summary: Facility Evaluation

raw_content:
Narrative:
On November 5th, 2025 at 10:35AM, Licensing Program Analyst (LPA) Hanako Primer conducted an unannounced Annual Inspection at the listed facility. LPA met with Sherice Youngblood, Program Director, Devorah Weiss, Compliance Officer, and Dina Letitchevski, Senior People Operations Generalist. LPA toured the facility inside and out. The Group Home is licensed to serve six clients. Present during the inspection were six clients. LPA reviewed five staff files. LPA inspected CPR and first aid certificates, health screening, onboarding training, TB tests, job descriptions, and CPI training in five out of five staff files. LPA Primer toured the facility. LPA observed four bedrooms and four bathrooms. LPA observed facility license, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA tested the water temperature and found it to be 122 degrees. LPA issued one technical violation under California Code of Regulations (CCR) 80088(e)(1) Fixtures, Furniture, Equipment, and Supplies. See attached LIC9102. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in nurse's station. The facility is in good repair and clean. LPA toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. LPA interviewed two staff and two clients. At this time there were no deficiencies. An exit interview was conducted and a copy of this report was given to Sherice Youngblood, Program Director.

met_with: Sherice Youngblood - Program Director


state: CA

facility_name: EVOLVE TREATMENT CENTER, DANVILLE

summary: Facility Evaluation

raw_content:
Narrative:
On 10/15/2025, Licensing Program Analyst (LPA) Jonathan Medina conducted a case management inspection to correct a licensing document dated 7/17/2025 for complaint 14-CR-20250512102801. LPA met with Facility nurse, Chynna Hooper. LPA disclosed the purpose of the inspection and was granted entry into the facility. At 2:00 p.m., LPA updated the LIC 9099 for complaint 14-CR-20250512102801 to reflect that only one deficiency was cited under California Code of Regulations (CCR), Title 22, Section 80078(a) - Responsibility for Providing Care and Supervision. The appeals process placed a hold on the Plan of Correction (POC) due date. The deficiency was re-assessed during today's visit, and a new due date was established. Now that the appeal process has concluded, the POC for the above-referenced complaint is outstanding and must be submitted by 10/31/2025. Please refer to LIC809-D for additional details. An exit interview was conducted, appeal rights were discussed, and a copy of this report was provided to Facility nurse, Chynna Hooper, whose signature below confirms receipt.

report_type: Facility Evaluation

met_with: Facility nurse, Chynna Hooper


facility_name: EVOLVE TREATMENT CENTER, GILROY

summary: Facility Evaluation

raw_content:
Narrative:
At 2PM, Licensing Program Analyst (LPA) Madi Fremont traveled to Evolve Gilroy to conduct an unannounced Case Management Inspection. LPA did not meet with any staff or other representative of the program. On September 30, 2021, the San Jose Children's Residential Program Regional Office received a letter from Evolve's Compliance Officer, Devorah Weiss. In this letter, Ms. Weiss reported that due to ongoing struggles brought about by the COVID-19 pandemic, the home located at Butch Drive in Gilroy, CA would be surrendering it's license and closing permanently. The purpose of LPA Fremont's unannounced Case Management Inspection on 10/26/2021 was to confirm that no clients or staff were present on the grounds before the facility is closed permanently in Community Care Licensing's Licensing Information System. LPA walked the grounds of the facility located at Butch Drive, and did not see any staff or clients present. There were no cars in the driveway, all windows and doors were shut, and there were no lights on in any of the buildings on the property. LPA Fremont confirmed with Licensing Program Managers Helga Wong and Carolyn Flynn that no clients are currently placed at Evolve Gilory, and the facility appears to be closed permanently. No deficiencies observed or cited. This document will not be signed by a facility representative as none were present on the property at the time of this inspection.

visit_type: Case Management

met_with: No one present on facility grounds


facility_name: EVOLVE TREATMENT CENTER, LAFAYETTE

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Minors are not treated with dignity Confidential interviews revealed conflicting statements that clients must leave the bathroom door ajar while using the restroom. Some confidential interviews reported that the clients did not have to leave the door open while using the restroom and other interviews stated that clients must leave the bathroom door ajar while using the restroom. It was noted in the facility's program statement that staff are to ensure that the clients keep the bathroom door ajar when using the restroom. Minors are not allowed hygiene items Confidential interviews revealed conflicting statements regarding whether clients are not allowed hygiene items. Interview information revealed that clients are given hygiene boxes that contain toothbrush, toothpaste, soap, shampoo, conditioner, deodorant, lotion, and other products which are available when the clients request them. Confidential interviews stated that clients are provided razors to shave but under the supervision of staff. It was noted in the facility's program statement that staff can withhold hygiene items from clients and provide them upon the request of the client depending on the client's level. Staff open minors' personal mail Confidential interviews indicated that the therapist keep all mail, unopened until the clients' next one-on-one therapy sessions. It was also disclosed that clients are required to open their letters in front of staff to make sure there is no contraband and confirmed that staff do not open clients' mails. Other confidential witnesses were unaware of the mail process and could not speak to this allegation. Some confidential witnesses stated that the clients open their personal mail in front of staff, and others stated the clients' primary therapists open their mail for them to screen letters and packages for contraband or triggering content. Minors not receiving an allowance Confidential interviews revealed that none of the minors received allowance during their residency at this Group Home. Per Facility Representative(s), the purpose of not providing clients allowance was to reduce the ability of incoming contraband. Facility Representative(s) also indicated that clients did not have a need for allowance as the Program provide the necessities for clients. Confidential interviews revealed that although allowance is not given, the facility provide for clients' needs which includes items while on outings. Minors are denied access to personal property Confidential interviews revealed that clients are denied personal property based on scheduled activities and for their safety. Some personal items are stored locked in a cabinet and made available to clients upon request. Per Facility Representative(s) some items such as razors require direct supervision, while other personal items (such as books, clothing and etc.) are not allowed to be possessed by clients because the item could trigger client's behaviors or jeopardize their safety while in treatment Based on the confidential interviews, observation, and record review, it has been determined that although the allegations that minors are not treated with dignity; minors are not allowed hygiene items; staff open minors' personal mail, minors not receiving an allowance, and minors being denied access to personal belongings may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. The program statement has been updated to ensure that the clients' needs will be met based on their individual assessments per Title Group Home Regulations. An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to Brandi Ellis.

Investigation Findings:
13On 10:25AM, Licensing Program Analyst (LPA) Madeleine Fremont arrived at the facility to deliver the findings of a complaint investigation. LPA Fremont met with Administrator Brandi Ellis and discussed the investigative findings. On June 7, 2021, the Department received a complaint alleging minors are not treated with dignity; minors are not allowed hygiene items; staff open minors' personal mail; minors are not receiving an allowance; minors are being denied access to personal property. Confidential interviews were conducted with 4 staff and 2 clients. Facility's Program Statement, Plan of Operation, Parent Handbook and Training Manual were reviewed. The following information was obtained during the course of the investigation: (CONTINUED ON LIC9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Madeleine Fremont LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: EVOLVE TREATMENT CENTER, LAFAYETTEFACILITY NUMBER: VISIT DATE: 12/02/2021

report_type: Complaint Investigation

met_with: Brandi Ellis

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13At 11:15am on 5/19/2023, Licensing Program Analyst (LPA) Karmen Balhotra made an unannounced complaint inspection to the facility listed above. The reason for the inspection is to deliver findings for the allegation listed above. LPA met with Dawniel Page, Regional Clinical Director - who helped facilitate the inspection. Over the course of the investigation, LPA conducted confidential interviews and a file review. Evidence obtained revealed that for the allegations of; minor broke their truth while in care is found to be unsubstantiated. This agency has investigated the complaint alleging the allegations listed above and have found that the complaint is unsubstantiated, meaning that although the allegation may have happened, or is valid, there is not a preponderance of the evidence to prove that the allegations above occurred. Based on today's inspection,no California Code of Regulations were cited. An exit interview was conducted, and a copy of this report was left with Regional Clinical Director. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Karmen Balhotra LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Dawniel Page


raw_content:
Narrative:
Based on confidential interviews and record review, the staff was outside the opened door and the night shift resumed their 15-minute checks starting at 10PM. Based on record review, the facility protocol is to observe by listening during hygiene time and ensure that youth keep their doors open. The allegation that staff did not provide supervision when clients have inappropriate sexual behaviors in the facility has not met the preponderance of doubt and is therefore unsubstantiated. LPA conducted an exit interview with Savannah Sullivan, Operations Manager at 11:35AM whose signature confirms the receipt of the document.

Investigation Findings:
13On 8/4/2023 at 11:15AM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of the visit was to deliver the finding for the above allegation. LPA met with Savannah Sullivan, Operations Manager. During the course of the investigation, LPA conducted twelve confidential interviews. LPA reviewed C1 and C2's treatment plans, shift notes for 7/21/2023-7/22/2023, incident reports, and facility's program statement. Based on confidential interviews, C1 and C2 did engage in sexual behaviors in the facility. Based on confidential interviews, three of the four interviewed remembered the door being open at the time. The same three interviewees had stated that the interaction happened in about 15-minutes. Based on confidential interviews, the sexual behavior happened during "hygiene" time between 9-10PM before the 15-minute checks are conducted between 10PM-6AM. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Selena Hood LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: EVOLVE TREATMENT CENTER, LAFAYETTEFACILITY NUMBER: VISIT DATE: 08/03/2023

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

met_with: Savannah Sullivan


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Based on confidential interviews and record review, the staff was outside the opened door at the time of the incident and the night shift resumed their 15-minute checks starting at 10PM. Based on record review, the facility protocol is to observe by listening during hygiene time and ensure that youth keep their doors open. According to confidential interviews, immediately after being aware of the allegations, the facility staff had separated the two clients involved, conducted support sessions for the clients, and moved one client to another home. The facility had also updated their facility protocol to include visual check-ins during hygiene time. The allegation that staff did not provide supervision when clients have inappropriate sexual behaviors in the facility has met the preponderance of doubt and is therefore substantiated. Based on the staff members following their protocol, and the actions taken by the facility after the incident occurred, LPA did not provide the facility with a citation. LPA conducted an exit interview with Elijah Aquilina, Residential Counselor at 11:50AM whose signature confirms the receipt of the document.

Investigation Findings:
13On 9/6/2023 at 11:38AM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of the visit was to deliver the finding for the above allegation. LPA met with Elijah Aquilina, Residential Counselor. LPA initially closed this complaint as unsubstantiated on 8/4/2023. During the course of the investigation, LPA conducted twelve confidential interviews. LPA reviewed C1 and C2's treatment plans, shift notes for 7/21/2023-7/22/2023, incident reports, and facility's program statement. Based on confidential interviews, C1 and C2 did engage in sexual behaviors in the facility. Based on confidential interviews, three of the four interviewed remembered the door being open at the time. The same three interviewees had stated that the interaction happened in about 15-minutes. Based on confidential interviews, the sexual behavior happened during "hygiene" time between 9-10PM before the 15-minute checks are conducted between 10PM-6AM. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Selena Hood LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: EVOLVE TREATMENT CENTER, LAFAYETTEFACILITY NUMBER: VISIT DATE: 09/06/2023

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

met_with: Elijah Aquilana

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
On 7/27/2023 at 10:40AM, Licensing Program Analyst (LPA) Selena Hood conducted a case management visit to the licensed facility. The purpose of this visit was to conduct a case management visit regarding an incident reported to Community Care Licensing (CCL) on 7/26/2023. LPA met with Savannah Sullivan, Operations Manager. Based on the incident report, a client in care had alleged that they had engaged in inappropriate touch with another client and had felt uncomfortable about the incident. LPA requested both client's Needs and Services plans, shift notes from 7/21/2023 and 7/22/2023, contact information for the reporting party, and contact information for on-shift staff members. One of the two clients involved had discharged to their other facility. LPA conducted five confidential interviews. LPA conducted an exit interview with Savannah Sullivan, Operations Manager at 11:50AM.


summary: Facility Evaluation

raw_content:
Narrative:
On 7-16-24 10:00AM, Licensing Program Analysts George Karkazis conducted an unannounced Annual/Random inspection at listed facility. LPA met with Angel Panlasigui, Operations Manager and toured the facility inside and out. The Group Home is licensed to serve 6 clients. Present during the inspection were 3 staff and 3 clients. At 10:55AM LPA Karkazis reviewed client and staff files. All staff and client files were complete, in good order and up to date. At 12:31PM, LPA Karkazis toured the facility. LPA Karkazis observed 3 bedrooms and 3 bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Karkazis tested the water temperature and found it to be 116 degrees which is in range. The thermostat read 67 which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in the staff office, in a locked cabinet. The facility is in good repair and clean. LPA Karkazis interviewed 3 staff and 3 clients. At 12:55PM LPA Karkazis toured the backyard. LPA Karkazis observed a sealed swimming pool in which you can walk on . The swimming pool was used last week. The backyard was in good repair and clean. At this time there are no deficiencies. An exit interview was conducted, appeal rights discussed and a copy of this report was given to Angel Panlasigui, Operations Manager.

visit_type: Annual

met_with: Angel Panlasigui, Operations Manager


summary: Facility Evaluation

raw_content:
Narrative:
On March 27, 2025, at 11: AM, Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced case management inspection at the above-referenced facility to follow up on a submitted Incident Report (IR). LPA met with Renee Nunes, Clinical Program Director. At the time of the visit, seven staff members and five clients were present. During the inspection, LPA interviewed the Program Director to obtain additional details regarding the incident and to clarify updates in the incident report. LPA verified that proper follow-up procedures were conducted through a review of shift notes and interviews. The IR was submitted regarding an incident that occurred on March 6, 2025. According to the report, (C1) experienced suicidal ideations and jumped from a staircase inside the facility. The Program Director explained that C1 became upset after being denied a home pass. At the time of the incident, C1 had only been at the facility for one week and was not yet eligible for a pass. While a risk assessment was being conducted, C1 suddenly got up without warning and ran toward the staircase. LPA confirmed that proper procedures were followed both before and after the incident. Prior to the jump, the county mobile crisis team (A3) had been contacted and was in route, as C1 was not complying with the established safety plan. During the visit, the Program Director provided LPA with copies of the safety plan and risk assessment for review. After the jump, staff promptly assessed C1's injuries and ensured that the client remained in place until emergency medical services (EMS) arrived. Due to C1's behaviors, a higher-level treatment facility was deemed necessary, and C1 has not returned to the facility. No violations of the California Code of Regulations, Title 22, Division 6 were cited during this inspection. An exit interview was conducted, and a copy of this report was provided to Renee Nunes, Clinical Program Director.

met_with: Renee Nunes - Clinical Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On August 12, 2025, at 2: PM, Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced case management inspection at the above-referenced facility to follow up on a submitted Incident Report (IR). LPA met with Alisa Anhold-Tung, Primary Therapist. At the time of the visit, eight staff members and five clients were present. During the inspection, LPA interviewed the Primary Therapist to obtain additional details regarding the incident and to clarify updates in the incident report. LPA verified that proper follow-up procedures were conducted through a review of shift notes and interviews. The IR was submitted regarding an incident that occurred on August 5, 2025. According to the report, staff discovered a napkin containing an unknown pill in the therapist's bathroom. Through confidential interviews, it was learned that a pill matching the one found in the therapist's bathroom was also discovered in a client's pants pocket along with THC vape pen. Interviews further revealed that clients have access to the therapist's bathroom either before or after a session, or when other bathrooms are occupied. As a follow-up to the incident, the home will continue to conduct body and drug checks on the suspected client. Immediately after the initial discovery, staff conducted a full house sweep and body checks, which led to the discovery of a matching individual pill in one of the clients' bathrooms. Through confidential client interviews, no one was able to confirm the identity of the pills. The suspected client was not present at the time of the visit. No violations of the California Code of Regulations, Title 22, Division 6, were cited during this inspection. An exit interview was conducted, and a copy of this report was provided to Alisa Anhold-Tung, Primary Therapist.

met_with: Alisa Anhold-Tung, Primary Therapist


facility_name: EVOLVE TREATMENT CENTER, WALNUT CREEK

raw_content:
Narrative:
Minors are not treated with dignity Confidential interviews revealed conflicting statements that clients must leave the bathroom door ajar while using the restroom. Some confidential interviews reported that the clients did not have to leave the door open while using the restroom and other interviews stated that clients must leave the bathroom door ajar while using the restroom. It was noted in the facility's program statement that staff are to ensure that the clients keep the bathroom door ajar when using the restroom. Minors are not allowed hygiene items Confidential interviews revealed conflicting statements regarding whether clients are not allowed hygiene items. Interview information revealed that clients are given hygiene boxes that contain toothbrush, toothpaste, soap, shampoo, conditioner, deodorant, lotion, and other products which are available when the clients request them. Confidential interviews stated that clients are provided razors to shave but under the supervision of staff. It was noted in the facility's program statement that staff can withhold hygiene items from clients and provide them upon the request of the client depending on the client's level. Staff open minors' personal mail Confidential interviews indicated that the therapist keep all mail, unopened until the clients' next one-on-one therapy sessions. It was also disclosed that clients are required to open their letters in front of staff to make sure there is no contraband and confirmed that staff do not open clients' mails. Other confidential witnesses were unaware of the mail process and could not speak to this allegation. Some confidential witnesses stated that the clients open their personal mail in front of staff, and others stated the clients' primary therapists open their mail for them to screen letters and packages for contraband or triggering content. Minors not receiving an allowance Confidential interviews revealed that none of the minors received allowance during their residency at this Group Home. Per Facility Representative(s), the purpose of not providing clients allowance was to reduce the ability of incoming contraband. Facility Representative(s) also indicated that clients did not have a need for allowance as the Program provide the necessities for clients. Confidential interviews revealed that although allowance is not given, the facility provide for clients' needs which includes items while on outings. Minors are denied access to personal property Confidential interviews revealed that clients are denied personal property based on scheduled activities and for their safety. Some personal items are stored locked in a cabinet and made available to clients upon request. Per Facility Representative(s) some items such as razors require direct supervision, while other personal items (such as books, clothing and etc.) are not allowed to be possessed by clients because the item could trigger client's behaviors or jeopardize their safety while in treatment Based on the confidential interviews, observation, and record review, it has been determined that although the allegations that minors are not treated with dignity; minors are not allowed hygiene items; staff open minors' personal mail, minors not receiving an allowance, and minors being denied access to personal belongings may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. The program statement has been updated to ensure that the clients' needs will be met based on their individual assessments per Title Group Home Regulations. An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to Taylor Culbertson.

Investigation Findings:
13On 12/02/2021 at 11:15AM, Licensing Program Analyst (LPA) Madeleine Fremont arrived at the facility to deliver the findings of a complaint investigation. LPA Fremont met with Administrator Taylor Culbertson and discussed the investigative findings. On June 7, 2021, the Department received a complaint alleging minors are not treated with dignity; minors are not allowed hygiene items; staff open minors' personal mail; minors are not receiving an allowance; minors are being denied access to personal property. Confidential interviews were conducted with 5 staff and 4 of 6 clients. Facility's Program Statement, Plan of Operation, Parent Handbook and Training Manual were reviewed. The following information was obtained during the course of the investigation: (CONTINUED ON LIC9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Madeleine Fremont LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: EVOLVE TREATMENT CENTER, WALNUT CREEKFACILITY NUMBER: VISIT DATE: 12/02/2021

met_with: Administrator Taylor Culbertson


raw_content:
Narrative:
Of the 5 clients that were interviewed regarding these allegations, all 5 clients stated they were given sufficient time for showering and personal/hygiene care. All clients reported that they were allowed more time for showering and hygiene based on their progress in the program, but that even at the minimum amount of hygiene time allotted after admission was enough time to complete their hygiene routine. Both staff who were interviewed reiterated this, reporting that even if the kids ran out of time in the bathroom, they were still given time outside of the bathroom with a vanity mirror to complete any hygiene tasks they had left. Of the 5 clients who were interviewed regarding these allegations, all 5 clients reported to this agency that they felt safe at Evolve, they had staff they were comfortable confiding in if needed, and that none of them had experienced any sort of sexual harassment from staff or other clients during their stay. All clients interviewed stated that supervision was heavily enforced and that they were never out of sight from staff, except when using the bathroom or showering. This agency has investigated the allegations (1) "Minor sexually harasses another minor;" and (2) "Minor not afforded sufficient time to perform personal care," and has found that although these allegations may be true or are valid, the preponderance of evidence standard has not been met, therefore the allegations are unsubstantiated, based on LPA's inability to contact the clients named in the original complaint at the time it was received. At this time, no deficiencies are observed or cited. An exit interview was conducted, and a copy of this report was emailed to Administrator Taylor Culbertson and Regional Nurse Ieshaa Ragland, whose signature on this form confirms receipt.

Investigation Findings:
13At 12:30PM, Licensing Program Analyst (LPA) Madi Fremont traveled to the home above for the purpose of conducting an unannounced complaint investigation inspection. LPA met with Regional Nurse Ieshaa Ragland, who helped facilitate this inspection. Currently in care are 7 ambulatory clients. (1 client was admitted this morning, and one client was discharged this afternoon. On 11/03/2021, the San Jose Children's Residential Program Regional Office received a complaint for Evolve Walnut Creek with two allegations: (1) "Minor sexually harasses another minor;" and (2) "Minor not afforded sufficient time to perform personal care." This complaint was investigated by LPAs Christopher Rollins and Madi Fremont. Over the course of this investigation, LPAs conducted interviews with 2 staff and 5 clients. LPA Fremont also attempted to interview all 6 clients who were present in the facility at the time this agency received this complaint, but was unsuccessful in making contact with any of those 6 clients. (CONTINUED ON LIC9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Madeleine Fremont LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CENTRAL COAST SC/RES, TRAEGER AVE., SUITE FACILITY NAME: EVOLVE TREATMENT CENTER, WALNUT CREEKFACILITY NUMBER: VISIT DATE: 10/27/2022

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

met_with: Regional Nurse Ieshaa Ragland


raw_content:
Investigation Findings:
13At 9:45AM, Licensing Program Analyst (LPA) Madi Fremont traveled to the home above for the purpose of conducting an unannounced complaint investigation inspection. LPA met with Chloe Jimenez in person and Devorah Weiss by telephone, who helped facilitate this inspection. Currently in care are 3 ambulatory clients. On 02/08/2023, the San Jose Children's Residential Program Regional Office received a complaint for Evolve Treatment Centers Walnut Creek with one allegation: "Facility does not have adequate staffing." This complaint was assigned to and investigated by LPA Fremont. Based on records review and interviews with staff and clients that show the facility has been utilizing a 1:6 staff-to-child ratio instead of the 1:3 ratio noted in the Licensee"s Plan of Operation, and reports that there was at least one incident when clients were left without staff at the facility for at least 30 minutes during a staff medical emergency, the allegation "Facility does not have adequate staffing" is found to be substantiated. A deficiency was cited per Title Regulations, Division 6, Chapter 1, Article 3, Section 80022(k) - Plan of Operation. Please see attached LIC9099-D for details. At this time, one deficiency was cited. An exit interview was conducted, Appeal Rights provided and discussed, and a copy of this report was emailed to Devorah Weiss and Chloe Jimenez, whose signature on this form confirms receipt. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Madeleine Fremont LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CENTRAL COAST SC/RES, TRAEGER AVE., SUITE FACILITY NAME: EVOLVE TREATMENT CENTER, WALNUT CREEKFACILITY NUMBER: 075650154

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

met_with: Chloe Jimenez and Devorah Weiss


raw_content:
Narrative:
According to seven confidential interviews and record review, the staff members on shift had separated the other clients in care from the one client that was having a behavioral episode (C1). According to these interviews, one staff member maintained engagement with C1 during this episode. According to record review and confidential interviews, the staff member working with C1 had called law enforcement when they had lost sight of the client. LPA was unable to interview C1 as they were hospitalized and then placed on long-term respite care. Based on two confidential interviews, the two interviewees relayed they did not have concerns with the facility's supervisory level of C1. Based on confidential interviews and record review, the clients in care were adequately supervised during the reported incident. The allegation that staff did not provide supervision of the clients to ensure health and safety in the facility may or may not have happened; however, it has not met the preponderance of doubt and is therefore unsubstantiated. LPA conducted an exit interview at 12:33PM over the phone with Devorah Weiss, Compliance Office. Compliance Officer approved that Candace Cruz, Senior Primary Therapist sign off on the report.

Investigation Findings:
13On 12/13/2023 at 11:55AM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to deliver the findings for the listed allegation. LPA met with Candice Cruz, Senior Primary Therapist. During the course of the investigation, LPA conducted sixteen interviews from October 30, 2023 to December 12, 2023. LPA reviewed C1's Needs and Service Plan, shift notes, staff schedule, and the Contra Costa County Sheriff's Office police report. Based on the record review of the staff schedule, the facility had two staff for six clients which was within ratio based on the facility's program statement. According to record review of the police report, law enforcement received an emergency call informing them that a client had eloped from the facility after a behavioral episode involving aggressive behavior and property damage. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Selena Hood LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO ASC, TRAEGER AVE., SUITE FACILITY NAME: EVOLVE TREATMENT CENTER, WALNUT CREEKFACILITY NUMBER: VISIT DATE: 12/13/2023

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

met_with: Candace Cruz


summary: Facility Evaluation

raw_content:
Narrative:
At 1:12PM, Licensing Program Analyst (LPA) Madi Fremont traveled to Evolve Walnut Creek for the purpose of conducting an unannounced Annual Inspection. LPA met with Facility Manager Ieshaa Ragland and Administrator Taylor Culbertson, who helped facilitate this inspection. Currently in care are 4 ambulatory clients, all of which were present during this inspection. During this inspection, LPA Fremont toured the facility inside and out. The home was observed to be clean and free of hazards. The home has two stories, with 4 client bedrooms, staff and therapy offices, a kitchen, living room, school room, nurse station, a spacious backyard, and a garage that has been turned into a gym and art room. All client bedrooms were clean, with designated storage space for each client. The client bathrooms were clean and free of hazards. Client hygiene items are kept in individually labeled bins in a locked cabinet in the upstairs hallway. LPA observed extra towels and linens in this closet as well. The nurses station remains locked, and contains the home's laundry machines, first aid kits, and centrally stored medications. The first aid kit is complete with all required elements. All medications are kept in a locked safe inside a locked cabinet. Each client's medications are separated into labeled bins. The kitchen was observed to be clean and free of food waste or debris. LPA observed at least 7 days of nonperishable food, at least 2 days of perishable food, as well as a backup supply of nonperishable food in case of emergencies. The weekly menu was posted in the kitchen. Client personal rights, the facility license, and the emergency disaster plan were all posted prominently. All smoke and carbon monoxide detectors were functional. The home has several fire extinguishers located throughout the facility. The gas and water shutoffs are located on the side of the house by the garage doors. The garage was equipped with an art station as well as a home gym for clients to utilize. (Continued on Lic809-c) The home has a spacious backyard which has several sitting areas for clients, as well as a basketball court, a lawn, and an in-ground pool. The pool is surrounded on all sides by a metal fence. The gate of this fence has a self-latching closure. All walkways were observed to be clear and free from obstructions. LPA observed the thermostat to be set at 75 degrees Fahrenheit. LPA observed the hot water temperature to be 117.4 degrees Fahrenheit. The home has two fireplaces, one of which is located in the upstairs staff office, and the other located in the school room. Both fire places are inoperable and are kept inaccessible to clients. The home is comfortably furnished with ample lighting and storage space. There are security alarms on all windows in the home, and security cameras in the interior and exterior of the facility. All cameras have been approved by Community Care Licensing and do not point toward any bedroom or bathroom. All chemicals and poisons are kept locked and inaccessible to clients. All sharps are kept locked and are tracked by a sharps checkout log. No firearms on the property. During this inspection, LPA Fremont reviewed 4 client files and 3 staff files. All client and staff files were complete with all required elements. At this time, no deficiencies were observed or cited. An exit interview was conducted, and a copy of this report was emailed to Administrator Taylor Culbertson, whose signature on this form confirms receipt.

met_with: Administrator Taylor Culbertson and Facility Manager Ieshaa Ragland


summary: Facility Evaluation

raw_content:
Narrative:
On 10/30/2023 at 2:17PM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. LPA was conducting an unrelated visit to the facility and was informed about an incident that occurred on 10/28/2023 where a neighbor had pointed a gun at the youth in care. LPA met with Savannah Sullivan, Operations Manager who helped facilitate the inspection. LPA conducted twelve confidential interviews. LPA requested copies of the staff schedule, daily notes, incident report, Needs and Services Plans, C1's face sheet, staff contact information, and security camera footage. At this time, further information is necessary. LPA conducted an exit interview with Savannah Sullivan, Operations Manager at 2:48PM whose signature confirms the receipt of this document.


summary: Facility Evaluation

raw_content:
Narrative:
On 4/19/2024 at 11:15am, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct a case management based on an incident that was reported on 4/12/2024 (0000448-FN). LPA met with Niki Tata, Primary Therapist and Candice Cruz, Senior Primary Therapist. LPA conducted two confidential interviews. LPA did not conduct an interview with client involved based on therapist recommendation. Therapist requested that LPA return the following week. LPA received copies of the involved clients' face sheet. LPA requested clients' treatment plans, staff schedule for April 2024, daily notes for April 2024, and video footage be sent via email. LPA was informed that the video footage could not be sent, but Compliance Director Devorah Weiss could show the information via Zoom. No deficiencies were cited during this visit. LPA conducted an exit interview with Candice Cruz, Senior Primary Therapist whose signature confirms the receipt of this document.

met_with: Niki Tata


summary: Facility Evaluation

raw_content:
Narrative:
On 7-17-24, 9:30AM Licensing Program Analysts George Karkazis conducted an unannounced Annual/Random inspection at listed facility. LPA's met with Angel Panlasigui, Operations Manager and toured the facility inside and out. The Group Home is licensed to serve 6 clients. Present during the inspection were 3 staff and 6 clients. At 10:05AM LPA Karkazis reviewed client and staff files. All staff and client files were complete and in good order. At 10:34AM, LPA Karkazis toured the facility. LPA Karkazis observed 4 bedrooms and 4 bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Karkazis tested the water temperature and found it to be 112.1 degrees which is in range. The thermostat read 66 degrees which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in the laundry room, in a locked cabinet, in a locked safe.. The facility is in good repair and clean. LPA Karkazis interviewed 2 staff and 3 clients, 3 clients refused interviews. At 10:59AM LPA Karkazis toured the backyard. LPA observed a swimming pool which was enclosed and locked with a fence that meets regulation. The backyard was in good repair and clean. At this time there were no deficiencies. An exit interview was conducted, appeal rights discussed and a copy of this report was given to Angel Panlasigui, Operations Manager.


summary: Facility Evaluation

raw_content:
Narrative:
On April 29, 2026, at 1:30 p.m., Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced case management inspection at the above-referenced facility to follow up on an Incident Report (IR) submitted by the facility and inspect fence repairs. LPA Medina met with Thomas Devries, Associate Operations Manager who also assisted with the walk through of the facility. During the inspection, LPA Medina interviewed staff regarding an incident that occurred. According to the Incident Report, a client became dysregulated, kicked down his bedroom door, and threw objects out of his window. On today's inspection, LPA requested additional information regarding the incident, including details about facility repairs resulting from the client's actions, clarification on follow-up procedures, and staffing requirements. LPA reviewed the client's safety plan, which was created as a result of the incident, as well as the shift notes for the day the incident occurred. Staff were found to have followed the facility's protocols by contacting the non-emergency line (A3) evaluate the client, which further assisted in de-escalating the client and safely return the client to the milieu. LPA was also able to confirm that appropriate staffing was available at the time of the incident. LPA reviewed the repairs and confirmed that the window had been repaired. However, staff reported that the door had recently been broken again. LPA was informed that the door will be repaired by this weekend. During interviews the client that broke the door the second time attempted self harm with a piece of the broken wood. LPA asked if Incident report has been made for that incident. Staff mentioned they are working on getting the report submitted. The incident occurred 5 days ago and are still within the 7 day time-frame. Additionally, during the inspection, LPA inspected the fence repairs surrounding the pool area and was able to clear the deficiency. An exit interview was conducted, appeal rights were discussed, and a copy of this report was provided to Thomas Devries, Associate Operation Manager. Signature on this report acknowledges receipt.

met_with: Thomas Devries - Associate Operation Manager


facility_name: EVOLVE TREATMENT VANALDEN

raw_content:
Narrative:
Minors are not allowed hygiene items Confidential interviews revealed conflicting statements regarding whether clients are not allowed hygiene items. Interview information revealed that clients are given hygiene boxes that contain toothbrush, toothpaste, soap, shampoo, conditioner, deodorant, lotion, and other products which are available when the clients request them. Confidential interviews stated that clients are provided razors to shave but under the supervision of staff. It was noted in the facility's program statement that staff can withhold hygiene items from clients and provide them upon the request of the client depending on the client's level. Staff open minors' personal mail Confidential interviews indicated that the therapist keep all mail, unopened until the clients' next one-on-one therapy sessions. It was also disclosed that clients are required to open their letters in front of staff to make sure there is no contraband and confirmed that staff do not open clients' mails. Other confidential witnesses were unaware of the mail process and could not speak to this allegation. Some confidential witnesses stated that the clients open their personal mail in front of staff, and others stated the clients' primary therapists open their mail for them to screen letters and packages for contraband or triggering content. Minors not receiving an allowance Confidential interviews revealed that none of the minors received allowance during their residency at this Group Home. Per Facility Representative(s), the purpose of not providing clients allowance was to reduce the ability of incoming contraband. Facility Representative(s) also indicated that clients did not have a need for allowance as the Program provide the necessities for clients. Confidential interviews revealed that although allowance is not given, the facility provide for clients' needs which includes items while on outings. Minors are denied access to personal property Confidential interviews revealed that clients are denied personal property based on scheduled activities and for their safety. Some personal items are stored locked in a cabinet and made available to clients upon request. Per Facility Representative(s) some items such as razors require direct supervision, while other personal items (such as books, clothing and etc.) are not allowed to be possessed by clients because the item could trigger client's behaviors or jeopardize their safety while in treatment Based on the confidential interviews, observation, and record review, it has been determined that although the allegations that minors are not treated with dignity; minors are not allowed hygiene items; staff open minors' personal mail, minors not receiving an allowance, and minors being denied access to personal belongings may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. The program statement has been updated to ensure that the clients' needs will be met based on their individual assessments per Title Group Home Regulations. An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to Devorah Weiss.

Investigation Findings:
13On 12/02/2021 at 10: AM, Licensing Program Analyst (LPA) Miguel Gomez arrived at the facility to deliver the findings of a complaint investigation. LPA Gomez met with Administrator, Devorah and discussed the investigative findings. On June 7, 2021, the Department received a complaint alleging minors are not treated with dignity; minors are not allowed hygiene items; staff open minors' personal mail; minors are not receiving an allowance; minors are being denied access to personal property. Confidential interviews were conducted with 3 staff and 5 of 6 clients. Facility's Program Statement, Plan of Operation, Parent Handbook and Training Manual were reviewed. The following information was obtained during the course of the investigation: Minors are not treated with dignity Confidential interviews revealed conflicting statements that clients must leave the bathroom door ajar while using the restroom. Some confidential interviews reported that the clients did not have to leave the door open while using the restroom and other interviews stated that clients must leave the bathroom door ajar while using the restroom. It was noted in the facility's program statement that staff are to ensure that the clients keep the bathroom door ajar when using the restroom. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Miguel A Gomez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: EVOLVE TREATMENT VANALDENFACILITY NUMBER: VISIT DATE: 12/02/2021

met_with: Devorah Weiss


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Olivia Rosas made an announced inspection to the Evolve Treatment, Aura on 12/02/21 at 12:30pm for the purpose of conducting Annual Inspection. LPA Rosas met with Staff#1(S1) who granted access to the facility and an inspection of the facility was conducted together. The Evolve Treatment, Vanalden is a therapeutic treatment program that's designed to accept "Private Placement's" for a length of 30 - 45 days and is licensed to provide care supervision for six (6) youths, ages 12-17 years; ambulatory only. Individuals mention in this report are identify on the Confidential Names List (LIC811) dated 12/02/21. Temperature and health checks are conducted at the entrance in the sign-in area. The home is set-up as follows and LPA inspected the following: This is a single story home with three (3) bedrooms, seven (7) bathrooms, art room, school room, kitchen/family room, dinning room, medication/laundry area, converted garage (gym), three (3) therapy rooms, group room, two (2) staff offices, outdoor seating area, and pool. S1 states that there are no guns or weapons on the premises. There is a pool on the premises that meets regulation requirements. There are 24 facility cameras on the premises, and an approved Camera Waiver on file. The facility has hand sanitizer dispensers for use. Bedroom #1: Is occupied by two (2) clients, the bedroom is equipped two (2) twin sized beds, with one (1) closet, and one (1) bathroom. Bedroom #2: Is occupied by two (2) clients, the bedroom is equipped two (2) twin sized beds, with one (1) closet, and one (1) bathroom. Bedroom #3: Is occupied by two (2) clients, the bedroom is equipped two (2) twin sized beds, with one (1) closet, and one (1) bathroom. All bedrooms have adequate lighting, adequate drawers, closet space, and lighting in the room. Bathrooms: Each bedroom in the home has a bathroom. Bathroom #4: Is located to the left once entering the front door into the facility. Bathroom #5: Is located inside the therapy room which is only used by the staff. Bathroom #6: Is located between the bedrooms and group room area. This bathroom is only used for storage and kept locked. Bathroom #7: Is located inside the staff office and is only used by the staff. LIC 809-C Page 1 of Living Room/Dining room/Kitchen: LPA observed to be clean and organized; equip with living room furniture including a dining table. There is a stove with six (6) burners all working at this time. There is a detached oven currently working at this time. There is a microwave and refrigerator/freezer. The sharp knives are kept locked in a lock box located inside a closet next to the kitchen. Some of the cleaning solutions are kept locked under the sink and the rest is stored and locked. The trash cans have tight lids on. LPA observed ample perishable food items in the refrigerator and the pantry is fully stocked with non-perishable food items. LPA observed enough perishable and Non-perishable food items for seven (7) days. The facility provides three (3) nutritious meals, snacks, and special snacks to the youth. All disinfectant/ poisons chemicals are properly stored inaccessible. There is a private chef that comes to the facility and prepares all meals for the youth. Converted Garage: The garage can be entered through the inside of the house using the door that is located to the right once entering the facility and through the laundry room as well. The garage is being used as a gym and extra food storage. The garage has extra refrigerator and non-perishable food items. The Laundry room: The laundry room is enclosed adjacent to the kitchen. The laundry detergent is distributed to children individually according to the load of their laundry. Cleaning solutions and detergent are kept locked inside the cabinets. Medication Closet Area: Is located next to the kitchen and above the washer and dryer. The cabinet is used to store and administer client medications. All medication is locked and accessible only to employees supervising stored medications. Dinning Area: There is a table with ten (10) chairs. There is also a covered fire place and a mounted TV. Family Room: There is ample seating space with one sofa and three (3) sofa chairs, mounted TV and covered fireplace. There is also a sliding door to exit out in the yard. Art Room and School Room: Are located to the right once entering the facility with ample seating space, desks, and computers. Therapy Rooms: There is a total of three (3) therapy rooms. One is located next to the meds/laundry area, the other one is located next to the staff office and the third therapy room is located outside in the back yard. Staff Offices: There is a total of two staff offices. One staff office is located next to the group room and the other staff office is located inside the staff office that has its own office space. LIC 809-C Page 1 of Backyard: There is a converted club house that is used as a therapy room. There is barbecue area with a grill. LPA also observed an outdoor seat area available for clients to use, one round table with chairs all around. The facility has a pool with a fence that is at least five feet high and has a fence does not obscure the pool from view. LPA Rosas and S1, observed the gate door to swing away from the pool, with self-close and self-latching device located no more than six inches from the top of the gate. The outdoor perimeter front yard, side yard and backyard were inspected and found cleared of debris and hazards materials. The passageways and porches are unobstructed. The facility has a first aid kit stored inside a locked cabinet in the medication/laundry area. The facility has a total of four fire extinguishers. One of the fire extinguishers is located in the kitchen area fully charged and the other fire extinguisher is mounted to the wall between the kitchen and dinning room. Fire extinguisher #3 is located across from bedroom #2 mounted to the wall. Fire extinguisher #4 is located in the group room. Disinfectants and poisons are inaccessible to the clients in care they are kept locked at all times. All knives and sharp objects are made inaccessible to the clients in care locked in a security box inside the locked cabinets in the family room. All posting requirements were met, (food menu, regulations, licenses, emergency disaster plan, Children's Personal Rights, and Ombudsman). The facility has a working telephone and youths can use the telephone unless restricted by court order. The Facility operates within license conditions and limitations including capacity limitations. Facility has a current, written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to youths. Licensee will report youth injuries requiring medical treatment. A review of Facility's Personnel Report Summary on 11/29/2021 indicates that all personnel have criminal record clearance has obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. LPA Rosas was not able to review client or staff files during this visit and will return to continue with the annual inspection. The facility keeps files and documents in digital system called KIPUERM. There were no deficiencies observed or cited at this time. Exit interview was conducted with S1 and a copy of this report was left at the facility.

met_with: Staff#1 (S1)


summary: Facility Evaluation

raw_content:
Narrative:
On December 14, 2023 at 9:17am, Licensing Program Analyst (LPA) Christine Wilson made an announced inspection to the Evolve Treatment, Vanalden for the purpose of conducting a 2-Year Annual Inspection. The Evolve Treatment, Vanalden is a therapeutic treatment program that's designed to accept "Private Placement's" for a length of 30 - 45 days and is licensed to provide care supervision for six (6) youths, ages 12-17 years; ambulatory only. There is a swimming pool which meets licensing regulations. There is a camera and Naloxone waiver on file. This is a one-story facility located at Vanalden Ave Tarzana CA 91356. LPA Wilson was greeted by staff DBT Skills Coach (S1) who allowed entrance into the facility. At 9:49am, LPA Wilson was greeted by the Operations Manager (OM) who provided LPA with a tour of the facility. At various times, throughout the tour LPA Wison and (OM) were accompanied by (CO). Individuals mentioned in this report are identified on the Confidential Names List [see LIC811 dated 12/14/2023.] On the premises were (2) clients (C1, C2) and (6) staff (S1, FC, OM, CO, TTV, and APD). There are 7 smoke detectors 2 carbon monoxide detectors. Thermostat 63 degrees. Water temperature averaged between 110-120 degrees. Home Entry:The entry of the home has a closet with emergency backpack containing travel binder and hygeine products. Bathroom 1: is used by clients and is a half bathroom with sink and toilet Bedroom Is is occupied by (C1) There are two beds with clean linens, closet, (1) large dresser and (2) small dressers, smoke alarm and an alarm on the sliding windows. There in a full on suite bathroom with shower, sink and toilet in good condition. Bedroom 2 is occupied by (C2)There are two beds with clean linens, closet, (1) large dresser and (2) small dressers, smoke alarm and an alarm on the sliding windows. There in a full on suite bathroom with shower, sink and toilet in good condition. (Continued on 812C page 2) Page Hallway closet with clean towels and linens Bedroom 3 is unoccupied. There are two beds with clean linens, closet, (1) large dresser and (2) small dressers, smoke alarm and an alarm on the sliding windows. There in a full on suite bathroom with shower, sink and toilet in good condition. Education Area: Has three (4) desks and round table and six (6) chairs Group Room Area: For group theraputic services has (6) chairs, fireplace is not used and a camera. Activity room has seating for (6) persons, tv, fireplace is unused, games, and additional hygeine products are in locked cabinets. Supply Closet: contains cleaning supplies and is locked. hygeine supplies, and personal cubbies. Garage: has gym equipment and fire extinguisher and two refrigerators Outdoor Area: Clean and free of debris and hazards. Features a pool with a fence and a basketball court Therapists Office: is the club house, has one desk, couch and smoke detector and separate heating/cooling HVAC Facility Vehicle: Toyota Sienna Current vehicle registration and insurance with Ace Company and Property and Casualty dated to expire on 12/20/2023. There is a 5ft perimeter fence. There are outdoor seating for 8 persons and table with a sand pit, grill and heating units are inoperable here are (3) HVAC Laundry Room: first aid kits are stored here. There was PRN kept in a unlocked cabinet in an individual packet. Medication room: controlled medications are double locked. There is a medication dispensary room with nursing, Dining room: This is a large space with tv, furniture for six (6) persons, TV Fireplace unused and decorated for Christmas Kitchen: Large cooking island with sink, , covered trashcans. Refrigerator is set at 40 degrees.Pantry has 2 weeks non perishable food and first aid kit. There is a sink, stove with six (6) burners and grill, Icemaker, toaster, two (2) dishwashers and ovens all in good repair. Client refrigerator with snacks available and fresh fruit on top. Cereals, snacks, sugar and teas are locked in cabinets (Continued on 812C page 3) Page Staff Office: There is a staff office with adjacent Program director's office and Facility Managers office. LPA Wilson reviewed following during the inspection: LPA Wilson requested the following forms for review, Register of Youth (LIC 9020), which was created during the time of the inspection, Personnel Report (LIC 500), Emergency Disaster Plan (LIC610C), Emergency Intervention Plan, vehicles registration and auto insurance. In addition, written menus, staff weekly schedule. Current Census is (2) residents, Staff Records Review: LPA ensured Administrator Certificate was current. LPA reviewed the Personnel Report (LIC 500) and confirmed that Direct Care Staff Ratio present for the three (2) clients in placement. At 9:26am, Manager nor a supervisor, was not on the premises at time of LPA Wilsons arrival. Observation and interview revealed that staff were not able to answer call placed by LPA Wilson to the facility phone at 9:30am, due to under staffing. LPA confirmed that all staff have required criminal record clearance. DOJ, FBI and Child Abuse Response, which meet qualification. LPA Wilson was able to complete three (2) staff file reviews (OM and APD) one (1) client file review (C1), one (1) staff interview (S1) .LPA was unable to complete a client interview. A review of Facility's Personnel Report Summary on 12/14/2023 indicates that all personnel have criminal record clearance and have obtained the necessary clearances with DOJ, FBI, [see LIC809D and LIC9102]. Exit interview was conducted with staff (CO) and a copy of this report was emailed to the facility.

met_with: DBT Skills Coach


summary: Facility Evaluation

raw_content:
Narrative:
On July 24, 2024 at 2:35pm, Licensing Program Analyst (LPA) Christine Wilson made an unannounced Case Management Incident Inspection to the above listed facility, regarding SIR dated 07/18/24. LPA was greeted by the Facility Nurse (FN). During the course of the incident investigation, it was revealed that on 07/18/24, staff (S1) had provided client (C1) a double dosage of medication acetaminophen. Per (FN) it was mistaken for Ibuprofen and the facility's Medical Director provides the general recommended dosages for acetaminophen. LPA Wilson inspected the MAR in Kipu, which was recorded according to regulations. LPA Wilson interviewed (FN). The licensee ensured staff was re-trained, new visuals and rules were posted in the office where medications were passed (photos taken). A Technical Violation was issued. An exit interview was conducted and report left with licensee. (FN) whose signature on this form confirm receipt of these documents.

met_with: Facility Nurse (FN)


summary: Facility Evaluation

raw_content:
Narrative:
On 12/4/25, LPA Wendely Moodie-Naranjo made an unannounced visit to the above-mentioned facility for the purpose of reviewing a deficiency cited on 12/3/25. LPA Moodie-Naranjo conducted an entrance interview and met with Operations Manager Romeo Eta. Facility was toured inside and out. Deficiency CCR 84088 (c)(1) broken bed in room # 1, next to window has been cleared and corrected. See LIC Cleared POC Letter. It was observed by LPA Moodie-Naranjo that bed was repaired. Exit interview conducted. Copy of this report to be emailed to Facility Administrator.

met_with: Romeo Eta- Operations Manager


summary: Facility Evaluation

raw_content:
Narrative:
On February 04, 2025, at 03: PM, Licensing Program Analyst (LPA) Wendely Moodie-Naranjo conducted an unannounced inspection at the above facility. Upon arrival, LPA was greeted by, Caitlin Gharibeh, Program Director (PD) , who granted LPA access to the facility. The purpose of the inspection is to conduct a case management inspection to investigate a self-reported incident that occurred on December 14th,2025. During today's inspection, LPA and LPM interviewed the Program Director (PD), and obtained copies of that LIC 500 and Client roster from the date of incident (12/14/25). Further investigation is needed to determine whether any violation has occurred. PER California Code Regulation, there are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report will be sent electronically to CO.

met_with: Caitlin Gharibeh-Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On 12/03/25 at 8:35AM Licensing Program Analyst (LPA) Wendely Moodie-Naranjo made an unannounced visit to Evolve Treatment Vanalden facility for the purpose of conducting an Annual/Random Required Inspection visit. LPA met with Farah Yousef, Residential Counselor), who granted access to the facility and Romeo Eta, Operations Manager and together a tour of the facility was conducted. This facility is licensed to provide care and supervision to six (6) ambulatory clients, ages 12-17 years old. The census is six (6) clients. The home is set-up as follows and the following was observed: This is a single story home with three (3) bedrooms, seven (7) bathrooms, art room, school room, kitchen/family room, dining room, medication/Nursing room, laundry area, converted garage (gym), two (2)therapy rooms, One (1) Zoom Room, one (1) group room, two (2) staff offices, outdoor seating area, and a gated pool. Bedroom #1: Is occupied by C1 and C2. The room is equipped with two twin size beds. There are adequate drawers, closet space, and lighting in the room. LPA observed a broken bed backrest (bed next to window). Bedroom window has an alarm Bedroom #2: Is occupied by C3 and C4. The room is equipped with two twin size beds. There are adequate drawers, closet space, and lighting in the room. Bedroom window has an alarm. Bedroom #3: Is occupied by C5 and C The room is equipped with two twin size beds. There are adequate drawers, closet space, and lighting in the room. Bedroom window has an alarm. Bathrooms: Each client's bedroom in the home has a bathroom. Bathroom doors were locked which can only be unlocked by staff members. Report continues on LIC 809-C page Continued from LIC 809 page Bathroom #4: There is one bathroom located to the left once entering the front door into the facility. Bathroom #5: Is located inside the therapy room which is only used by the staff. Occasionally in case of emergency that bathroom 4 is not functional, clients have access to this bathroom. Bathroom #6: Is located between the bedrooms and group room area. This bathroom is only used for storage. Bathroom #7: Is located inside the staff office and is only used by the staff. Kitchen: There is a stove with six (6) burners all working at this time. There are two(2) detached ovens currently working at this time. There is two(2) microwaves, two(2) toasters, two(2) countertop ice makers and refrigerator/freezer. The food service in the home is adequate with perishable/nonperishable food supplies. The cleaning solutions are made inaccessible to the clients and stored/ locked under the kitchen sink and in the hallway closet. There were two trash cans, one missing a lid. Chef logs out the knives when they will be used, located in a locked box inside staff room. All smoke detectors and carbon monoxide are operable. Dining Area: There is a table with six (6) chairs. There is also a covered fireplace and a mounted TV. There is a camera in Dining Area. Family Room: There is ample seating space with one sofa and four (4) sofa chairs, mounted TV and covered fireplace. Ample storage cabinets for art supplies, games and puzzles. There is also a sliding door to exit out in the yard. Art Room:Is located to the right once entering the facility adjacent to school room with ample seating space, one(1) table, six(6) chairs, art storage cabinet, art supplies and books. There is a camera inside of art room. School Room: Are located to the right once entering the facility with ample seating space, six(6) desks, and four(4) computers. Therapy Rooms: There is a total of two (2) therapy rooms. One is located next to the laundry area, and the second therapy room is located outside in the back yard (Club House). Zoom Room: This room is located adjacent to the group room and near staff office and is used for zoom meetings. Staff Offices: There is a total of four staff offices. One staff office is located next to the group room and the other staff office is located inside the staff office that has its own office space and two therapist offices(one by the laundry room and another one outside). Report continues on LIC 809-C page Medication/Nursing Room: Is located outside of staff room across from Group Room and is used to store and administer client medications. All medication is locked and accessible only to employees supervising stored medications. Medication records and logs are electronic.The facility has a first aid kit stored inside a locked cabinet in the medication room. There is a camera inside medication room. Laundry Area:There is a washer and dryer available, ample storage with linens and bed comforters and locked detergents. Backyard: The entrance area and backyard are all free of debris and hazardous materials. There is a barbecue area with a grill. There is also a swimming pool on the premises with a five-foot fence with a self-latching lock. Converted Garage/Gym: Can be entered through the inside of the home through a door next to the laundry area. The garage has been converted into a gym space. The facility has a first aid kit stored inside a locked cabinet in the medication. The facility has a total of four fire extinguishers. Facility is clean, safe, sanitary and in good repair. Passageways, stairways, inclines, ramps and open porches are unobstructed. Swimming pools, hot tubs, spas, or similar bodies of water in facilities serving children are made inaccessible to clients. Disinfectants/cleaning solutions and poisons inaccessible to clients. Temperatures in rooms that clients occupy are maintained between 66 and 85 degrees (F). Hot water temperatures are maintained between 105 and 120 degrees (F). Children in care are supervised & protected at all times. Facility has non-perishable foods for one week and perishable foods for two days. Medications are locked and accessible only to employees supervising stored medications. Children not restricted in telephone use except by court order. Children accorded dignity in personal relationships with others in the home. Children live in a safe, healthy, comfortable facility and are treated with respect. Children can contact the licensing agency or foster Care Ombudsperson in confidence without threats or punishments for making complaints. Children attend school, extracurricular, cultural and personal enrichment activities. Facility maintains personal property and valuables. LPA is unable to review Children's records at this time due time constrains. Children and staff files will be reviewed at a later date. LPA will follow up regarding broken bed and trash can lids, pool equipment and paving on the side of the property. Facility operates within license conditions & limitations including capacity limitations. Page All smoke detectors and carbon monoxide are operable. There is a working telephone line available for clients to use . Per California Code of Regulations, Title Regulations, Division 6, Chapters 1 & 5, the following deficiencies were observed and cited at the time of inspection. (See LIC809-D) Exit interview was conducted and a copy of this report will be emailed to the facility administrator. Page 4

met_with: Devorah Weiss-Facility Administrator


facility_name: EVOLVE TREATMENT, AURA

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Based on the confidential interviews, observation, and record review, it has been determined that although the allegations that minors are not treated with dignity; minors are not allowed hygiene items; staff open minors' personal mail, minors not receiving an allowance, and minors being denied access to personal belongings may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. The program statement has been updated to ensure that the clients' needs will be met based on their individual assessments per Title Group Home Regulations. An exit interview was conducted, appeal rights discussed, and a copy of this report was provided to Devorah Weiss. It was noted in the facility's program statement that staff are to ensure that the clients keep the bathroom door ajar when using the restroom. Minors are not allowed hygiene items Confidential interviews revealed conflicting statements regarding whether clients are not allowed hygiene items. Interview information revealed that clients are given hygiene boxes that contain toothbrush, toothpaste, soap, shampoo, conditioner, deodorant, lotion, and other products which are available when the clients request them. Confidential interviews stated that clients are provided razors to shave but under the supervision of staff. It was noted in the facility's program statement that staff can withhold hygiene items from clients and provide them upon the request of the client depending on the client's level. Staff open minors' personal mail Confidential interviews indicated that the therapist keep all mail, unopened until the clients' next one-on-one therapy sessions. It was also disclosed that clients are required to open their letters in front of staff to make sure there is no contraband and confirmed that staff do not open clients' mails. Other confidential witnesses were unaware of the mail process and could not speak to this allegation. Some confidential witnesses stated that the clients open their personal mail in front of staff, and others stated the clients' primary therapists open their mail for them to screen letters and packages for contraband or triggering content. Minors not receiving an allowance Confidential interviews revealed that none of the minors received allowance during their residency at this Group Home. Per Facility Representative(s), the purpose of not providing clients allowance was to reduce the ability of incoming contraband. Facility Representative(s) also indicated that clients did not have a need for allowance as the Program provide the necessities for clients. Confidential interviews revealed that although allowance is not given, the facility provide for clients' needs which includes items while on outings. Minors are denied access to personal property Confidential interviews revealed that clients are denied personal property based on scheduled activities and for their safety. Some personal items are stored locked in a cabinet and made available to clients upon request. Per Facility Representative(s) some items such as razors require direct supervision, while other personal items (such as books, clothing and etc.) are not allowed to be possessed by clients because the item could trigger client's behaviors or jeopardize their safety while in treatment.

Investigation Findings:
13On 12/02/2021, Licensing Program Analyst (LPA) Miguel Gomez arrived at the facility to deliver the findings of a complaint investigation. LPA Gomez met with Administrator, Devorah Weiss and discussed the investigative findings. On June 7, 2021, the Department received a complaint alleging minors are not treated with dignity; minors are not allowed hygiene items; staff open minors' personal mail; minors are not receiving an allowance; minors are being denied access to personal property. Confidential interviews were conducted with 4 staff and 4 of 6 clients. Facility's Program Statement, Plan of Operation, Parent Handbook and Training Manual were reviewed. The following information was obtained during the course of the investigation: Minors are not treated with dignity Confidential interviews revealed conflicting statements that clients must leave the bathroom door ajar while using the restroom. Some confidential interviews reported that the clients did not have to leave the door open while using the restroom and other interviews stated that clients must leave the bathroom door ajar while using the restroom. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Miguel A Gomez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: EVOLVE TREATMENT, AURAFACILITY NUMBER: VISIT DATE: 12/02/2021


summary: Facility Evaluation

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Licensing Program Analyst (LPA) Olivia Rosas made an announced inspection to the Evolve Treatment, Aura on 12/02/21 at 10:00am for the purpose of conducting Annual Inspection. LPA Rosas met with Staff#1(S1) who granted access to the facility and an inspection of the facility was conducted together. The Evolve Treatment, Aura is a therapeutic treatment program that's designed to accept "Private Placement's" for a length of 30 - 45 days and is licensed to provide care supervision for six (6) youths, ages 12-17 years; ambulatory only. Individuals mention in this report are identify on the Confidential Names List (LIC811) dated 12/02/21. Temperature and health checks are conducted at the entrance in the sign-in area. The home is set-up as follows and LPA inspected the following: This is a two story home with four (4) bedrooms, eight (8) bathrooms, living room/school room, two (2) therapy rooms, two (2) office rooms, medication room, laundry room, group room, dining area, converted garage (gym), tennis court, and a gated pool. There are 23 facility cameras on the premises, and an approved Camera Waiver on file. There are no security bars on the windows. S1 states that there are no guns or weapons on the premises. There is a pool on the premises that meets regulation requirements. The facility has hand sanitizer dispensers. Living Room/Dining room/Kitchen: LPA observed to be clean and organized; equip with living room furniture including a dining table. There is a stove with five (5) burners all working at this time. There is a detached oven that is also working at this time. There is a microwave and refrigerator/freezer. The sharp knives are kept locked in a lock box located inside the staff office closet upstairs. Some of the cleaning solutions are kept locked under the sink and the rest is stored and locked upstairs in the staff office. The trash cans have tight lids on. LPA observed ample perishable food items in the refrigerator and the pantry is fully stocked with non-perishable food items. LPA observed enough perishable and Non-perishable food items for seven (7) days. The facility provides three (3) nutritious meals, snacks, and special snacks to the youth. All disinfectant/ poisons chemicals are properly stored inaccessible. There is a private chef that comes to the facility and prepares all meals for the youth. Report continues on LIC 809-C Page 1 of Converted Garage: The garage can be entered through the inside of the house using the door that is located to the right once entering the facility and through the laundry room as well. The garage is being used as a gym/art room. The Laundry room: The laundry room is enclosed adjacent to the kitchen. The laundry detergent is distributed to children individually according to the load of their laundry. Cleaning solutions and detergent are kept locked inside the cabinets. Group Room: There is ample seating for clients. Dinning Room: Is located next to the kitchen and there is one round table with nine (9) chairs. Medication Room: This room is located adjacent to the kitchen. The medication room is kept locked and only available to staff supervising and administering client medications. Staff Offices: There is a total on two (2) staff offices. One is located next to the medication room and the other one is located upstairs. Staff office located upstairs has a bathroom, storage, and closet converted to a setting area. The staff office has access to a patio that is kept locked. Therapy Rooms: There is a total of two (2) therapy rooms: One is located next to the laundry room and the other one is located outside in the converted guest room. Bedrooms (upstairs) Bedroom #1: Occupied by two (2) clients, the bedroom is equipped two (2) twin sized beds, comfortable mattresses, with one (1) closet, and one (1) bathroom. Bedroom #2: Occupied by two (2) clients, the bedroom is equipped two (2) twin sized beds, one (1) closet, and one (1) bathroom. Bedroom #3: Occupied by one (1) client, the bedroom is equipped with one (1) twin sized beds, comfortable mattresses, and one (1) closet, and one (1) bathroom. Bedroom #4: Occupied by one (1) client, the bedroom is equipped with one (1) twin sized beds, and one (1) walk in closet, and one (1) bathroom. All bedrooms have adequate lighting, adequate drawers, closet space, and lighting in the room. Bathrooms: Each of the bedrooms have a bathroom. Bathroom #5: Is located to the right once entering the facility. This bathroom is only used by clients. Bathroom #6: Is located inside therapy room #1. Bathroom #7: Is located inside the staff office upstairs and Bathroom #8 is located inside therapy room #2 outside in the guest house. Living Room/School Room: Is located to the right once entering the facility. The living room has ample seating. There is one (1) couch, two (2) sofa chairs, covered fire place and a mounted TV. The school room has desks with chairs and computers for clients to use. Elevator: non-functional or operational, observed to be empty, locked, and equipped with a gate and a disconnected phone. S1 stated they do not plan to use the elevator. Page 2 of Outdoors: There is a converted guest room used as a therapy room. There is propane grill in good condition also observed to be secure and safe. The facility has a pool with a fence that is at least five feet high and has a fence does not obscure the pool from view. LPA Rosas and S1, observed the gate door to swing away from the pool, with self-close and self-latching device located no more than six inches from the top of the gate. There is a pond located in the backyard that has no water and is empty. The outdoor perimeter front yard, side yard and backyard were inspected and found cleared of debris and hazards materials. The passageways and porches are unobstructed. The facility has a first aid kit stored inside a locked cabinet in the medication room. One of the four fire extinguishers is located in the kitchen area fully charged and the other fire extinguisher is located inside the laundry room fully charged. The third fire extinguisher is located next to bedroom #3 mounted onto the wall and the fourth fire extinguisher is located next to the staff office mounted onto the wall fully charged. Disinfectants and poisons are inaccessible to the clients in care they are kept locked at all times. All knives and sharp objects are made inaccessible to the clients in care locked in a security box inside the closet in the staff office upstairs. The Chef logs out the knives when they will be used. All smoke detectors and carbon monoxide are operable. There is a working telephone line available for clients to use. All posting requirements were met, (food menu, regulations, licenses, emergency disaster plan, Children's Personal Rights, and Ombudsman). The facility has a working telephone and youths can use the telephone unless restricted by court order. The Facility operates within license conditions and limitations including capacity limitations. Facility has a current, written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to youths. Licensee will report youth injuries requiring medical treatment. A review of Facility's Personnel Report Summary on 11/29/2021 indicates that all personnel have criminal record clearance has obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. LPA Rosas was not able to review client or staff files during this visit and will return to continue with the annual inspection. The facility keeps files and documents in digital system called KIPUERM. There were no deficiencies observed or cited at this time. Exit interview was conducted with S1 and a copy of this report was left at the facility.


summary: Facility Evaluation

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On 4/14/23, at 9:18am Licensing Program Analyst (LPA) Christine Wilson made an unannounced visit to this facility, for the purpose of conducting a Case Management inspection to address concerns regarding an order to individual of immediate exclusion. LPA Wilson was met by S2, who provided a tour of the facility indoors, and outdoor grounds. (7) staff members were present in the facility with (6) clients. S2 provided a staff roster (Evolve Aura Contacts List) (2) staff present in the facility were not included on this list: S3 and S6, but were listed on the LIC500. An order of immediate exclusion was issued by CDSS office April 6, 2023 to inform the facility that, unless notified otherwise in writing by CDSS, staff (S1) must immediately be removed from any contact with clients and not be physically present in any agency or home licensed/approved by the Department. [See Confidential Names form (LIC811), dated 4/14/23 for names.] LPA Wilson received a Personnel Report (form LIC500 from Staff #4 and Staff #5, which does not show S1 associated to this facility. Guardian Report shows that S1 was separated, on 04/10/2023, and is no longer associated to this facility. LPA Wilson also received notification that S1 was terminated from employment, effective 04/10/2023. Based on evidence obtained, LPA Wilson has verified that S1 is no longer present, or employed with any Evolve Growth Initiatives facility. Individuals mentioned in this report are identify on the Confidential Names List (LIC811) dated 04/14/23. There are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was left at the facility.

met_with: Staff #2 (S2)


summary: Facility Evaluation

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On 12/15/23 at 10: AM Licensing Program Analyst (LPA) Jhane Haynes arrived at the above facility, for the purpose of conducting Annual/Random inspection. LPA met with Joseph Raya-Ward(OM) who granted access into the facility. Together OM, PD and LPA toured the home both inside and out. This is a two-story home located in a residential area. There is a gated swimming pool on the premises. LPA observed the following during facility tour: First Floor Entry contains posting of license and accreditation, sign in sheet. Group Room #1/School Room contains ample seating, activity stations, fireplace, six desks and computers for client education use. Storage Closet stored paper goods not limited to paper towels and other supplies. Garage/Gym house gym mat and equipment, table and chairs, extra storage fridge. Bathroom #1 is a half bathroom with toilet and sink in functioning order. Laundry Room contains washer, dryer, sink and locked cabinets that stores additional cleaning and laundry supplies. Emergency dried food supply is also stored in cabinet. There is a door that leads to the garage. Therapist Office contains a couch, chair, and desk. Locked Closet containing inactive elevator. Staff does not have keys. Group Room #2 contained eight seats, TV, retired fireplace, and re-purposed bar area that stored additional activity supplies, contraband, sports equipment, and sunscreen. (See LIC809-C Page 1 of 3 ) Dining Area contained adequate seating and table in good repair. Kitchen contained two sinks, dishwasher, microwave, five burner stove top, double oven and refrigerator all in good repair. Trashcan had secured lid. LPA observed adequate dinnerware and utensils for clients, accessible snacks for in between meals and posted weekly meal plan. Refrigerator and freezer operating at temperatures within regulation and is observed to have perishables for two days and food items dated. Pantry observed to have non-perishables for one week. Med Room contained locked cabinets that stored PRNs, prepped medications for clients, first aid kits with required supplies and additional aid to administer medication and offer first aid. Behind a locked cabinet contains a safe that facility nurse has access to. Med log is stored electronically on Kipu. There is a locked door that leads to PD office. PD(Program Director) Office contains desk, shelf a couch and two chairs. Exterior contains propane grill, table, and ample seating that clients may eat at, three HVAC units located on side of the facility along with utility shutoff valves and outdoor trashcans. There is a pool on site with a locked gate at least 5ft and door opens outwards. There is also a tennis court, basketball hoop and two gazebos. Electrical panel is stored west of building. The facility utilizes a Toyota Sienna to transport clients in working condition and current insurance and registration. Second Floor Stairway/Entry contains extra storage cabinets and client hygiene bins. Blocked door to decommissioned elevator, door to staff office and client bedrooms. Bedroom #1 rooms C3. It contains two twin beds, six dresser unit and additional bedside drawers. There is a locked closet door that an offsite staff has key to. Ensuite bathroom contains double sink, toilet and tub/shower combo with running water not exceeding the maximum temperature. Bedroom #2 rooms C2. It contains two twin beds, two dressers and closet. Ensuite bathroom is equipped with drawers for storage double sink, shower, separate tub(non-functioning), and toilet with running water not exceeding the maximum temperature. (See LIC809-C Page 2 of 3 ) Bedroom #3 rooms C4. It contains one twin bed, two dressers and locked closet. Ensuite bathroom is equipped with single sink, shower/tub combo and toilet with running water not exceeding the maximum temperature. Bedroom #4 rooms C3. It contains one twin bed, two dressers locked door to staff office. Ensuite bathroom is equipped with shower, separate tub(non-functioning), double sinks, toilet, and bidet(non-functioning) with running water not exceeding the maximum temperature. Staff Office contains two desks, additional storage closet that housed PPE equipment, IT closet housing network related equipment, walk in closet for extra supplies and linen, sunroom with chairs, balcony access. Ensuite bathroom contains staff bathroom, non-functioning sauna, cabinet storage for additional hygiene supplies and staff items. Several fire extinguishers are found throughout the facility. Fire alarms were tested at the time of visit and is operable. Facility temperature does not exceed 80 degrees. Facility was granted waiver for cameras that are found in the facility common areas. LPA obtained staff and client roster and LIC610. Staff have guardian clearance. LPA conducted confidential interviews with S1 and C2. (See LIC811 [Confidential Names]) Due to time constraints LPA will return to complete file review. Facility is clean, safe, and in good repair. No deficiencies will be cited at this time. An exit interview was conducted, and a copy of this report was provided to program director. (LIC809-C Page 3 of 3)

met_with: Joseph Raya-Ward Operations Manager