summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Jean Stidman and Elena Gonzalez-Soto made an announced pre licensing inspection on 08/02/2024 at 9:00 a.m. During the inspection, LPAs met with Christina Griffith, House Manager, who assisted with the inspection. LPAs conducted a walk-through of the facility. LPAs observed the facility is a two story, seven bedroom and five bathrooms and the property has a two barns and a workshop. There were four children and four staff present during the inspection. LPAs conducted interviews with three staff, reviewed three children and one non-minor dependent file, and reviewed five staff files. LPAs inspected and/or reviewed the following: Physical Plant: Personal Rights__X___ Disinfectants/Cleaning solutions inaccessible: _X__ Refrigerator Temperature at or below 45 degrees F 45 degrees. Freezer Temperature at or below 0 degrees the garage freezers are at -1 degrees F for white freezer. Nonperishable Foods one week and fresh perishable foods two days minimum__X___ Working telephone __X_ Carbon monoxide detectors __X First Aid Kit fully stocked_X__ Common Room available__X__ Dining area (enough seating, furniture good condition, not broke or damaged) __X_ Medication centrally stored, locked/inaccessible _X_ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F)__112.5 degrees_. Fire Extinguishers inspected September 2023. Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _x Soap and Paper towels __X_ Laundry Facilities(available) __X___ Bedrooms-required linen and furnishings __X___ Facility free of vermin _X__ Bedroom (required bedding/furniture, furniture in good repair) __X__ Disaster Preparedness Disaster preparedness supplies verified __X_ Staff Records: Number of Staff files reviewed Fingerprint Clearances/Exemptions __5_, CACI __5__, Criminal Record Statement __5__, Employment Dates __5__, Position Titles __5__, Personnel Record ___5__, Physician's Report __5__, T.B. Test __5__, First Aid Certificate __5__, Education Verification __5__, Employee Rights __5__, and Medical Training Verification __5__.Client Records Number of Clients files reviewed four Individual Program Plan four Cash Resources four No violations were cited. Exit interview conducted and a copy of this report was left with Christina Griffith, House Manager.

met_with: Christina Griffith, House Manager


state: CA

facility_name: WANTS SMALL WORLD FAMILY CARE HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 11/1/ Licensing Program Analyst(LPA) Jean Stidman conducted an unannounced Post-Licensing inspection and met with Cynthia Want Licensee. LPA inspected the facility inside and outside and observed the home is a two story home with seven bedroom and five bathrooms and the property has a two barns and a workshop. There were four children and four staff present during the inspection. LPA conducted interviews with two staff, reviewed three children's and one non-minor dependent's file, and reviewed five staff files. LPA inspected and/or reviewed the following: Physical Plant: Personal Rights__X Disinfectants/Cleaning solutions inaccessible: _X__ Refrigerator Temperature at or below 45 degrees F 37 degrees. Freezer Temperature at or below 0 degrees -1 degrees F. Nonperishable Foods one week and fresh perishable foods two days minimum__X__Working telephone __X_ Carbon monoxide detectors _X First Aid Kit fully stocked_X__ Common Room available__X_ Dining area (enough seating, furniture good condition, not broke or damaged) __X_ Medication centrally stored, locked/inaccessible _X_ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F) The facility's kitchen sink water temperature is 136 degrees F. The hallway bathroom temperature is 129.5 degrees F. The nursery sink temperature is 113 degrees F. The facility has separate hot water heaters for the bathrooms. The kitchen sink and hallway bathroom water heaters were turned down. Fire Extinguishers inspected September 2024. Toilets wash basin, bath and shower fixtures in good repair/no leaks_x Soap and Paper towels __X_ Laundry Facilities(available) __X__ Bedrooms-required linen and furnishings __X___ Facility free of vermin _X__ Bedroom (required bedding/furniture, furniture in good repair) __X__ Disaster Preparedness Disaster preparedness supplies verified __X_ Staffing Five staff files were reviewed. LPA observed the files contain criminal record clearance, CPR & First Aid Certificate, health screening & TB, application, personal rights and required education. Children's Records Three children's files and one Non-Minor Dependent file was reviewed. LPA observed the files contain admission agreement, Identification & emergency information, medical assessment, medical consent forms, Individual Program Plan, Centrally Stored Medication and Destruction Record, Medication Administration Records, Cash Resources, Personal Property & Valuables, personal rights, weight record and immunization record. The following items were reviewed for compliance: Annual fees, Personnel Roster LIC500, LIC610C. Facility citation violation of California Code of Regulations, Title 22, Division 6, regulation 80088(e)(1) Furniture, Fixtures, Equipment, and Supplies. Exit interview conducted, a copy of this report and appeal rights were left with Cynthia Want Licensee

report_type: Facility Evaluation

visit_type: Annual

met_with: Cynthia Want Licensee


summary: Facility Evaluation - 4 deficiencies

raw_content:
Narrative:
On 7/29/ Licensing Program Analyst (LPA) Jean Stidman conducted an unannounced Annual inspection and met with Shawn Want, Licensee. LPA inspected the facility inside and outside and observed the home is a two story home with seven bedroom and five bathrooms and the property has a two barns, a workshop, workshop annex, metal shipping container, one horse trailer and one utility trailer, chickens, goats and horses. There were five children and four staff present at the beginning of the inspection and two children and one Non-Minor Dependent and two other staff arrived during the inspection. LPA conducted interviews with two staff, reviewed three children's and one non-minor dependent's file, and reviewed five staff files. LPA inspected and/or reviewed the following: Physical Plant: Personal Rights__X Disinfectants/Cleaning solutions inaccessible: _X__ three Refrigerators Temperatures are between 33-37 degree F, four Freezer Temperatures are between -6 to -1 degree F. Nonperishable Foods one week and fresh perishable foods two days minimum__X__Working telephone __X_ Carbon monoxide detectors _X First Aid Kit fully stocked_X__ Common Room available__X_ Dining area (enough seating, furniture good condition, not broke or damaged) __X_ Medication centrally stored, locked/inaccessible _X_ Hot Water temperature at four sinks are between 107.5-115 degrees F, Fire Extinguishers inspected September 2024. Toilets wash basin, bath and shower fixtures in good repair/no leaks_x Soap and Paper towels __X_ Laundry Facilities(available) __X__ Bedrooms-required linen and furnishings __X___ Facility free of vermin _X__ Bedroom (required bedding/furniture, furniture in good repair) __X__ Disaster Preparedness Disaster preparedness supplies verified __X_ Staffing Three licensee and two staff files were reviewed. LPA observed two licensee and two staff files contain criminal record clearance, CPR & First Aid Certificate, health screening & TB, application, personal rights and required education. LPA observed one licensee file is missing TB test, application, personal rights, first aid and CPR, and required education/training and/or experience. The facility is being cited violation of California Code of Regulation, Title 22 regulations 80019(e) Criminal Record Clearance, 83010(a) Limitations on Capacity and Ambulatory Status, 800669a) Personnel Records, 83066(a)(2) Personnel Records for Specialized Small Family Homes, 83070(b)(12) Child's Records, 83168.3(d) Needs and Services Plan, 80077.5(b)(1) Care for Clients with Contractures. Exit Interview conducted and a copy of this report was left with with Shawn Want

Deficiencies:
80019(e): Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility
80066(a): Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information
83065.1(a): (2) For any training or additional training from which the licensee or other in-home health care provider is not exempt:
83168.3(d): Deficient Practice Statement
1
2
3
4Based on record review the licensee did not comply with the section cited above in one Non-Minor Dependent's file which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/29/2025
Plan of Correction
1
2
3
4

met_with: Shawn Want, Licensee

title: contain the following

title:
Needs and Services Plan

(d) The Transitional Independent Living Plan shall be signed by the nonminor dependent, the caregiver, and the person or agency responsible for placing the nonminor dependent, such as a social worker or probation officer, and maintained in the records for the nonminor dependent as specified in Section 83170, Nonminor Dependents' Records.

This requirement is not met as evidenced by


facility_name: WAULS SMALL FAMILY HOME

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Based on information from confidential interviews, Licensing Program Analyst has determined the finding is substantiated, meaning the preponderance of the evidence standard has been met, for a violation of personnel rights, which poses an immediate health, safety and personal rights risk of harm to children placed in care. The facility is issued a citation Type A [See page LIC9099-D for cited deficiency]. An exit interview was conducted, and appeal rights were discussed. A copy of this report, Confidential Names List and appeal rights were provided/emailed to Facility Administrator.

Investigation Findings:
13On 09/18/2023 at 1:14pm, Licensing Program Analyst (LPA) Christine Wilson made an unannounced inspection to the above listed facility.LPA Wilson was greeted by staff (S10) who provided access to the facility. The purpose of the inspection was to conclude the investigation on the above allegation. The investigation included confidential interviews with, including but not limited to, clients, facility staff members, and administrative staff. Information obtained revealed enough evidence to determine that the allegation took place and staff performed an inappropriate restraint. The child was in his bedroom attempting to regulate. A child shoving a staff person, does not warrant a restraint hold. (Continued on LIC 9099C) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Christine Wilson 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 FACILITY NAME: WAULS SMALL FAMILY HOMEFACILITY NUMBER: 197607251

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

report_type: Complaint Investigation

met_with: House Manager (S10)

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
LPA Phillips was not able to determine if the above said allegations occurred, therefore the allegations are determined to be unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and a copy of this report will be emailed to Asilia Wauls/Administrator.

Investigation Findings:
13On March 8, 2024, at 10: AM Licensing Program Analyst (LPA) Zena Phillips made an unannounced visit to WAULS SMALL FAMILY HOME and spoke with Jose Orellano/Facility Manager who granted access and provided the census. The purpose of this visit was to deliver the findings regarding the above complaint allegations. During the investigation LPA Phillips conducted confidential interviews, reviewed facility files, Special Incident Reports, and staff schedules. Staff deny the allegations: Staff hit minor in care and Staff spoke inappropriately to minor in care. Staff deny that a Gerald works at facility. LPA review of facility files did not find a staff named Gerald having worked at the facility. LPA Phillips was unable to interview Child #1 due to Child #1 nonverbal. However LPA Phillips did observe Child #1 and did not observe any bruises or marks on Child #1. Inconsistent statements and documentary evidence did not produce corroborating evidence to support the allegations: Staff hit minor while in care, or Staff spoke inappropriately to minor in care. Confidential interviews reveal that Child #1 does not like riding the bus due to the harness required for riding the bus. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: WAULS SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 03/08/2024

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

met_with: Jose Orellana/Facility Manager

complaint_status: unsubstantiated


raw_content:
Narrative:
The facility is cited on the attached LIC 9099-D for violations of Title 22, Section 80065(a) - Personnel shall demonstrate the ability to work cooperatively and ensure the well-being of clients; and Section 80061(b)(1)(H) - Licensees must report incidents that threaten the emotional or physical health and safety of clients. The failure to document and report the altercation, along with the lack of professional conduct by staff, demonstrates a breach of regulatory responsibilities and a failure to protect the dignity and emotional safety of clients. An exit interview was conducted, and a copy of this report will be emailed to the licensee. The facility is required to submit a corrective action plan addressing the cited violations to ensure compliance with CDSS regulations and prevent the recurrence of similar incidents.

Investigation Findings:
13On 04/16/2025 at 10: AM, LPA Dennis Jarmin arrived at Wauls Small Family Home to discuss the findings of a complaint investigation regarding staff failing to report incident(s) involving minor(s) and engaging in inappropriate interactions in the presence of minors. LPAs met with the licensee and explained that the investigation concluded on 03/27/2025. During the investigation, LPAs conducted interviews, reviewed records, and gathered supporting evidence. Confidential interviews and records confirmed that staff engaged in a verbal altercation on facility grounds in the presence of clients. The incident was neither documented nor reported to the Department, as required. This reflects a failure to maintain professional conduct and protect the emotional well-being of clients. Additionally, the facility failed to submit a Special Incident Report (SIR), violating mandated reporting requirements. Based on a preponderance of evidence, the allegation of Inappropriate Staff Conduct/Lack of Supervision is Substantiated. Deficiencies are cited for failure to provide proper supervision and report significant incidents in accordance with Title 22 regulations. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Enrique M Hernandez LICENSING EVALUATOR NAME: Dennis Jarmin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: WAULS SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 04/16/2025

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

met_with: LICENSEE


summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward interviewed the facility manager and Client #1 who is the roomate of Client #3. Management detrmined that due to conflicting details given by Client #1 and the facility manager that a substantiated finding could not be supported. Based on the confilicting accounts obtained by LPA Jones-Steward during the investigation of this allegation, it is resolved as unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Citations on this Visit Report are Under Appeal! 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: WAULS SMALL FAMILY HOMEFACILITY NUMBER: 197607251

met_with: Chary Hallon


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Zena Phillips made an unannounced visit to the Wauls Small Family Home for the purpose of conducting an Annual/Random Inspection. LPA met with Asilia Wauls who granted access to the home and a tour of the home was conducted together with the licensee. This is a two story, SIX (6) bedrooms, FOUR (4) bathrooms home with living room and fireplace, kitchen, dining area. The home is license to care for FOUR (4) children, ages 3-17, one(1) non-ambulatory and three (3) ambulatory clients LPA observed the follow during the inspection: Bedroom #1: is an extra bedroom and activity space for visiting guests. this bedroom is usually locked an inaccessible to consumers in care. LPA observed twin size bed, lamp, dresser and small table. Bedroom #2: Is occupied by C1. There is a twin size bed, adequate drawer space, closet and lighting. Bedroom #3: Is occupied by C2, There is a twin size bed, adequate drawer space, closet and lighting. Bedroom #4: Is currently C3 . There is one twin size bed, adequate drawer space, closet and lighting. There is also a desk and chair in this room. Bedroom #5: is vacant LPA observe one couch, tv, desk and table with lamps, and a walk in full bathroom. Space is currently being used for employee lounge. Bedroom #6: is occupied by Licensee, LPA observed a king bed and office space. There is no swimming pool or bodies of water on the premises. The home has comfortable mattresses, clean linens, blankets, and pillows, all in good repair. The home is clean, safe, sanitary, and in good repair. Medicines, disinfectants, and cleaning solutions are inaccessible to children. Hot water is kept at a safe temperature. Facility has one functioning carbon monoxide detectors that meet the statutory requirements. All smoke detectors were tested and operable at the time of inspection. LPA observed a fire extinguisher in the kitchen that was operable at the time of inspection. There are no fire arms or dangerous weapons in the home. Licensee maintains age appropriate first aid supplies in the home. The home operates within capacity and limitations of license. There are no children sharing a bedroom at this time. Adequate supervision is provided for children in care. Licensee ensures three nutritious meals, snacks, and special diets. Children in care are accorded personal rights. Licensee submits special incident reports as required. Needs and Services plans are in children's files for each child in the home, the licensee maintains a separate, complete, and current record on file. Exterior grounds are free unsafe objects and well maintained. All adults residing in the home have Child Abuse Index checks, and have DOJ/FBI criminal record clearances. Licensee is current with her foster parent training hours for this year. Licensee has current First Aid and CPR training, and training was obtained from an accredited agency. Per California Code Regulations, TITLE 22, DIVISION 6, CHAPTERS 9.5, there were no deficiencies observed or cited at the time of inspection. Exit Interview was conducted and this report was left with licensee.

met_with: Asilia Wauls/ Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Zena Phillips made an unannounced visit to the Wauls Small Family Home for the purpose of conducting an Annual/Random Inspection. LPA met with Asilia Wauls/Licensee who granted access to the home and a tour of the home was conducted together with the licensee. This is a two story, six (6) bedrooms, four (4) bathrooms home with living room and fireplace, kitchen, dining area. The home is license to care for four (4) children, ages 3-17, one (1) non-ambulatory and three (3) ambulatory clients. LPA observed the follow during the inspection: Bedroom #1: LPA observed double size bed, lamp, closet, dresser with five (5) drawers, chest of drawers with six (6) drawers, lazy boy lounge chair, night stand with three (3) drawers and three (3) lamps for lighting. There is one full bathroom downstairs, with shower and bath combo and sink. LPA confirmed water is not more than 120 degrees and meets compliance requirements. Bedroom #2: Is occupied by C1. There is a twin size bed, adequate drawer space, closet and lighting. Bedroom #3: Is occupied by C2, There is a twin size bed, adequate drawer space, closet and lighting. Bedroom #4: Is currently C3 . There is one twin size bed, adequate drawer space, closet and lighting. There is also a desk and chair in this room. Bedroom #5: is vacant LPA observe one couch, tv, desk and table with lamps, and a walk in full bathroom used for storage. Space is currently being used for employee lounge. Bedroom #6: is occupied by Licensee, LPA observed a king bed and office space. The hallway cabinet upstairs has extra linens and towels for residents. LPA observed fire extinguisher upstairs hallway to be fully charge. There is no swimming pool or bodies of water on the premises. cont on 809c The home has comfortable mattresses, clean linens, blankets, and pillows, all in good repair. The home is clean, safe, sanitary, and in good repair. Medicines, disinfectants, and cleaning solutions are inaccessible to children. Hot water is kept at a safe temperature. Facility has four (4) functioning carbon monoxide detectors that meet the statutory requirements. All smoke detectors were tested and operable at the time of inspection. LPA observed a fire extinguisher in the kitchen that was operable at the time of inspection. There are no fire arms or dangerous weapons in the home. Licensee maintains age appropriate first aid supplies in the home. LPA observed the backyard to have four (4) bicycles, basket court, and extra large trampoline for residents. Exterior grounds are free unsafe objects and well maintained. LPA observed front are of the facility to have table with four chairs and two additional chairs set off to the side. The home operates within capacity and limitations of license. There are no children sharing a bedroom at this time. Adequate supervision is provided for children in care. Licensee ensures three nutritious meals, snacks, and special diets. Children in care are accorded personal rights. Licensee submits special incident reports as required. Needs and Services plans are in children's files for each child in the home, the licensee maintains a separate, complete, and current record on file. Exterior grounds are free unsafe objects and well maintained. Per California Code Regulations, TITLE 22, there were no deficiencies observed or cited at the time of inspection. Exit Interview was conducted and this report was left with licensee.

met_with: Asilia Wauls/Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On 10/18/2024, Licensing Program Analyst (LPA), Kim Dear and Licensing Program Manager Enrique Hernandez made an unannounced visit to the Wauls Small Family Home for the purpose of conducting an Annual/Random Inspection. LPA met with Asilia Wauls/Licensee who granted access to the home and a tour of the home was conducted together with the licensee. This is a two story, six (6) bedrooms, four (4) bathrooms home with living room and fireplace, kitchen, dining area. The home is license to care for four (4) children, ages 3-17, one (1) non-ambulatory and three (3) ambulatory clients. LPA observed the follow during the inspection: Bedroom #1: LPA observed double size bed, lamp, closet, dresser with five (5) drawers, chest of drawers with six (6) drawers, lazy boy lounge chair, night stand with three (3) drawers and three (3) lamps for lighting. There is one full bathroom downstairs, with shower and bath combo and sink. LPA confirmed water is not more than 120 degrees and meets compliance requirements. Bedroom #2: Is occupied by C1. There is a twin size bed, adequate drawer space, closet and lighting. Bedroom #3: Is occupied by C2, There is a twin size bed, adequate drawer space, closet and lighting. Bedroom #4: Is currently C3 . There is one twin size bed, adequate drawer space, closet and lighting. There is also a desk and chair in this room. Bedroom #5: is vacant LPA observe one couch, tv, desk and table with lamps, and a walk in full bathroom used for storage. Space is currently being used for employee lounge. Bedroom #6: is occupied by Licensee, LPA observed a king bed and office space. The hallway cabinet upstairs has extra linens and towels for residents. LPA observed fire extinguisher upstairs hallway to be fully charge. There is no swimming pool or bodies of water on the premises. cont on 809c The home has comfortable mattresses, clean linens, blankets, and pillows, all in good repair. The home is clean, safe, sanitary, and in good repair. Medicines, disinfectants, and cleaning solutions are inaccessible to children. Hot water is kept at a safe temperature. Facility has four (4) functioning carbon monoxide detectors that meet the statutory requirements. All smoke detectors were tested and operable at the time of inspection. LPA observed a fire extinguisher in the kitchen that was operable at the time of inspection. There are no firearms or dangerous weapons in the home. Licensee maintains age appropriate first aid supplies in the home. LPA observed the backyard to have four (4) bicycles, basket court, and extra-large trampoline for residents. Exterior grounds are free unsafe objects and well maintained. LPA observed front are of the facility to have table with four chairs and two additional chairs set off to the side. The home operates within capacity and limitations of license. There are no children sharing a bedroom at this time. Adequate supervision is provided for children in care. Licensee ensures three nutritious meals, snacks, and special diets. Children in care are accorded personal rights. Licensee submits special incident reports as required. Needs and Services plans are in children's files for each child in the home, the licensee maintains a separate, complete, and current record on file. Exterior grounds are free unsafe objects and well maintained. Per California Code Regulations, TITLE 22, there were no deficiencies observed or cited at the time of inspection. Exit Interview was conducted, and this report was left with licensee.

met_with: Asilia Wauls


summary: Facility Evaluation

raw_content:
Narrative:
On 10/22/2024, Licensing Program Analyst (LPA), Kim Dear and Licensing Program Manager Enrique Hernandez made an unannounced visit to the Wauls Small Family Home for the purpose of a Case Management, Annual Continuation Inspection. This is a continuation from the initial Annual inspection conducted on 10/18/2024. LPA met with Chary Hallon the facility Administrative Assistant and Licensee, Asilia Wauls, the Licensee, During the inspection, the LPA was provided (4) four client and (5) five staff files. On this inspection the following areas were covered: Operations, Staffing Records, Client Records and SHCN. see the LIC 811, Confidential Names form, dated 10/22/24. The Administrative Assistant and Program Manager are present at the facility a minimum of 40 hours a week, as verified by the staff schedule. Appropriate staff/client ratios were verified during this inspection. Postings: All licensing posting requirements were met. Facility posts client rights in dining area adjacent to kitchen. Clients are not restricted in telephone use by court order. Clients are treated with dignity in personal relationships with staff and others. Clients live in a safe, healthy, comfortable home style environment and are treated with respect. Clients can contact licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. LPA Dear reviewed the following during the inspection: Client Records: Facility maintains client cash resource. Client records contain authorization for medical care signed by each client's authorized representative. Client records copies of the original Needs and Services Plan signed by each child and their authorized representative(s). Clients attend school daily, extracurricular activities, cultural and personal enrichment activities. LPA inspected facility van and observed working seat belts, valid registration, insurance, and a first aid kit. Per CA Regulations Title 22, there were no deficiencies observed or cited. An exit Interview was conducted, and a copy of this report will be provided to the Licensee.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On March 21, 2025, Licensing Program Analyst, LPA, Kim Dear conducted a Case Management, Incident report at the Wauls Small Family Group Home. A health and safety assessment were conducted upon arrival to the facility. LPA met with Chary Hallon, Facility Administrator and Ailisia Wauls, Licensee in response to the Special Incident Report submitted to the Community Care Licensing Department, (CCLD), to investigate a possible violation of Client personal rights. The incident, which was received by the department, on February 03, 2025, Client 1, (C1) had a crisis and began acting out within the facility and staff, (S1). According to the Incident Report, C1 became agitated after arguing with another resident. As S1 attempted to redirect C1, C1 became physically aggressive toward (2), two staff and began spitting bodily fluids from his, (C1) mouth and kicking the staff. [see LIC Confidential Names List form (LIC811), dated 03/21/2025, for names]. LPA Dear interviewed Licensee and the Facility Administrator. At this time, the Department has made no determination on whether a violation has occurred. A copy of this report was provided to the Licensee/ Facility Administrator.

met_with: Ailsia Wauls, Licensee and Chary Hallon, Program Assistant


summary: Facility Evaluation

raw_content:
Narrative:
On March 21, 2025, Licensing Program Analyst, LPA, Kim Dear conducted a Case Management, Incident report at the Wauls Small Family Group Home. A health and safety assessment were conducted. LPA met with Chary Hallon, Facility Administrator and Aislia Wauls, the Licensee in response to the Special Incident Reporting submitted to the Community Care Licensing Department, (CCLD), to investigate a possible violation of client(s) personal rights. The incident, which was received by the department, on March 11, 2025, involved a Client 1, (C1) and Staff 1, (S1). According to the Incident Report, C1 became agitated after arguing with a fellow resident. As S1 attempted to redirect C1, C1 became physically aggressive and began inflicting property damage to the facility. Report further lists a lack of proper supervision of the hygiene of C1. LPA Dear interviewed Licensee and/ or the Facility Administrator. At this time, the Department has made no determination on whether a violation has occurred A copy of this report was provided to the Licensee/ Facility Administrator.

met_with: Chary Hallon, Program Assistant and Ailisa Wauls, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On March 21, 2025, at 10: AM, Licensing Program Analysts. LPA, Kim Dear conducted a Case Management - Incident inspection at the above facility. LPA met with Chary Hallon, Facility Administrator (FA), in response to a Special Incident Report that was submitted to the Community Care Licensing Division (CCLD), to investigate a possible personal rights violation. The incident, which was received by the CCL Department, on 2/4/2025, involving Client 1, (C1). Incident began on January 31, 2025, when a FA was informed by a North Los Angeles County Regional Center Supervisor, that allegations of restraint, spanking, a client being hit in their chest and told to grab their "privates". The report received to CCLD has launched a case management, follow- up. [see LIC811, Confidential Names List form. LIC811, dated 03/21/2025, for names]. LPA interviewed Facility Administrator; no other staff nor clients were available at the time of visit. Currently, the CCL Department has made no determination on whether the (4), four violations have occurred. A copy of this report will be provided to the Facility.

met_with: Chary Hallon, Program Administrator and Ailisia Wauls, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On 10/9/25 at 10: AM LPA arrived at the above facility to conduct a annual/required inspection. LPA meet with Asilia Wauls Licensee. A tour of the home was conducted. The facility is licensed to provide care and supervision services for four (4) children, ages 3-17 years old, ambulatory only. The census today is 4. Licensee lives in the home. The facility is set up as follows: It is a two bedroom house, with a backyard, and a garage. There are four bedrooms and 2 bathrooms for the clients. There is one bedroom for the licensee and one bathroom for the staff. There are no bodies of water on the premises and windows are operational. There are 2 fully charged fire extinguisher in the house. There are dual smoke/carbon detectors in each bedroom. Entry Way: In the entry way posted in a prominent public place are copies of the facility license, personal rights, facility sketch, grievance procedures, client roster, disaster plan, and facility sketch. Bedroom #1: Located at the front of the house adjacent to the entry way is bedroom#1. This room is used by a client. There is adequate lighting, AC, drawers, a closet, a full sized bed, pillows, sheets, and a blanket. There is a table with a chair. There is a window with a screen in good condition. The client in this room has AWOL tendencies so there is an alarm on the window to alert when it opens. The alarm system inadvertently prevents the window from fully opening. LPA addressed this with staff who said they would remove the alarm. School Area: Next to the entry way is the school area. There are 4 desks and a couch. The area is for clients to do homework. There is a computer for school. Living room: The living room is open and connected to the school area and leads to the dinning area. The living room has adequate seating with couches, a TV, and games including arcade machines. There is a fire place adequately covered and inaccessible. There is a door that leads to the backyard and stairs that lead upstairs. Dining Area: The dinning area is open and connected to the kitchen. The dinning area included a table with adequate seating for the clients. Kitchen: The kitchen is complete with a fridge/freezer unit adequately filled with perishable food. LPA observed an adequate amount of plates, cups, bowls, and utensils. LPA observed an operational stove, oven and microwave. There is a working carbon monoxide detector. LPA observed posted in the kitchen facility menu and activity schedule. Laundry Room: Next to the kitchen, this door is locked. The room holds client medication, first aid kit, laundry, cleaning solutions, and sharps. The first aid kit was observed to be fully equipped and in compliance. Garage: The Garage is kept locked and inaccessible to clients. Only accessible from the laundry room which is also locked. The facility vehicle is stored here. LPA observed the facility vehicle insurance and registration. The garage has an extra fridge/freezer and a pantry stocked with perishable and non-perishable food. Bathroom #1: Located after the kitchen. This bathroom is for clients. LPA observed and tested the toilet, shower, and sink. The sink temperature was tested to be 105 degrees F. Bedroom #2: Located after bathroom #1. This room is used by a client. It contains a twin bed, drawers, desk, and adequate closet space. There is adequate lighting, AC, pillows, sheets, and a blanket. There is a table with a chair. There is a working window with working security bars that open from the inside. Upstairs Landing: LPA observed closet space filled with extra towels, linens, and blankets. Bedroom #3: This room is used by a client. There is adequate lighting, AC, drawers, a closet, a twin bed, pillows, sheets, and a blanket. There is a table with a chair. There is a window with a screen in good condition. The window is able to open. Bathroom #2: This bathroom is for clients. LPA observed and tested the toilet, shower, and sink. The sink temperature was tested to be 105 degrees F. Bedroom #4: This room is used by a client. There is adequate lighting, AC, drawers, a closet, a twin bed, pillows, sheets, towels, and a blanket. There is a window that leads to an outdoor patio which is inaccessible to clients. Staff Room: There is a staff room that is locked and inaccessible to clients. The room is for staff to relax. There is a bathroom. Extra supplies are stored here. There is an outdoor patio for staff. Client files are locked and stored here. Backyard: The facility has a back yard that is accessed through the living room. The backyard has adequate amount of space for clients to run around. There is a trampoline, adequate seating, and a grassy area. There are bikes for clients. The area is clear of debris and safe. LPA started the CARE Tools Checklist. LPA requested and received a copy of the staff and client roster. LPA observed the facility vehicle registration and insurance. LPA observed LIC 610D the Emergency and Disaster Plan. LPA observed earthquake and fire drills from 2025. LPA observed medication logs for all clients including physician orders and Centrally stored Medication and Destruction Records.LPA observed that client medications are stored separately and locked in the laundry room. LPA will return to continue the inspection, reviewing the staff and client files, conducting staff and client interviews and completing the CARE Tools Checklist. No deficiencies cited at this time. A copy of this report was given to the Licensee.

met_with: Asilia Wauls Licensee


summary: Facility Evaluation

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Narrative:
On 10/17/ Licensing Program Analyst (LPA) Reagan Cohen made an unannounced visit to the above facility for the purpose of continuing an annual/Random inspection. LPA meet with Asilia Wauls Licensee. LPA continued the CARE Tools Checklist. LPA preformed a client and staff files review and documented on LIC 858 and LIC 859. LPA reviewed staff training logs and client medication, MARS, and Destruction logs. LPA will return to interview staff and clients, and complete the CARE Tools Checklist. No deficiencies cited. Exit interview conducted. A copy of this report was given to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On January 29, 2026, at 11: AM, Licensing Program Analyst (LPA), Aimee Moratalla conducted a case management - other (a follow up) on an incident investigation at Wauls SFH and met with the Licensee, Asilia Wauls. The incident report concerning inappropriate conduct of two staff members was received by the department on 02/03/2025 that allegedly violated the personal rights of a client. During this visit, LPA spoke to the Licensee and the Administrative Assistant regarding the alleged violation. LPA requested a copy of the following documents: LPA Moratalla requested copies of the following documents: Client Roster (LIC9020) and Personnel Report (LIC500). The following documents - training certificate of the two staff members for CPI, training sign-in sheet (CPI and Clients) and a screen shot of the email received from Regional Center will be emailed to LPA. Based on interviews and information gathered, this case management, the Department determined no further investigation is needed. There are no deficiencies cited per California Code of Regulations, at this time. Exit Interview conducted, and a copy of this report will be emailed to Licensee.

met_with: Licensee, Asilia Wauls


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Narrative:
The Licensee provided documented evidence of AM, and PM Daily Notes and Body checklist. Due to a lack of evidence obtained during the investigation, LPA Gray determined that the allegation is Unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that a violation occurred. There are no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was left at the with the Administrator Asila Wauls.

Investigation Findings:
13On 01/21/2026 at 1: PM Licensing Program Analyst (LPA) Andrew Upshaw made an unannounced visit to conclude the complaint investigation. Prior to entering the facility LPA Upshaw conducted a health and safety risk assessment. During the investigation, LPA Gray interviewed all relevant parties available and gathered pertinent information in reference to the allegation. Based on confidential interviews and documentary evidence, there is no evidence to determine that the minor sustained an unexplained burn while in care. There were no medical records of serious injury sustained, medical treatment was provided via in-house First-Aid. Records include Client 1's (C1) INDIVIDUAL PROGRAM PLAN (IPP) NORTH LOS ANGELES REGIONAL CENTER Person/Family Centered Planning. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Andrew Upshaw LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: WAULS SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 01/21/2026

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

met_with: Asilia Wauls, Administrator


raw_content:
Narrative:
The SC also shared that they looked into the allegations and did not find any evidence to support the claims. The SC also said that when the client was moved to an adult facility, the client kept requesting to move back to the Wauls facility, and once AWOLed from the adult facility, back to the Wauls facility. Finally, the LPA interviewed the client, who contradicted the allegations and shared that they loved the Wauls facility and its staff. The client stated they had never been threatened, interrupted while sleeping, or mishandled by facility staff. The client even said they want to go back to living at the Wauls facility. Based on staff testimony and lack of evidence to the claim, while the allegations were made and shared with others, LPA only received testimony from the staff, witnesses, and the client that the allegations did not occur. The SC stated that the client has a history of making false allegations, and the client contradicted all the allegations, sharing that the allegations did not happen, and in fact that they want to move back to the Wauls facility. Therefore, based on the available information LPA gathered from interviews, the preponderance of the evidence standard has not been met; therefore, the allegation of "Staff threatened a client, Staff interrupted a client while sleeping, & Staff mishandled a client" is found to be unsubstantiated. No deficiencies cited. Exit Interview Conducted and a copy of this report was given to the Licensee.

Investigation Findings:
13On 2/5/26, Licensing Program Analyst (LPA) Reagan Cohen arrived at the above facility and met with Asilia Wauls Licensee for the purpose of delivering complaint findings regarding the above allegation. During the course of the investigation, LPA interviewed involved staff, clients, and witnesses. The complainant shared that they were told the allegations, but never witnessed or saw evidence of the allegations. All staff interviews denied the allegations and denied that any staff had committed the allegations against any clients. Staff interviews shared that the client often made false claims and allegations when they were upset and did not get their way. LPA interviewed the client's Service Coordinator (SC), who also stated that the client has a history of eloping and making false allegations. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Reagan Cohen LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: WAULS SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 02/05/2026


facility_name: WE CARE SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On November 2, 2021 at 10:30AM, Licensing Program Analyst (LPA) Carol Anderson and Licensing Program Analyst Jesus Cervantes conducted an unannounced annual required inspection. LPA Anderson and LPA Cervantes met with Licensee Anna Carmody. LPA Anderson and LPA Cervantes inspected the small family home (SFH) with Licensee. LPA Anderson and LPA Cervantes inspected both indoor and outdoor areas of the facility. The facility has four clients in care. The facility is set up as follows: Downstairs: Bedroom #1- One client, one twin bed and appropriate furnishing. Bedroom # 2- One client, two twin beds and appropriate furnishing. Upstairs: Bedroom # 3- One queen bed and sleeps licensee's 28-year-old son. Bedroom # 4- One crib for C4 and appropriate furnishing. Bedroom #5 - Licensee bedroom. The facility has three bathrooms, a family room, a living room and a kitchen. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. Inside the facility there was an operable smoke detector located in each bedroom and common areas. There was also an operable carbon monoxide detected located in the dining area. The fireplace was properly screened. The medications were locked and stored in a cabinet under the stairs. Cleansers/chemicals were locked and stored in the laundry room. Sharp knives were inaccessible and stored the pantry. The First Aid Kit was in the medication cabinet and contained all required items. There were no guns or weapons as stated by licensee at this time. The hot water temperature was tested and noted to be 107 degrees. Proper storage of all food was noted. The Emergency Disaster Plan posted at this time. A copy of the license was readily available to LPA during time of inspection. Proper storage of all food was noted. The Emergency Disaster Plan posted at this time. A copy of the license was readily available to LPA during time of inspection. The backyard where children have access to play was completely fenced and free of hazards. Toys were safe, clean and age appropriate for the age group of children to be cared for both inside and outside the facility. Staff 1 did not have tuberculosis test results and health screening in file or ready for review. The following deficiency is being cited and noted in accordance with CCL rules and regulations under Title Division Chapter 1. An exit interview was conducted, and a copy of this report was left with Licensee Anna Carmody.

met_with: Anna L. Carmody


summary: Facility Evaluation

raw_content:
Narrative:
On November 29,2022 at 10:00AM, Licensing Program Analyst (LPA) Carol Anderson met with Licensee Anna Carmody. The purpose of this visit was to conduct an annual required inspection of the small family home. The facility was toured both inside. The facility has four clients in care. Presently, Client 1 (C1) and Client 2 (C2) were present during today's inspection. C1 and C2 were unable to be interviewed. Also, there were no staff available to be interviewed during today's inspection. The facility is set up as follows: Downstairs: Bedroom #1- One client, one twin bed and appropriate furnishing. Bedroom # 2- two clients, two twin beds and appropriate furnishing. Upstairs: Bedroom # 3- Licensee's adult son. Bedroom # 4- One client, one twin bed and appropriate furnishing Bedroom #5 - Licensee w/spouse bedroom. The facility has five bedrooms, four bathrooms, a family room, a living room and kitchen. Bedrooms were arranged so that no more than two children share a room. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. Inside the facility there was an operable smoke detector located in each bedroom and common areas. There was also an operable carbon monoxide detected located in the dining area. The fireplace was properly screened. The medications were locked and stored in a cabinet under the stairs. Cleansers/chemicals were locked and stored in the laundry room. Sharp knives were inaccessible and stored the pantry. The First AID Kit was in the medication cabinet and contained all required items. The following documents are posted in the facility; facility license, personal rights and emergency disaster plan. Licensee stated there are no firearms at facility at this time. Per licensee there are no bodies of water at facility currently. Based on the facility inspection and file reviews this date, there are no deficiencies at this time An exit interview was conducted, and this report was reviewed, and a copy left with Licensee Anna Carmody.


summary: Facility Evaluation

raw_content:
Narrative:
On November 28,2023, at 10:48AM, Licensing Program Analyst (LPA) Carol Anderson conducted an annual/required inspection of the facility. LPA met with Licensee Anna Camody. Two clients were not interviewed due to client's lack of verbal abilities. One client was unavailable to be interviewed. One staff is employed at the facility but was not available to be interviewed during today's inspection. LPA Anderson inspected the exterior and interior of the facility as follows: l Downstairs: Bedroom #1- One client, one twin bed and appropriate furnishing. Bedroom # 2- One client, two twin beds and appropriate furnishing. Upstairs: Bedroom # 3- Licensee's adult son. Bedroom # 4- One client, one twin bed and appropriate furnishing Bedroom #5 - Licensee w/spouse bedroom. The facility has five bedrooms, four bathrooms, a family room, a living room and kitchen. Bedrooms were arranged so that no more than two children share a room. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. Inside the facility there was an operable smoke detector located in each bedroom and common areas. The fireplace was properly screened. The medications and first aid kit were locked and stored in a cabinet under the stairs and contained all required items. Disinfectants/Cleansers supplies were locked and stored in the laundry room. Sharp knives were inaccessible and stored the pantry. Hot water temperature reading 105 degrees. LPA Anderson reviewed staff and clients' files and they had the necessary forms A A review of Guardian on November 28,2023 indicates that four of five individuals associated to the facility had DOJ, FBI and child abuse index check clearances. One individual fingerprint are pending on Guardian per Licensee Carmody stated that individual does not work at the facility. The following documents are posted in the facility, facility license, personal rights and emergency disaster plan. Facility had non-perishable foods and perishable foods. Licensee Carmody stated that there are no firearms at facility. Per licensee there are no bodies of water at facility currently. Based on the facility inspection and file reviews this date, there are no deficiencies at this time An exit interview was conducted, and this report was reviewed, and a copy left with Licensee Carmody.

met_with: Anna L.Carmody


summary: Facility Evaluation

raw_content:
Narrative:
On October 9, 2025, at 10: AM, Licensing Program Analyst (LPA) Cynthia Velasquez arrived unannounced at the facility to conduct an annual/required visit. LPA was greeted by Anna Carmody, Licensee. An inspection of the facility was initiated and Administrator accompanied. The front entrance to the facility was clean and there were no obstructions at entrance. There is a Recreation Vehicle (RV) located on the eastern side of the parking lot. There are wide stairs and an open driveway which was ADA accessible. The backyard was fenced throughout the perimeter and was landscaped. There were three small dogs outside, and they were tame. The facility is licensed for 4 clients and currently is at capacity. The facility has 5 bedrooms and 4 baths. At entrance there is a family room with two couches, a table with two large cylinder candles, and a formal dining area. There is another living room adjacent to the kitchen which has a couch, love seat, and a chair. There is a mounted TV set, and a door which leads to the backyard. The kitchen had fresh fruit options, a refrigerator with at least 3-5 days of perishable milk, meat, and vegetables. The cabinets contained canned, pasta, and jarred items. A staircase led to the master bedroom, and 2 client bedrooms. There is a client bedroom downstairs, and a bedroom upstairs where licensee's adult son occupies. All client rooms had twin beds, dressers, and closet space. Client files and employee/staff files will be reviewed on return of LPA, on another day. Licensee was getting ready for an appointment when LPA arrived. Inspection tool will be initiated upon return visit as well. A copy of this document was signed and provided to licensee.

met_with: Anna Carmody, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On October 16, 2025, at 10: AM, Licensing Program Analyst (LPA) Cynthia Velasquez arrived unannounced at the facility to continue conducting annual/required visit. LPA was greeted by Anna Carmody, Licensee. An inspection of staff/client files was conducted, as well as inspection tool completion. Five staff files were reviewed and all files were in compliance with Health Screenings, CPR, Tuberculosis Screenings, Job Descriptions, Hire Dates, and Training. Four client files were reviewed and all files were in compliance with Placement Agreements, Health Passports, Dental Screenings, Contact information of physicians, County Social Workers, and emergency contact information. Licensing, emergency disaster information and drills, carbon monoxide, and smoke detectors were visible and working. Additional postings for rights, and menus were observed. Based on observations made during the inspection, no deficiencies were observed during previous visit to facility and today's visit. An exit interview was conducted, and a copy of this report was given to Anna Carmody, Licensee.


raw_content:
Narrative:
Confidential interviews indicated C1 had a visit at the home from their advocate where C1 and the advocate played together. Other confidential interviews indicated, during the visit, C1 was noisy, disruptive, yelling, and screaming. Confidential interviews indicated C1 disturbed other clients in the home with the loud behavior. Confidential interviews indicated S1 intervened and made C1 aware they were being too loud and disturbing others. Confidential interview indicated S1 was yelling at C1 for their behavior. Conflicting confidential interviews indicated S1 did not yell, but used a direct, firm tone that was not concerning. It was reported that licensee did not meet the needs of child in care. It was reported that S1 was not available to be provided with updates on C1 and to sign forms for C1's therapy services. Confidential interviews indicated C1 received therapy services on a weekly basis. Confidential interviews indicated staff sign off on C1's therapist's log. Confidential interviews indicated there was at least one staff available if an administrative representative was needed. Confidential interview indicated if S1 was not available in person, they could be reached over the phone. Additionally, confidential interview indicated S1 returned calls within a reasonable amount of time. Based on conflicting confidential interviews, the allegations licensee yelled at child in care and licensee did not meet the needs of child in care may have happened or may be valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Anna Carmody, Licensee.

Investigation Findings:
13On December 4, 2025 at 9: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Anna Carmody, Licensee to discuss the investigative finding for the allegations noted above. LPA Jauregui conducted an inspection of the facility on July 31, 2025, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed three staff (S1-S3), one client (C1), and one therapist. LPA attempted to interview two clients (C3-C4) but was unable to obtain a statement due to the children's limited verbal abilities. Pertinent documents were obtained. On July 28, 2025, Community Care Licensing (CCL) received allegations that licensee yelled at child in care and licensee did not meet the needs of child in care. It was reported that licensee yelled at child in care. It was reported that S1 yelled at C1 for playing too loud in the home and for a mess C1 made in the home. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: WE CARE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 12/04/2025

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


raw_content:
Narrative:
It was reported that due to lack of supervision, minor was able to gain access to pornography. It was reported that C1 accessed pornography from their own device in the home. It was reported that C1 took the device with them to their bedroom and the device was immediately removed from C1. Confidential interview indicated C1 began to lock themself in their bedroom with their device. Confidential interview indicated staff began to monitor C1 and caught C1 accessing inappropriate websites. According to confidential interviews, following the incident, C1 only has access to a Nintendo switch and watches television in the common area with a staff present. Although the investigation revealed that the incident occurred, evidence did not indicate that it occurred due to lack of supervision. It was reported that adult in home touched the minor inappropriately. It was reported that a "babysitter" in the home helps C1 shower in the home. It was reported that C1 does not require assistance in bathing. It was reported that C1 was touched by the "baby sitter." Confidential interviews indicated the shower head is removable and staff assist with guiding the shower head in areas for C1 to scrub and to prevent C1 from spraying water in other parts of the bathroom. Confidential interviews indicated C1 does not like to be touched and staff only assist with cleaning with C1's permission. Confidential interview indicated assistance with wiping is provided if requested by C1. The investigation did not provide evidence of C1 being touched inappropriately. Based on confidential interviews, the allegations due to lack of supervision, minor was able to gain access to pornography and adult in home touched the minor inappropriately, may have happened or may be valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Licensee Anna Carmody.

Investigation Findings:
13On December 17, 2025 at 12: PM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Licensee Anna Carmody to discuss the investigative finding for the allegations noted above. LPA Jauregui conducted an inspection of the facility on August 13, 2025, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed two staff (S1-S2), one therapist, one and one relative. LPA attempted to interview one client (C1), however, C1 refused. Pertinent documents were obtained. On August 6, 2025, Community Care Licensing (CCL) received allegations that due to lack of supervision, minor was able to gain access to pornography and adult in home touched the minor inappropriately. It was reported that during a visit C1 demonstrated inappropriate behavior with their buttocks. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: WE CARE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 12/17/2025

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


raw_content:
Narrative:
Confidential interview indicated playful tone is used when speaking to the children and a firm direct tone when they are being disciplined. Confidential interview indicated S2 "yells" and "picks on" C1. A confidential interview indicated C2 uses "S2 yelling and screaming" when someone is upset. Confidential interviews indicated there are other children in the home who have behaviors that cause them to be loud. Another confidential interview indicated there are children in the home who yell and curse but it has not been observed to be towards any children or staff. Although it was concluded during the investigation that there is yelling in the home, the investigation did not produce sufficient evidence to conclude that S1 and S2 yell at C1 or C2. Based on confidential interviews, the allegation that foster parents yell at minors in care may have happened or may be valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Anna Carmody, Licensee.

Investigation Findings:
13On January 22, 2026 at 9: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Anna Carmody, Licensee to discuss the investigative finding for the allegation noted above. LPA Jauregui conducted an inspection of the facility on October 21, 2025, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed one staff (S1), one San Diego Regional Center Service Coordinator, one County Social Worker (CSW2), and five school personnel staff (SP1-SP5). LPA attempted to interview one client (C4), however, C4 refused. LPA attempted to interview three clients (C1-C3), but was unable to obtain a clear statement due to their limited verbal abilities. Pertinent documents were obtained. On October 16, 2025, Community Care Licensing (CCL) received allegation that foster parents yell at minors in care. It was reported that C1 does not feel safe around S1 and "S2" because they yell at C1 and others in the home. It was reported that there is another minor in the home who has reported S1 and S2 yelling in the home, but it is unknown what the yelling is about. Continued.... UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: WE CARE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 01/22/2026

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


raw_content:
Narrative:
Confidential interview indicated C1 curses, engages in property destruction and has negative seeking behaviors. Confidential interview indicated C1 seeks attention from visitors in the home by being loud and disruptive. Confidential interview indicated a firm and direct tone is used when speaking to the clients. Confidential interview indicated S2 "yells" at C1. Conflicting confidential interview denied yelling or being disrespectful towards clients. Although it was concluded during the investigation that there is yelling in the home, the investigation did not produce sufficient evidence to conclude that clients are being physically or verbally abused. Based on confidential interviews, the allegation that foster child is being physically abused while in care and foster child is being verbally abused while in care may have happened or may be valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Steven White II.

Investigation Findings:
13On January 29, 2026 at 12: PM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Steven White II and Licensee Anna Carmody over the phone to discuss the investigative finding for the allegation noted above. LPA Jauregui conducted an inspection of the facility on November 6, 2025, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed one staff (S1) and one San Diego Regional Center Service Coordinator. LPA attempted to interview one client (C1), however, C1 refused. LPA attempted to interview three clients (C2-C4) but was unable to obtain a clear statement due to their limited verbal abilities. Pertinent documents were obtained. On October 29, 2025, Community Care Licensing (CCL) received allegations that foster child is being physically abused while in care and foster child is being verbally abused while in care. It was reported that C1 was being disruptive, pushing chairs, climbing tables, screaming, and cursing out loud while attending a class in church. It was reported that the reason for C1's behavior is due to being physically and verbally abused in the home. Continued.... UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: WE CARE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 01/29/2026

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

met_with: Steven White II


raw_content:
Narrative:
Confidential interview indicated staff do not restrain or go hands on with the clients. Confidential interview indicated there is parental control on the devices used by C1. Confidential interview denied showing explicit content to clients in care. Confidential interview did not yield evidence to conclude the allegations occurred and the investigation did not yield witnesses to the alleged abuse. Based on confidential interview, the allegations that staff showed explicit media content to foster child and staff restrained foster child may have happened or may be valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Anna Carmody, Licensee.

Investigation Findings:
13On March 5, 2026 at 9: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Anna Carmody, Licensee to discuss the investigative finding for the allegation noted above. LPA Jauregui conducted an inspection of the facility on December 17, 2025, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed one staff (S1). LPA attempted to interview one client (C1), however, C1 refused. LPA attempted to interview three clients (C2-C4) but was unable to obtain a clear statement due to their limited verbal abilities. Pertinent documents were obtained. On December 16, 2025, Community Care Licensing (CCL) received allegations that staff showed explicit media content to foster child and staff restrained foster child. It was reported that S1 held C1 down and S2 forced C1 to watch explicit content. It was reported it is unknown when the last time this occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: WE CARE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 03/05/2026

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

met_with: Anna Carmody


facility_name: WHERE THERE'S A WILL

summary: Facility Evaluation

raw_content:
Narrative:
On August 21, 2025, at 9:30AM, Licensing Program Analyst (LPA) Rachel Vanegas met with Where There's A Will Small Family Home (SFH) Applicant, Willie Warren, at the Riverside Children's Residential Regional Office for the purpose of conducting a Component II meeting. LPA discussed corrections and revisions needed for the Program Statement and supporting documents. The following is a summary of the corrections and revisions discussed and requested. These revisions are due by close of business on September 5, 2025. Guardian: The applicant is not currently associated or eligible with the Small Family Home #366000026. A1. Application (LIC 200) Please provide an original document for the updated application reflecting changes submitted on 07/03/2025. A2. Applicant Information (LIC 215) Please provide training certificates to reflect applicable training requirements for qualifications and experience verification. A4. Affidavit Regarding Client Cash Resources (LIC 400) Please provide original documents for the revisions submitted on 07/03/2025. Please review and revise the amount that you will safeguard to align with the amount of bond you have selected. **** A9. Budget Information (LIC 420) Please review and include the names and ages of the person's income you have included in this document. Please also identify sources of income. A10. Personnel Report (LIC 500) Please remove "administrator" and "back-up administrator" as job titles identified on this document. A11. Personnel Record (LIC 501) Please provide training certificates to reflect applicable training requirements for qualifications and experience verification. Please provide an LIC 501 for additional staff identified on LIC 500. A12. Health Screening Report (LIC 503) Please provide the original document for revisions submitted on 07/03/25. Please review and revise Position Title to state "Licensee". Please provide an LIC 503 for additional staff identified on LIC 500. A13. Criminal Record Statement (LIC 508D) Please complete this document for Where There's A Will SFH. A14. Emergency Disaster Plan (LIC 610C) Section I: Revise Administrator job titles to state Licensee. Section II: Include names of identified emergency service numbers provided. Section IV: Provide signed authorization letters for the use of relocation sites from the agency or business owners, including their name and job title. A15. Facility Sketch (LIC 999) Identify camera locations on the facility grounds All client bedrooms must be identified on the sketch of the facility Indicate exit routes by number as shown on the LIC 610C Emergency Disaster Plan A16. Fire Inspection LPA will follow up regarding fire clearance request. Per applicant, this has not been completed. **** B7. Facility Program Description Please review and revise Table of Contents for accuracy Please clarify client sources (placement agencies) intended for your program Please review and revise all references to "Administrator/Owner" to "Licensee" Please remove references to Inland Regional Center as per discussion, this does not apply. Please identify all acronyms and abbreviations before use (ex. DSP, CCL, etc.) Goals Please ensure that references to communication and connections with family, etc. is in alignment with court orders. (Pg. 4) Please ensure that you identify a consistent reference to clients as "Consumers" or "Children", etc. (Pg. 4) Please provide more information regarding "base" staff to client ratio that your program will provide. (Pg. 5) Please provide a daily schedule of activities to be provided by the facility. This should state who plans, conducts and assists clients in participating in these activities. Please provide a one month schedule of planned social, educational and recreational activities. This should state who plans, conducts, and assists clients in participating in these activities. Client Population To Be Served Please identify placement source (Pg. 6) Please review and revise reference to posting confidential information outside of client bedrooms (pg. 6) Please provide clarification regarding reference to "medication dispensing" (Pg. 6) Medication Please specify adequate and appropriate medication storage (Pg. 7) Medical Assessment/TB Test prior to or within 30 days of acceptance Please describe where first aid supplies and a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency will be stored. Please describe how staff that are responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross. **** Please describe how psychotropic medication shall only be used in accordance with the written directions of the physician prescribing the medication and in accordance with authorization requirements specified in Sections 369.5(a)(1) and 739.5(a)(1) of the Welfare and Institutions Code and Section 83070(b)(11). Please describe how the facility will obtain a copy of the current court order, or written authorization of the child's parent or guardian, for each psychotropic medication, as defined in Section 84001(p)(4). Please include that there can be temporary administration of psychotropic medication authorized on the JV220(A) Physician's Statement while the JV223 is pending Please describe or provide the consent forms, completed by the child's authorized representative(s), to permit the facility to authorize medical care. Please provide a statement that medication errors will need to be reported and documented to Community Care Licensing (CCL), per reporting requirements timeframes. Please provide a statement that any medication refusal by a client is considered a "Special Incident" and a report will be sent to CCL. Please revise and revise reference to Title 17 & Title Regulations (Pg. 8) Please revise and provide more information and clarity to the medication destruction policy to state how the medication will be transported and documented (by who, when, etc.) to be destroyed by the issuing pharmacy (Pg. 12) Please provide timelines for medication refill request procedure (Pg. 12) Please specify the frequency of medication storage audits that will be conducted by the Licensee (Pg. 14) Transportation Please describe how the motor vehicles used to transport clients shall be maintained in safe operating condition. Please include a statement stating that the licensee and their staff are prohibited from smoking a tobacco product or permitting any person from smoking a tobacco product in a motor vehicle that is regularly used to transport children, regardless of when the children are present. This prohibition applies when the motor vehicle is moving or at rest. Please include statement that the licensee shall provide transportation for a child in a timely manner to and from the following: **** (1) Health-related services. (2) School. (3) Extracurricular, enrichment, cultural, and social activities, in accordance with the reasonable and prudent parent standard specified in Section 83067. Please describe how the facility shall ensure that the transportation provided safeguards the health and safety of a child and shall not violate the personal rights of a child as required by Section 83072. No Corporal Punishment Please review and revise any reference to physical restraint, as this is not allowed, etc. (Pg. 27 and Page 28) Needs and Services Plan Please review and revise this section to clearly identify the Licensee's responsibility for creating a Needs and Services Plan for a client within 30 days of placement. (Pg. 29) Visiting Please review and clarify where identified visits will occur (Pg. 31) Procedures for Reporting Incidents Please review and revise this section to provide a procedure that includes timeframes including how to submit a grievance/complaint, who responds, the timeframe, how the outcome is documented, where the procedure is documented. Please include complaint hotline phone number/contact information and CCL information as well (Pg. 34) Notes Please provide information and clarify the use of Daily Supervisory Notes or remove it (Pg. 35) Admission Agreement Please provide the Admission Agreement on a separate and stand-alone page/document (Pg. 38) It currently is started on a page that includes Community Resources, etc. **** Please include space for required signatures on the Admission Agreement (Pg. 40) You may utilize the LIC 604 as a reference or guide to ensure that all of the required information is present on your Admission Agreement. Please identify the following: - Persons accepted for care, including age range and compatibility determination process, when necessary. - Criteria for assessing appropriateness of placement given an individual client's needs (i.e., interviews, procedures for obtaining and developing the necessary paperwork, etc.) - Needs and services plan. - Provide a statement that clients/residents will be informed of their rights and that client's/resident's rights will not be violated). - Describe the pre-admission appraisal plan in this section. - Describe how the facility will obtain emergency information. - Describe the sign-in and sign-out procedures. - Describe the physical examination requirements/immunization requirements in this section. Including Tuberculosis screening. Rules of Discipline/Personal Rights: Please include reference to grounds for dismissal/relocation/removal from placement. Please describe how the child and authorized representative will sign the personal rights form at intake and each time a new right has been added. (Lic 613b (06/22)). Please include how a copy of the discipline policy will be reviewed and provided to the child and authorized representative and will be signed by both parties as well. Sample Menu: Please include a sample menu that will reflect: Planned meals and snacks for one week (minimum), foods used should be from the four basic food groups. Portion sizes. Times meals served. Addendum: Please review and revise/identify where cameras are located and include information to ensure compliance with Children's Residential Program Provider Information Notice 24-09 (pg. 43) LPA Vanegas conducted an exit interview and a copy of this report along with the signed LIC 281C, Care Tools Pre-licensing form, and Children's Residential Program Provider Information Notice 24-09 were reviewed and provided to the applicant, Willie Warren.

met_with: Applicant - Willie Warren


summary: Facility Evaluation

raw_content:
Narrative:
On November 26, 2025 at 09: AM, Licensing Program Analyst's (LPAs) Rachel Vanegas and Valerie Wilson arrived at Where There's A Will Small Family Home (SFH) to conduct a pre-licensing inspection. LPAs met with Applicant - Willie Warren who led a tour of the home. The home was toured both inside and out with the applicant. Currently there are no clients in placement. The home is a one story building with four bedrooms and two bathrooms which are set up as follows: Bedroom #1 (Master) has one bed sleeps the Applicant Bedroom #2 (Clients) has two single beds and will sleep two clients Bedroom #3 (Applicant's Adult Child) has one single bed and sleeps the applicant's adult child Room #4 (Flex Room) is used as a recreation room The home also consists of a great room/living room, kitchen, dining area, two bathrooms, a locked laundry room, a two car garage, and the backyard. The client's bedroom is arranged so that no more than two client's will be in the room. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There were combo smoke/carbon monoxide detectors in every bedroom and hallway. The combo detectors were checked and in properly functioning order. The home's central air conditioning module was located in the back yard. The home's tankless water heater was located in the garage and was set at 116. Degrees Fahrenheit. The home appliances were in working order at the time of this inspection. *Continued on the next page* The client and staff files will be located in a locked storage closet in the hallway. There was adequate food storage space. LPAs observed a two day supply of perishable and a seven day supply of non-perishable food. A trash can for storage of solid waste had a tight-fitting lid and was present in the kitchen. The sharp knives are located in a locked kitchen cabinet under the sink, inaccessible to clients. The medications will be located in a locked storage cabinet in the hallway near the laundry room. The hot water in the kitchen was measured and registered at 110.6 degrees Fahrenheit. The home's First Aid kit was accessible and is located in the kitchen and contained all required supplies. There were two fire extinguishers present in the home. One fire extinguisher is located in the kitchen under the sink and one is located in the garage. Both fire extinguishers were observed to be properly charged and inspected by the fire department. There are two firearms in the home in a secured safe located in the master bedroom, which is locked and inaccessible to clients in care. The ammunition is stored in a separate safe in the applicant's locked master bedroom closet, separate from the firearm. There is no pool or accessible body of water at the home at the time of this inspection. The backyard where clients will have access to play is fenced. The home has three security cameras located on the outside perimeter of the home (door bell and two views of the backyard, outdoor and indoor cameras do not record audio). There is one motion sensor in the living room and chimes on all doors and windows. There will be two additional cameras installed inside of the home (one in the hallway/entryway and one in the living room/dining room). The following corrections need to be made: Final revisions to program statement including Video Surveillance Policy and Psychotropic Medication Administration. Component III was completed during this visit. An exit interview was conducted and a copy of this report and appeal rights were reviewed and provided to the applicant, Willie Warren. Application will be forwarded to the Licensing Program Manager for Licensing upon receipt and confirmation of corrections made to the Program Statement and final fire clearance approval being received.

visit_type: Prelicensing


facility_name: WHITE SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 06/29/21 at 11:30 am, Licensing Program Analyst (LPA), Zena Phillips and Licensing Program Manager (LPM) Lakescia Smith made an unannounced visit to the White Small Family Home to conduct a required/random inspection. LPA met with Edmond White who granted access to the home and a tour of the home was conducted together. The facility is licensed to care for four (4) Developmentally Disabled children ages 3-17 years, Ambulatory only. They only accept Regional Center clients. The census today is two (2). Currently residing in the home are Licensees and children. The home is operating within the capacity and limitations of license.Children have individual beds, comfortable mattresses, clean linens, blankets, and pillows, that are in good condition.The home is clean, safe and sanitary, and in good repair. Outdoor activity space is free of obstructions and hazards. There are no firearms in residence. The home is set up as follows: This is a two story home with five (5) bedrooms, four (4) bathrooms, family room, living room, dining area, kitchen, and dining area. The home is clean, safe, sanitary, and in good repair. Adequate supervision is provided for children in care. Bedroom # 1- Occupied by adopted child There is one full size bed, bathroom, adequate drawer space, restroom, closet and lighting. Bedroom # 2 -Occupied by C1 and C2. There are two full size beds, bathroom, adequate drawer space, closet and lighting. Comfortable mattresses, clean lines, blankets, and pillows that are in good repair. Bedroom # 3- Is vacant. There are two full size beds and adequate drawer space, closet and lighting. comfortable mattresses, clean lines, blankets, and pillows that are in good repair. Bedroom # 4- Occupied by Licensees There is a queen size bed, restroom, office space, adequate drawer space, closet and lighting. Bedroom # 5- guest room. There is a full size, adequate drawer space, closer and lightning. Bathrooms: There are four (4) bathrooms. Toilets, sinks, tub/showers are clean and in operating condition. Water temperature measured within a safe range. Living Room: There is a television, furniture is in good repair. Fire place available that is locked and safe. Dining Area: One table with eight chairs. Kitchen: There is a stove/oven with (4) burners all working currently. There is a microwave and refrigerator/freezer. There is a table with six chairs. They have adequate perishable and nonperishable food available. All knives, trash, disinfectant and cleaning solutions are inaccessible to children. They are locked in top cabinet in the kitchen. Licensee ensures three nutritious meals, snacks, and special diets. Food supply is ample in the home. Laundry Room: A washer and dryer available. Backyard: Outdoor activity space is free of obstructions. There are no bodies of water on the premises. Two big dogs on the premises, both have valid license and up to date shot records. There is a fire pit and basketball court Licensee provides services identified in child's needs and services and individualized health care plans for children with special health care needs. Licensee provides for direct supervision of clients participating in or present at potentially dangerous activities or areas in the facility. Facility personnel are instructed to report observations or evidence of violations of the child's personal rights. Children can contact the licensing agency or the Foster Care Ombudsperson in confidence without threats or punishment or retaliation for making complaints. Children have the right to attend school and participate in extracurricular, cultural, and personal enrichment activities consistent with the child's age and developmental level. Caregivers safeguards children's resources, personal property, and valuables. Caregiver has written authorization to obtain medical and dental care. Personal rights forms in children files. Caregivers and other adults residing in the home have Child Abuse Index Checks. Facility personnel files document that staff meet qualification requirements Emergency Disaster and Mass Casualty is current and available for review. Emergency Disaster and Mass Casualty Plan: designations of administrative authority and staff assignments are current. Home maintains appropriate Fire Clearance. There are no deficiencies cited and exit interview conducted.

met_with: Edmond White


summary: Facility Evaluation

raw_content:
Narrative:
On 05/12/22 at 8:30 am, Licensing Program Analyst (LPA), Zena Phillips and Licensing Program Analyst (LPA) Kuliema Calloway made an unannounced visit to the White Small Family Home to conduct a required/random inspection. LPA's met with Antonia White who granted access to the home and a tour of the home was conducted together. The facility is licensed to care for four (4) Developmentally Disabled children ages 3-17 years, Ambulatory only. The facility currently has two clients age 20 years old. They only accept Regional Center clients. The census today is two (2). Currently residing in the home are Licensees and children. The home is operating within the capacity and limitations of license. Children have individual beds, comfortable mattresses, clean linens, blankets, and pillows, that are in good condition. The home is clean, safe and sanitary, and in good repair. Outdoor activity space is free of obstructions and hazards. There are no firearms in residence. The home is set up as follows: This is a two story home with five (5) bedrooms, four (4) bathrooms, family room, living room, dining area, kitchen, and dining area. The home is clean, safe, sanitary, and in good repair. Adequate supervision is provided for children in care. Bedroom # 1- Occupied by adopted child There is one full size bed, bathroom, adequate drawer space, restroom, closet and lighting. Bedroom # 2 -Occupied by C1 and C2. There are two full size beds, bathroom, adequate drawer space, closet and lighting. Comfortable mattresses, clean linens, blankets, and pillows that are in good repair. cont on 809 c Bedroom # 3- Is vacant. There are two full size beds and adequate drawer space, closet and lighting. comfortable mattresses, clean lines, blankets, and pillows that are in good repair. Bedroom # 4- Occupied by Licensees There is a queen size bed, restroom, office space, adequate drawer space, closet and lighting. Bedroom # 5- guest room. There is a full size, adequate drawer space, closer and lightning. Bathrooms: There are four (4) bathrooms. Toilets, sinks, tub/showers are clean and in operating condition. Water temperature measured within a safe range. Living Room: There is a television, furniture is in good repair. Fire place available that is locked and safe. Dining Area: One table with eight chairs. Kitchen: There is a stove/oven with (4) burners all working currently. There is a microwave and refrigerator/freezer. There is a table with six chairs. They have adequate perishable and nonperishable food available. All knives, trash, disinfectant and cleaning solutions are inaccessible to children. They are locked in top cabinet in the kitchen. Licensee ensures three nutritious meals, snacks, and special diets. Food supply is ample in the home. Laundry Room: A washer and dryer available. Backyard: Outdoor activity space is free of obstructions. There are no bodies of water on the premises. One big dog on the premises, with valid license and up to date shot records. There is a fire pit and basketball court. Licensee provides services identified in child's needs and services and individualized health care plans for children with special health care needs. Licensee provides for direct supervision of clients participating in or present at potentially dangerous activities or areas in the facility. comt on 809c Facility personnel are instructed to report observations or evidence of violations of the child's personal rights. Children can contact the licensing agency or the Foster Care Ombudsperson in confidence without threats or punishment or retaliation for making complaints. Children have the right to attend school and participate in extracurricular, cultural, and personal enrichment activities consistent with the child's age and developmental level. Caregivers safeguards children's resources, personal property, and valuables. Caregiver has written authorization to obtain medical and dental care. Personal rights forms in children files. Caregivers and other adults residing in the home have Child Abuse Index Checks. Facility personnel files document that staff meet qualification requirements Emergency Disaster and Mass Casualty is current and available for review. Emergency Disaster and Mass Casualty Plan: designations of administrative authority and staff assignments are current. Home maintains appropriate Fire Clearance. There are no deficiencies cited and exit interview conducted and copy of report will be emailed to Licensee

met_with: Antonia White/ Licensee