrative:
and a busted lip. Record review revealed on June 13, C1 became escalated and aggressive towards S1, alleging S1 had called C1 an idiot. Confidential interviews reported instead of S1 deescalating C1, S1 was arguing with C1, which escalated the situation. Confidential interviews reported Staff #2 (S2) and Staff #3 (S3) were attempting to de-escalate both C1 and S1, as S1 and C1 continued to argue. Confidential interviews reported during the entire time S2 was attempting to de-escalate the situation, S1's actions of arguing and pushing C1 away in an aggressive manner, continued to escalate the situation resulting in S1 coming from the side/behind of C1, and knocking C1 to the ground. S1's action of knocking C1 to the ground caused C1's face and stomach to land on the gravel driveway where the incident occurred. Additionally, the manner in which S1 took C1 to the ground resulted in S2 to also falling to the ground as S2's arm was trapped between S1 and C1. Confidential interviews reported once C1 was on the ground S1 then jumped on top of C1's back landing with S1's torso on top of C1 and began banging C1's head on the rocks/gravel beneath him. Confidential interviews reported after the incident S1 contacted Program Director (PDir) informing PDir that S1 "took C1 down." Confidential interviews and photographs revealed as a result of this incident and the manner in which S1 "took C1 down," C1 sustained injuries to C1's nose, arms, and lip. Based on record review and confidential interviews the allegation staff member (Staff #1 [S1]) physically assaulted resident (Child #1 [C1]) is substantiated. The preponderance of evidence standard has been met. Facility is cited for violation of Interim Licensing Standards (ILS) standard Personal Rights 87072(d) The licensee shall ensure that each child, regardless of whether the child is in foster care is accorded the personal rights specified in Welfare and Institutions Code Section 16001.9 as applicable. In addition, the licensee shall ensure that each child is accorded the following personal rights. An Enhanced Civil Penalty (ECP) determination is pending. If an ECP is assessed a Community Care Licensing (CCL) representative will return to the facility to deliver the penalty assessment. A copy of the report was discussed and provided along with appeal rights to Alpha Connection - Anoka Ranch, Administrator Evonnda Hull.

Investigation Findings:
13On November 16, 2021 at 6:09pm Licensing Program Analyst (LPA), Nicole Strickland, met with Apha Connection - Anoka Ranch, Administrator Evonnda Hull to deliver the findings for the above stated allegation. The investigation was conducted Community Care Licensing (CCL) Investigation Branch Special Investigator (SI) Marlon William. The investigation included interviews with Program Director (PDir), Administrator (ADM), County Social Worker (CSW), two of six residents (Child #1 [C1] and Child #2 [C2]), four staff members (Staff #1 [S1], Staff #2 [S2], Staff #3 [S3], and Staff #4 [S4]) and San Diego County Social Worker from the Open Case Investigations Unit (OHI). In addition, county records, medical records and facility records were reviewed. On June 30, 2021, Community Care Licensing (CCL) received an allegation alleging staff member (Staff #1 [S1]) physically assaulted resident (Child #1 [C1]). Specifically, it was reported S1 and C1 got into an argument resulting in S1 jumping on top of C1 causing C1 to sustain a bloody nose, scratches to C1's arms, ***CONTINUED ON PAGE 2*** 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: ALPHA CONNECTION-ANOKA RANCH, THEFACILITY NUMBER: VISIT DATE: 11/16/2021

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


raw_content:
Narrative:
Confidential witnesses denied the allegations. Additional confidential witness statements indicate that C1 was possibly injured during a physical altercation between C1 and C4. Confidential witness statements also revealed that C1 and C2 were involved in a physical altercation because C1 had destroyed C2's personal TV. Additional confidential witness statements indicate that C1 was the aggressor towards the other clients at the facility. Confidential witness statements revealed that C1 was bulling the other clients at the facility. Additional confidential witness statements indicate that no clients were making sexual advances towards C1 and that the clients are all teenagers and they make inappropriate comments. Confidential witness statements revealed that C1's cell phone was destroyed by C2 because C1 had destroyed C2's personal TV and the house TV. Additional confidential witness statements indicate that C1 did sustain injuries while at the STRTP home. Confidential witness statements revealed that C1 was being physically abused by the clients at the home. Additional confidential witness statements indicate that C4 was making sexual advances towards C1. Confidential witness statements revealed that C1's cell phone was destroyed by C2 and that the other clients had destroyed C1's personal property. FM stated that C1 had destroyed C2's TV and the facility living room TV. FM also stated that he attempted to deescalate C1 prior to C1 destroying C2's and the house TV's. FM stated that C1 and C2 were involved in a physical altercation (wrestling) and that FM had intervened and separated C1 and C2. FM stated that he had observed redness around C1 and C2's neck and arms. FM states that the clients jokingly make inappropriate sexual comments to one another and that the comments are not made in a serious manner in making sexual advances. FM stated that he verbally redirects the clients to stop making inappropriate comments. AD stated that C1 was not being physically abused by the clients and that it was C1 bullying and intimidating the other clients at the home. AD stated that the clients did not make sexual advances towards C1. CSW states that it was C1 bullying the other clients CSW went on to add that C1 was also destroying the facility property. CSW was unaware of the client's making sexual advances towards C1, and that the clients were destroying C1's property. Based on confidential interviews, the allegation that alleged client #1 (C1) sustained injuries while in care, C1 is being physically abused by other clients in the home, clients are making sexual advances towards C1, and that the clients are destroying C1's property., may have occurred, however is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Facility Manager (FM), Tyler Frankland.

Investigation Findings:
13On December 17, 2021 at 8:57AM, Licensing Program Analyst (LPA) Jose Gonzalez met with Alpha Connection Anoka Ranch Facility Manager (FM), Tyler Frankland, to deliver the findings for the above stated allegations. LPA conducted a safety inspection at the facility at 9:57am on August 13, 2021 and no safety hazards were observed. LPA also reviewed seven of seven client's records. During the investigation, interviews were conducted with four of the seven clients, Facility Manager (FM), Facility Administrator (A), and County Social Worker (CSW). An interview with client's #3, #4, and #5 (C3, C4, C5) was attempted but the clients refused to be interviewed. The Department received a complaint on August 10, 2021, that alleged client #1 (C1) sustained injuries while in care, C1 is being physically abused by other clients in the home, clients are making sexual advances towards C1, and that the clients are destroying C1's property. *R- 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: ALPHA CONNECTION-ANOKA RANCH, THEFACILITY NUMBER: VISIT DATE: 12/17/2021

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

met_with: Facility Manager (FM), Tyler Frankland


raw_content:
Narrative:
Confidential witness statements also revealed that the clients have the option to turn in their money to be secured in a lock box inside of a locked file cabinet located in the staff office. Confidential witness statements indicate that no money was found in C1's bedroom and that C1 never turned in C1's money for safeguarding. Additionally, witness statements indicate that the facility administrative staff does not condone such behavior and that the administrative staff did not pay C1 to physically assault other clients in care. Witness statements also revealed that it was not observed that staff paid C1 to assault the other clients. Witness statements indicate that the facility staff do supervise the clients throughout the milieu and that the facility monitors the client's interactions. Additional confidential witness statements indicate that the facility staff had removed C1's money from a black lock box located in C1's bedroom. Witness statements also revealed that C1 was paid by facility administrative staff to assault other minors in care. Additionally, witness statements indicate that the facility administrative staff would pay C1 $200.00 a week to assault the other clients that were not following the STRTP house rules. Witnesses further stated, that the facility staff did not supervise the clients and that the facility staff were not monitoring the client's interactions. Confidential witness statements also revealed that the facility administrative staff condone such behavior. Based on confidential interviews, the allegation that alleged the facility staff did not safeguard client #1 (C1) money, facility staff paid C1 to physically assault other clients in care, and that the facility did not supervise 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, appeal rights explained, and a copy of this report was provided to Facility Administrator (FA), Evonda Hull.

Investigation Findings:
13On February 4, 2022 at 10:23AM, Licensing Program Analyst (LPA) Jose Gonzalez met with Alpha Connection Anoka Facility Administrator (FA), Evonnda Hull, to deliver the findings for the above stated allegations. LPA conducted a safety inspection at the facility at 9:54am on July 16, 2021 and no safety hazards were observed. LPA also reviewed seven of seven client's records. During the investigation, interviews were conducted with five of seven clients, as two clients refused to be interviewed, Executive Director (ED), Assistant Executive Director (AED), Staff #1 (S1) Staff #2 (S2), Staff #3 (S3), and County Social Worker (CSW). The Department received a complaint on July 7, 2021, that alleged the facility staff did not safeguard client #1 (C1) money, facility staff paid C1 to physically assault other clients in care, and that the facility did not supervise clients. Confidential witnesses denied the allegations. Additional confidential witness statements indicate that the facility staff does safeguard the clients' money. R- 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: ALPHA CONNECTION-ANOKA RANCH, THEFACILITY NUMBER: VISIT DATE: 02/04/2022

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


raw_content:
Narrative:
Confidential interviews indicate that staff #1 (S1) was asleep during the assault. Regarding the allegation, the facility staff did not report the incident to C1s responsible party in a timely manner. Confidential interviews revealed that C1s county social worker (CSW) had emailed Alpha Connection Youth and Family Services Program Director (PD) and Facility Administrator (FA) requesting the incident report of C1 being assaulted and pictures of C1s injuries on 01/31/2022. Additional confidential interviews indicate that C1s CSW also contacted PD on 01/31/2022. Confidential interviews revealed that C1s CSW emailed on PD 02/01/2022 with the summation of their conversation and again requested a copy of the incident report of C1s assault and pictures of C1 injuries. Based on confidential interviews and pictures of C1's injuries that the lack of supervision resulted in client #1 (C1) being assaulted by client #2 (C2) while in care is Substantiated as the preponderance of evidence standard has been met for the allegation. This poses an immediate health, safety, or personal rights risk to clients in care. The facility is being cited under Short-Term Residential Therapeutic Program Interim Licensing Standards (ILS) Chapter 7. Version 4, 87072(11) Personal Rights To be free of physical, sexual, emotional, or other abuse, and from corporal or unusual punishment, *exploitation,* infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature including, but not limited to, interference with the daily living functions of eating, sleeping, or toileting, or withholding of shelter, clothing, or aids to physical functioning. Based on confidential interviews and evidence gathered that the facility staff did not report the incident to C1s responsible party in a timely manner is Substantiated as the preponderance of evidence standard has been met for the allegation. This poses a potential Health, Safety, or Personal Rights risk to children in care. CCR 80061Reporting requirements (a)(1)(D)(G) The facility is being cited under Short-Term Residential Therapeutic Program Interim Licensing Standards (ILS) Chapter 7. Version 4, 87072(11) Personal Rights To be free of physical, sexual, emotional, or other abuse, and from corporal or unusual punishment, *exploitation,* infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature including, but not limited to, interference with the daily living functions of eating, sleeping, or toileting, or withholding of shelter, clothing, or aids to physical functioning. The facility is being cited under CCR 80061Reporting requirements (a)(1)(D)(G)An exit interview was conducted, appeal rights explained, and a copy of this report was provided to CEO, Barron Wilson. Confidential interviews indicate that C1 was not transported to the hospital to receive medical attention. Additional confidential interviews revealed that the clients are not in possession of marijuana. Confidential interviews indicate that marijuana has not been observed by facility staff during perimeter and room searches. Additional confidential interviews revealed that the clients keep the marijuana on their person during room searches. Confidential interviews indicate that the client's AWOL from the facility when room searches are being conducted. Based on confidential interviews, the allegation that alleged facility staff did not seek medical attention for client #1 (C1) and that the clients are in possession of marijuana at the facility, may have occurred, however is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to CEO, Barron Wilson.

Investigation Findings:
13On April 11, 2022, at 1:23 pm, Licensing Program Analyst (LPA) Jose Gonzalez and Licensing Program Manager (LPM) Christina Barnes met with Alpha Connection Anoka Chief Executive Officer (CEO), Barren Wilson to deliver the findings for the above stated allegations. LPA conducted a safety inspection at the facility at 11:05 am on February 11, 2022, and no safety hazards were observed. LPA also reviewed six of six client's records. During the investigation, interviews were conducted with six of six clients (C1, C2, C3, C4, C5, C6), Facility Manager (FM), Staff #2, #3 (S2, S3), and County Social Worker (CSW). The Department received a complaint on February 7, 2022, that the lack of supervision resulted in client #1 (C1) being assaulted by client #2 (C2) while in care. Confidential interviews indicate that C2 had assaulted C1. Additional confidential interviews revealed that C2 had hit C1 with two belts in their bedroom behind closed doors. Confidential interviews indicate that C1 had red marks across their upper back, behind both ears, both sides of their face, and neck. Additional confidential interviews revealed that C3 had to intervene and stop C2 from assaulting C1. R- 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: ALPHA CONNECTION-ANOKA RANCH, THEFACILITY NUMBER: 366401649

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:


raw_content:
Narrative:
found in the home. While other confidential information received by Licensing Office stated that the allegations had occurred, and that S1 had given C1 marijuana in lieu of medication, as well as smoked marijuana with C1 while in care. Confidential information received also stated that some staff will allow clients to smoke marijuana in the backyard area. Based on confidential information obtained during the course of this investigation, there is insufficient evidence to prove the conduct inimical allegation, thus the allegations that staff member # 1 (S1) gave Child # 1 (C1) marijuana in lieu of medication, as well as smoked marijuana with C1 while in care, may have occurred, however is not supported or proven by evidence. Therefore, the above allegations are unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided

Investigation Findings:
13Licensing Program Analyst (LPA), Daniel Mena met with Facility Director, Tyler Frankland to discuss the investigative findings for the above stated allegation. Special Investigator, Brittany Hudec (SI) conducted an inspection to the Short Term Residential Therapeutic Program (STRTP) on December 07, 2021. Special Investigator (SI), Brittany Hudec interviewed three staff (S1, S2, S3), six of six foster children (C1, C2, C3, C4, C5 & C6), two County Social Workers (CSW1, CSW), as well as reviewed police, client and facility records. Community Care Licensing received information on December 06, 2021 alleging that staff member # 1 (S1) gave Child # 1 (C1) marijuana in lieu of medication, as well as smoked marijuana with C1 while in care. Information obtained in confidential interviews did not corroborate the allegations with a preponderance of evidence. Confidential interviews denied that S1 or any other staff had ever provided marijuana in lieu of medication, or smoked marijuana with C1 or any other children in care. Confidential interviews also denied that staff allow or encourage minors to smoke marijuana in the home. According to confidential information, staff will always confiscate marijuana if it is UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Daniel Mena 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: ALPHA CONNECTION-ANOKA RANCH, THEFACILITY NUMBER: VISIT DATE: 04/28/2022

met_with: Tyler Frankland


raw_content:
Narrative:
The facility is cited for California Code of Regulations (CCR) Reporting requirements (a)(1)(D)(G). See attached LIC 9099D for cited deficiency. An exit interview was conducted, appeal rights explained and a copy of this report was provided to Amy Osborn, along with the LIC 811.

Investigation Findings:
13On May 27, 2022 at Amy Osborn, Licensing Program Analyst's (LPA's) Darlene Almaraz-Oseguera and Jose Gonzalez conducted an unannounced inspection to the facility to deliver the findings of the above allegation. LPA met with Amy Osborn. LPA Jose Gonzalez conducted an inspection of the facility on September 17, 2021 at 11:11 am and no immediate deficiencies were observed. Four of four children (C1, C2, C3, C4), four staff and facility administrator were interviewed. It was reported to Community Care Licensing (CCL) that facility staff did not report an injury that occurred with C1, to C1's authorized representative. Confidential interviews reported that on September 15, 2021, C1 was observed with a bruise/black eye on C1's right eye. Confidential interviews reported that C1 and C2 had gotten into a physical altercation, which resulted in C1 sustained a black eye. Confidential interviews reported that C1 authorized was not aware of this incident/injury, as staff did notify C1's authorized representative. Based on confidential interviews and evidence gathered that the facility staff did not report C1's blackeye to C1's authorized representative is Substantiated as the preponderance of evidence standard has been met for the allegation. This poses a potential Health, Safety, or Personal Rights risk to children in care. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Darlene Almaraz LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE This is an official report of an unannounced visit/investigation of a complaint received in our office on 09/15/2021 and conducted by Evaluator Darlene Almaraz PUBLICCOMPLAINT CONTROL NUMBER: 19-CR- FACILITY NAME:ALPHA CONNECTION-ANOKA RANCH, THEFACILITY NUMBER: ADMINISTRATOR:EVONNDA HULLFACILITY TYPE: ADDRESS: ANOKA RDTELEPHONE: (760) 247- CITY:APPLE VALLEYSTATE: CAZIP CODE: CAPACITY:6CENSUS: 5DATE: 05/27/ UNANNOUNCEDTIME BEGAN: 09: AM MET WITH:Amy OsbornTIME COMPLETED:10: AM 9Facility staff did not prevent youths from engaging in physical altercations INVESTIGATION FINDINGS: 13On May 26, 2022 at 9:25am, Licensing Program Analyst's (LPA's) Darlene Almaraz-Oseguera and Jose Gonzalez conducted an unannounced inspection to the facility to deliver the findings of the above allegation. LPA met with Program Director Amy Osborn. LPA Jose Gonzalez conducted an inspection at the facility on September 17, 2021 at 11:11 am and no immediate deficiencies were observed. Four of four children (C1, C2, C3, C4), four staff and facility administrator were interviewed. It was reported to Community Care Licensing (CCL) that staff did not prevent C1 and C2 from getting into a physical altercation. Confidential interviews reported that on September 15, 2021, C1 was observed with a bruise on the right eye. Confidential interviews reported that C1 and C2 got into physical altercation and staff did intervened. Confidential staff interviews reported that staff separated C1 and C2, however it is unclear how long staff took to respond and separate the clients. The interviews that were provided to the LPA were not consistent regarding the allegation that staff did not prevent C1 and C2 from getting into a physical altercation and interviews did not provide any further specific details. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Amy Osborn, along with the LIC 811. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Darlene Almaraz LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 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: ALPHA CONNECTION-ANOKA RANCH, THEFACILITY NUMBER: 366401649

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: Amy Osborn


raw_content:
Narrative:
Additional confidential interviews revealed that S1 did not kick C3. Based on confidential interviews that staff #1 (S1) physically abused C1 while in care is Substantiated as the preponderance of evidence standard has been met for the allegation. This poses an immediate health, safety, or personal rights risk to clients in care. The facility is being cited under Short-Term Residential Therapeutic Program Interim Licensing Standards (ILS) Chapter 7. Version 4, 87072(11) Personal Rights To be free of physical, sexual, emotional, or other abuse, and from corporal or unusual punishment, *exploitation,* infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature including, but not limited to, interference with the daily living functions of eating, sleeping, or toileting, or withholding of shelter, clothing, or aids to physical functioning. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Facility Administrator (FA), Evonnda Hull.

Investigation Findings:
13On June 3, 2022, at 10:41 am, Licensing Program Analysts (LPAs) Jose Gonzalez and Darlene Oseguera met with Alpha Connection Anoka Facility Administrator (FA), Evonnda Hull to deliver the findings for the above stated allegations. LPA conducted a safety inspection at the facility at 10:28 am on December 21, 2021, and no safety hazards were observed. LPA also reviewed six of six client's records. During the investigation, interviews were conducted with six of six clients (C1, C2, C3, C4, C5, and C6), Facility Manager (FM), Staff #1 (S1), Staff #2 (S2), Facility Director (FD), and County Social Worker #2 (CSW2). The Department received a complaint on December 17, 2021, that staff #1 (S1) physically abused C1 while in care. Confidential interviews indicate that S1 had pushed C1 and C2. Additional confidential interviews revealed that S1 had kicked C3. Confidential interviews indicate that C1 had punched S1 in the back of S1 head. Additional confidential interviews revealed that S1 admitted that S1 had pushed C1 away. Confidential interviews indicate that S1 had reported the incident to Program Director and Facility Manager. Confidential interviews indicate that S1 did not push C2.***CONTINUED on LIC C***** SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Jose Gonzalez 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: ALPHA CONNECTION-ANOKA RANCH, THEFACILITY NUMBER: 366401649

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


facility_name: ALPHA CONNECTION-NISQUALLY NEST, THE

raw_content:
Narrative:
Additional confidential interviews revealed that C2 did choke and suffocate C1. Confidential witness statements indicate that staff did not observe C2 choke and suffocate C1 because the incident occurred in C1 and C2 bedroom. CSW stated that C1 has a history of aggression. CSW also stated that C1 has a history of being hospitalized and placed on 5150 holds. Based on confidential interviews, the allegation that alleged facility staff did not provide a safe environment for client 1 (C1)., may have occurred, however is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Facility Director (FD), Lourdes Galeana.

Investigation Findings:
13On September 2, Licensing Program Analyst (LPA) Jose Gonzalez met with Facility Director (FD), Lourdes Galeana to issue the findings for the above stated allegations. LPA inspected the facility at 10:53am on April 22, 2021, reviewed facility file and six of six clients' files. During the investigation, interviews were conducted with three out of six clients, three of the six clients refused to be interviewed, STRTP facility staff, Facility Director (FD), and County Social Worker. On April 19, 2021 the department received a complaint that alleged facility staff did not provide a safe environment for client 1 (C1). Confidential witness statements indicate that staff were supervising the clients. Additional confidential interviews revealed that C2 did not choke nor suffocated C1. Confidential witness statements indicate that facility staff did not observe the alleged incident that C2 had suffocated C1. Additional confidential interviews revealed that facility staff verbally redirected C1 and C2 to stop horse playing and that horse playing was not allowed. Confidential witness statements indicate C1 and C2 began to fight and that facility staff immediately intervened and separated C1 and C2.R- 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: ALPHA CONNECTION-NISQUALLY NEST, THEFACILITY NUMBER: VISIT DATE: 09/02/2021

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

met_with: Facility Director Lourdes Galeana


raw_content:
Narrative:
corroborate these allegations with a preponderance of evidence. Confidential interviews denied a lack of supervision resulting in C1 being injured while in care. According to confidential information, C1 and C4 got into an altercation in which staff immediately intervened. According to confidential interviews, C1 was asked if they were fine and offered medical attention to which C1 declined. It was not until the following day that C1 began to complain of pain in their arm and was taken by staff to receive medical care and was diagnosed with a "sprained shoulder." Confidential interviews also denied that C1 ever tested positive for COVID 19. According to confidential information, although other clients in the home were COVID positive during the time that C1 resided in the home, C1 was tested for COVID on at least two occasions to which C1 tested negative. Confidential interviews also denied allegation that C1 had missed school due to short staffing. According to confidential interviews, if there is insufficient staff for transportation, they will obtain additional help from one of their other facilities. Regarding allegation that C1 was not receiving the required products for their hair care, confidential interviews denied that this was true and stated that whenever the facility does not have a product for a specific type of hair, clients can request it from the staff and they will purchase it. While other confidential information received by Licensing Office stated that these allegations had occurred. Based on confidential information obtained during the course of this investigation, the allegations that Child # 1 (C1) was injured while in care due to lack of supervision, that staff did not report that C1 was COVID positive, that C1 did not attend school on one occasion due to a staffing shortage, and that staff is not assisting C1 with hygiene, more specifically that staff was not providing the required products for C1's hair care, may have occurred, however is not supported or proven by evidence. Therefore, the above allegations are unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided.

Investigation Findings:
13Licensing Program Analyst (LPA), Daniel Mena met with Facility Manager, Psami Savea to discuss the investigative findings for the above stated allegations. Licensing Program Analysts (LPAs), Jose Gonzalez and Daniel Mena conducted an inspection to the Short Term Residential Therapeutic Program (STRTP) on February 11, 2022 at 9:01am and on May 27, 2022 at 11:00am. No immediate hazards observed. LPAs Gonzalez and Mena interviewed five staff (S1, S2, S3, S4 & S5), four foster children (C1, C2, C3 & C4), as well as reviewed client and facility records. LPA Mena was unable to interview Child # 5 (C5), due to their current whereabouts being currently unknown. Community Care Licensing received information on February 4, 2022 alleging that Child # 1 (C1) was injured while in care due to lack of supervision, that staff did not report that C1 was COVID positive, and that C1 did not attend school on one occasion due to a staffing shortage. Allegation also claimed that staff is not assisting C1 with hygiene needs, more specifically that staff was not providing the required products for C1's hair care. LPAs obtained conflicting information in confidential interviews and did not UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Daniel Mena 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: ALPHA CONNECTION-NISQUALLY NEST, THEFACILITY NUMBER: VISIT DATE: 06/16/2022

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

met_with: Pasami Savea


raw_content:
Narrative:
evidence. Confidential interviews denied that any "grown men" deliver or drop off drugs and alcohol to any of the clients, and that facility is not only gated, but that there are also motion lights and alarms on the doors and windows of the facility which would have alerted staff if this had occurred. Confidential interviews stated that if drugs and alcohol is obtained by clients, it is usually done so while on AWOL (absence without official leave) status or on approved leave passes. According to confidential interviews, searches are conducted upon return to the facility, but that clients often hide contraband near their private areas which they know will not be searched by staff. LPAs also obtained conflicting information regarding allegation that C4 had access to a knife and had made threats against C1 and other clients. According to confidential information, C1 had never actually had possession of a knife, and that only verbal threats were made. Other confidential information received regarding knife, stated that C4 "might" have made the comment while cooking and holding knife under the supervision of staff but could not recall, while other confidential interviews stated that C4 possibly found a knife inside one of the vehicle's belonging to one of the boy's home. Confidential interviews also denied having any knowledge of C1 having any personal items stolen, while other confidential interviews stated that C1 never filled out a reimbursement request when told to report stolen items and even later told some staff that they had found the items that they thought were previously stolen. Based on confidential information obtained during the course of this investigation, the allegations that Child # 1's (C1) possessions are not being safe guarded, that minors have access to drugs and alcohol due to "grown men" dropping these items off at facility, as well as a lack of supervision by staff that led to Child # 4 (C4) gaining access to a knife and making threats to other minors in care; including C1, may have occurred, however is not supported or proven by evidence. Therefore, the above allegations are unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided.

Investigation Findings:
13Licensing Program Analyst (LPA), Daniel Mena met with Facility Manager, Psami Savea to discuss the investigative findings for the above stated allegations. Licensing Program Analysts (LPAs), Jose Gonzalez and Daniel Mena conducted an inspection to the Short Term Residential Therapeutic Program (STRTP) on February 18, 2022 at 10:45am and on May 27, 2022 at 9:08am. No immediate hazards observed. LPAs Gonzalez and Mena interviewed five staff (S1, S2, S3, S4 & S5), four foster children (C1, C2, C3 & C4), as well as reviewed client and facility records. LPA Mena was unable to interview Child # 5 (C5), due to their current whereabouts being currently unknown. Community Care Licensing received information on February 14, 2022 alleging that Child # 1's (C1) possessions are not being safe guarded, that minors have access to drugs and alcohol due to "grown men" dropping these items off at facility, as well as a lack of supervision by staff that led to Child # 4 (C4) gaining access to a knife and making threats to other minors in care; including C1. LPAs obtained conflicting information in confidential interviews and did not corroborate the allegations with a preponderance of UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Daniel Mena 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: ALPHA CONNECTION-NISQUALLY NEST, THEFACILITY NUMBER: VISIT DATE: 06/16/2022

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


summary: Complaint Investigation - Substantiated - 1 deficiency - 1 allegation

raw_content:
Narrative:
reported C1 was rushed to the Emergency Department after consuming a whole bottle of alcohol. Confidential interviews reported the incident occurred in the late evening of February 10, 2022. Confidential interviews reported C1 and Child #2 (C2) entered the facility bathroom at approximately 11:30 pm were C1 consumed an entire bottle of alcohol, the amount of time C1 and C2 spent in the bathroom is uncertain as confidential interviews report it was a long time with statements noting anywhere from an hour to an hour and a half as time given. Confidential interviews reported staff did try to enter the bathroom and reported was blocked. However, facility communication log was unable to provide evidence of the timeline for the evening as the communication log for February 10, 2022 had no entries. A review of the Serious Incident Report (SIR) provided for the incident written by the facility, incident occurred on 2/11/2022 at 12:38 am and reported time in bathroom was fifteen minutes. Confidential interviews reported when C1 exited the bathroom staff observed C1 to stumble out of the bathroom stumbling words and shortly after C1 began vomiting. Confidential interviews reported feeling concerned as it was unknown if other substances were consumed or if C1's prescribed psychotropic medications may cause dangerous side effects. Confidential interviews reported that staff contacted Administrator (ADM) who was overheard to say let C1 sleep it off, not to call 9-1-1, and continue to assess. Confidential interviews reported when staff arrived for the overnight shift, the staff was made aware of the concerns for C1 and observed C1 to have labored breathing and reported C1's color to be changing prompting staff to call 9-1-1. Confidential interviews and record review revealed C1 was transported to the hospital on 2/11/2022 at 0233 hours and diagnosed with Acute Alcohol Intoxication and dehydration. Based on confidential interviews and record review the allegations Lack of supervision resulted in minor (Child #1 [C1]) consuming excessive amount of alcohol while in care, requiring hospitalization, Medical treatment for minor (C1) in care was not sought with reasonable promptness that met the needs of the child and Minor (C1) was not properly supervised while in care are substantiated. The preponderance of evidence standard has been met. Facility is cited for violation of Interim Licensing Standards (ILS) standard 87065.2 (b)(1) PERSONNEL DUTIES (b) Direct care staff shall perform the following duties: (1) supervision, protection, and care of children at all times, individually and in groups, 87072(c) PERSONAL RIGHTS (c) The licensee shall ensure that each child, regardless of whether the child is in foster care, is accorded the personal rights specified n Welfare and Institutions Code Section 16001.9 as applicable, and 87065.2 (a)(2) PERSONNEL DUTIES (a)The Facility manager shall meet the requirements of Health and Safety code section 1522.4 and be responsible for: (2) Supervising the direct care staff, ensuring appropriate care and ****** supervision is provided to the children in accordance with applicable law, licensing regulations, and the facilities polices. An immediate civil penalty is being assessed to the facility for violation of 87065.2 (a)(2) PERSONNEL DUTIES (a)The Facility manager shall meet the requirements of Health and Safety code section 1522.4 and be responsible for: (2) Supervising the direct care staff, ensuring appropriate care and supervision is provided to the children in accordance with applicable law, licensing regulations, and the facilities polices. A civil penalty for repeat violation of 87065.2 (b)(1) PERSONNEL DUTIES (b) Direct care staff shall perform the following duties: (1) supervision, protection, and care of children at all times, individually and in groups is also being assessed to the facility. A copy of the report was discussed and provided along civil penalty assessments (LIC 421FC, and LIC 421IM) with appeal rights to Alpha Connections Nisqually Nest, Administrator (ADM), Evonda Hull

Investigation Findings:
13On July 13, 2022 at 3:48pm Licensing Program Analyst (LPA), Nicole Strickland, arrived at Alpha Connections Nisqually Nest, and met with Administrator (ADM), Evonda Hull to deliver the findings for the above stated allegations. The investigation was conducted by Community Care Licensings Investigations Branch Special Investigator (SI) Brittney Hudec and LPA Strickland and included interviews with three staff (Staff #1 [S1], Staff #2 [S2], Staff #3 [S3]) six foster youth (child #1 [C1], Child #2 [C2], Child #3 [C3], Child #4 [C4], Child #5 [C5] and Child #6 [C6]), two Kings County County Social Workers (CSW#1, CSW#2), Kings County Department of Children and Family Services Investigator, and ADM. In addition, county records and facility records were reviewed. On February 22, Community Care Licensing (CCL) received three allegations alleging lack of supervision resulted in minor (Child #1 [C1]) consuming excessive amount of alcohol while in care, requiring hospitalization, medical treatment for minor in care was not sought with reasonable promptness that met the needs of the child, and minor was not properly supervised while in care. Specifically it was 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: ALPHA CONNECTION-NISQUALLY NEST, THEFACILITY NUMBER: VISIT DATE: 07/13/2022

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

Deficiencies:
87065.2: (2) Supervising the direct care staff, ensuring appropriate care and supervision is provided to the children in accordance with applicable law, licensing regulations, and the facilities polices.

met_with: Evonda Hull


raw_content:
Narrative:
Additional confidential interviews revealed that the facility staff did not document on Medication Administration Record Sheet (MARS) logbook that the medications were administered to minors. Confidential interviews disclosed that facility staff had to contact the facility staff from the previous shift of 07/04/2022 to ensure the medications were administered per doctor orders. The Department also received an allegation that the facility was operating out of ratio. Confidential interviews revealed that on 07/05/2022, Staff #1 (S1) had transported Staff #2 (S2) home, which left the Facility Manager (FM) with six minors. Additional confidential interviews revealed that the FM was aware that the facility would be out of ratio and had instructed S1 to take three minors on the transport to S2's home. Confidential interviews disclosed that it was observed by a County Social Worker (CSW) that FM was out of ratio with six clients. FM admitted that the facility was out of ratio with six minors present with only one staff member on 07/05/22. Based on LPA confidential interviews and County Social Worker observations, the facility staff did not maintain accurate medical records for minor(s) in care, and the facility was operating out of ratio are substantiated as the preponderance of evidence standard has been met for the allegations. The facility will be cited for a violation of the Interim Licensing Standards (ILS) 87070(b)(13)(H) Children's Records and 87065.5 (a)(1) Direct Care Staff/Child Ratios. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Program Director (PD), Amy Osborn..

Investigation Findings:
13On July 21, 2022, at 9:16 am, Licensing Program Analysts (LPAs) Jose Gonzalez and Joon Choi met with Program Director (PD), Amy Osborn, to deliver the findings for the above-stated allegations. LPAs conducted a safety inspection at the facility at 10:46 am on July 8, 2022, and no immediate health and safety hazards were observed. LPAs also reviewed Medication Administration Record Sheet (MARS) logbook and six out of six clients' records. During the investigation, interviews were conducted with one out of six clients (C1 was at school, C2, C3, C4, and C6 were asleep), Facility Manager (FM), Program Director (PD), Staff #1 (S1), Staff #3 (S3), and County Social Worker (CSW). On July 6, 2022, the Department received an allegation that the facility staff did not maintain accurate medical records for minor(s) in care. Confidential interviews revealed that the facility staff administered medications to minors on 07/04/2022, but on 07/05/2022 a County Social Worker had observed the MARS logbook did not contain documentation that the medications were administered. ******* CONTINUED on LIC 9099C****** SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Jose Gonzalez 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: ALPHA CONNECTION-NISQUALLY NEST, THEFACILITY NUMBER: VISIT DATE: 07/21/2022

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

Deficiencies:
87065.5: (1) During the hours of 7 am to 10 pm, there shall be one awake and on duty direct care staff for every three children, or fraction thereof, present, at a minimum.1
2
3
4
5
6
7Per Program Director Amy Osborn staff were retrained on appropriate staff to client ratio with all Nisqually staff on 07/07/2022. PD stated that staff was issued administrative warnings and reeducated on proper ratio. Proof of training module and staff sing in sheet documentation was faxed to LPA by 07/08/2022.
8
9
10
11
12
13
14Based on LPA confidential interviews: ,

met_with: Program Director (PD), Amy Osborn

title: (a)(1) Direct Care Staff/Child Ratios In a facility with a licensed capacity of six or fewer children, there shall be coverage by direct care staff as follows


raw_content:
Narrative:
Confidential interviews indicate that the minors do not feel safe at the home because other minors are threatening them when the facility staff are not monitoring their interactions. The Department also received allegations that facility staff #1 (S1) are sleeping during work shifts. Confidential interviews indicate the facility staff are not sleeping during work their shifts. Additional confidential interviews revealed that male staff do not work nocturnal shifts at the Nisqually Nest home. Confidential interviews indicate that S1 has not worked a shift at this STRTP home. Confidential interviews revealed that they have not observed S1 working at the STRTP home. Additional interviews revealed that facility staff are sleeping at the STRTP home. Confidential interviews disclosed that it was observed that a facility staff was sleeping during their shift. Additional interviews revealed that facility staff are stressed out. Based on confidential interviews, the allegation that facility staff are not providing supervision to the minors in care and that facility staff #1 (S1) is sleeping during work shifts may have occurred, however is not supported, or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Amy Osborn.

Investigation Findings:
13On August 23, 2022, at 12:51 pm, Licensing Program Analysts (LPA's) Jose Gonzalez and Joon Choi met with Program Director (PD), Amy Osborn to deliver the findings for the above-stated allegations. LPA conducted a safety inspection at the facility at 2:48 pm on March 18, 2022, and no immediate health and safety hazards were observed. LPA also reviewed six of six clients' records. During the investigation, interviews were conducted with six of six clients (C1, C2, C3, C4, C5, and C6), Facility Manager (FM), and Staff #1 (S1). The Department received a complaint on March 18, 2022, that alleged facility staff are not providing supervision to the minors in care. Confidential interviews indicate that facility staff are providing supervision for the minors in care. Additional confidential interviews revealed that the facility staff intervened immediately when the residents argued or fought. Confidential interviews indicate that the facility staff are checking on the minors every 15 to 30 minutes. Additional confidential interviews revealed that minors are picking on other minors when the facility staff are not supervising the minors. **CONTINUED on LIC 9099** UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Jose Gonzalez 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: ALPHA CONNECTION-NISQUALLY NEST, THEFACILITY NUMBER: VISIT DATE: 08/23/2022

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


raw_content:
Narrative:
***This is an amended report of a report that was originally issued on 9/8/2022*** On May 6, 2022, Community Care Licensing (CCL) received an allegation alleging Minors are smoking marijuana while in care. Specifically, it was reported during three out of four unannounced visits County Social Worker #1 (CSW1) observed residents inside their rooms smoking marijuana. Record review of the facilities communication log/running log revealed during the period for April 13, 2022 through May 1, 2022 staff noted 14 separate incidents were residents (Child #1 [C1], Child #2 [C2], Child #3 [C3], Child #4 [C4] and/or Child #5 [C5]) were observed to be smoking alone or with other residents. Confidential interviews confirmed that residents smoke in the bedrooms/bathrooms or in the backyard of the facility. Based on confidential interviews and record review the allegation minors are smoking marijuana while in care is substantiated. The preponderance of evidence standard has been met. Facility is cited for violation of Interim Licensing Standards (ILS) standard 87087 (c) Buildings and Grounds. The licensee shall prohibit smoking in the facility and on the grounds of the facility. . A copy of the report was discussed and provided along appeal rights to Alpha Connections - Nisqually Program Director (PD) Elysia Moore.

Investigation Findings:
13***This is an amended report of a report that was originally issued on 9/8/2022*** On 9/8/2022, 2022 at 11: AM Licensing Program Analysts (LPA) Joon Choi and Jessica Peete, met with Alpha Connections - Nisqually Nest Program Director (PD), Elysia Moore to deliver the finding for the above stated allegation. The investigation was conducted by Special Investigator (SI) Britany Hudec and LPA Strickland and included interviews with seven foster youth (Child #1 [C1], Child #2 [C2], Child #3 [C3], Child #4 [C4], Child #5 [C5], Child #6 [C6] and Child #7 [C7]), seven staff members (Staff #1 [S1], Staff #2 [S2], Staff #3 [S3], Staff #4 [S4], Staff #5 [S5], Staff #6 [S6] and Staff #7 [S7]), ADM, two San Diego Department of Children and Family Services (DCFS) County Social Workers (CSW [CSW1] and [CSW2]) two Kings County DCFS CSWs (CSW3 and CSW4), and Kings County DCFS Investigator. In addition, county records and facility records were reviewed. SubstantiatedEstimated 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: ALPHA CONNECTION-NISQUALLY NEST, THEFACILITY NUMBER: VISIT DATE: 09/08/2022

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

Deficiencies:
87087: 1
2
3
4
5
6
7

met_with: Evonda Hull, Administrator

title:
(c) Buildings and Grounds. The licensee shall prohibit smoking in the facility and on the grounds of the facility.

This requirement is not met as evidenced by

description:
1
2
3
4
5
6
7