raw_content:
Narrative:
Investigation revealed the following: It was alleged that minor sustained an unexplained bruise while in care. Manager denied the allegation. Manager stated that children who were roommates had a physical altercation where one child bit a child and the other child reacted to being bit by hitting the child. A bruise was not initially observed by staff but child had teeth mark impressions on their arm and child later developed bruising. Manager stated incident was documented and children were moved to separate rooms. LPA was unable to interview children as one child is non-verbal and other child refused to speak with LPA. LPA reviewed interviews and observations conducted by LPA Joshua Rareula on March 23, 2022 and April 21, 2022. LPA Rarela made observations of child who was non- verbal and received confirmation from his teachers that child is unable to speak or respond to questioning. In additional interviews conducted with other children made by LPA Rarela children had similar statements in identifying issues with one child but that all children got along with staff and that they had not observed or been victim to any staff be physically abusive to children. Documents reviewed coincide with statements received in how child obtained bruising. Staff reported incident to agencies reporting incident and addressed the issue by transitioning children to different rooms and intervening when necessary. Based on the information gathered, although the allegation may have happened or is valid, the preponderance of evidence to prove the allegation was not met, therefore the allegation is unsubstantiated. An exit interview was conducted. A copy of this report Confidential Names Form, and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On 05/6/ Licensing Program Analyst (LPA) Dawn Mahecha made an announced visit to the First Step facility to deliver the findings to the above identified complaint investigation. LPA spoke with Administrator Crystal Carrillo and informed manager of investigative findings. Investigation consisted of the following: On 1/21/ LPA Karen McGee conducted 10-day inspection to facility (see LIC 811 confidential names, dated January 21, 2022). Between 4/29/22 and 4/30/ LPA interviewed one (1) child and reviewed previous interviews and observations made by LPA Joshua Rarela. Additionally, LPA interviewed additional staff. LPA attempted to contact county social worker (CSW) and therapist. On 4/30/ LPA reviewed documents received and information provided. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Dawn Mahecha 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 32-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, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: FIRST STEPFACILITY NUMBER: VISIT DATE: 05/06/2022

met_with: Crystal Carrillo, Facility manager


state: CA

facility_name: FIRST STEP

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
The LPA observed that the client was placed at the facility on March 5, 2020 and removed on September 30, 2021. The LPA observed an Appraisal/Needs and Services Plan dated October 1, 2020. The LPA observed that the County Placement Worker signed the document on January 20, 2021. The LPA observed a Quarterly Report dated September 17, 2021. The investigation revealed that the initial County Social Worker was no longer assigned the case. It is determined that the facility provided an Appraisal/Needs and Services Plan as required by the Plan of Operation. It is noted that the Appraisal/Needs and Services Plan is not within the 90 day plan, but consideration is given due to the Covid Pandemic. The LPA cannot corroborate that the facility did not provide paperwork. The investigation revealed that the facility was aware for two-to-three months of the plan to transfer Ref. #1 to an adult residential facility. It revealed that the facility had less than less than 24 hours to pack Ref. #1's belongings for the transfer once they received the call that a placement was open for Ref. #1. The LPA was provided inconsistent statements as to whether Ref. #1's belongings were provided in either a box or bags. It revealed that the witness stated a box, but no details were provided as to whether it was a moving box. The investigation revealed that the witness was concerned more with the lack of contents in the box as opposed to the container the belongings were transported in. The LPA cannot corroborate the allegation that Ref. #1's belongings were not provided. The LPA cannot corroborate evidence to determine if there was a Personal Rights violation based upon the type of container Ref. #1's belongings were transported. The LPA reviewed the Medical Treatment Record dated June 23, 2020 signed by the physician; and the Health and Education Passport dated February 16, 2021. The LPA cannot corroborate the allegation that the client was not taken to their medical appointment. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that alleged violations occurred, therefore the allegations are unsubstantiated. There are no deficiencies to be cited regarding these allegations. A copy of this complaint was provided to the facility representative.

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

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

report_type: Complaint Investigation

met_with: Crystal Carrillo

complaint_status: unsubstantiated


raw_content:
Narrative:
Ref. #1 revealed that the proper procedures were followed for them to foster Ref. #2 and Ref. #2 was provided home passes in order to visit Ref. #1's home and meet Ref. #1's maternal parent and sister, who lived in the home. Ref. #2 denied the allegation, stating that Ref. #1 served as a role model and took care of Ref. #2. The investigation revealed that there were no allegations of sexual inappropriateness made against Ref. #1. It revealed that the facility conducted a meeting with Ref. #1 regarding favoritism with the clients. The CSW expressed concerns about the rumors started by another client at the facility. The LPA cannot corroborate the allegation. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that an alleged violation occurred, therefore the allegation is unsubstantiated. There are no deficiencies to be cited regarding these allegations. A copy of this complaint was provided to the facility representative.

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

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

met_with: Ronnie Mackey


facility_name: FIRST STEP TREATMENT HOME

raw_content:
Narrative:
Confidential interviews stated C1 was at the facility for about ten days, C1 refused to follow facility rules and C1 was an AWOL risk. Confidential interviews stated all clients are treated with respect, the food menu and the activity calendar are followed however, other information provided alleged the incidents occurred. Based on confidential interviews, the allegations that facility staff argue with Client #1 (C1), facility staff do not provide enough for C1 to eat and facility staff do not provide activities for C1 while in care may have occurred, however are not supported or proven by evidence. Therefore, the allegations are unsubstantiated. An exit interview was conducted, and a copy of this signed report was emailed to Facility Administrator Deanna Mellos.

Investigation Findings:
13On August 05, 2022, at 12:00 p.m. Licensing Program Analyst (LPA) Marisol Lopez arrived at the facility unannounced and met with Facility Administrator Deanna Mellos of First Step Treatment Home to discuss the investigative findings for the allegations noted above. On September 09, 2021, at 12:15 p.m., Licensing Program Analyst (LPA) Marisol Lopez met with Facility Manager Antonio Tucker to conduct an unannounced initial complaint investigation. LPA conducted a safety inspection and no deficiencies were observed at that time. During the investigation, LPA conducted confidential interviews with four staff (S1-S4), four clients (C1-C4), and reviewed incident reports. On September 01, 2021, the Department received allegations that facility staff argue with Client #1 (C1), facility staff do not provide enough for C1 to eat and facility staff do not provide activities for C1. Confidential interviews contradicted the information stating that staff do not argue with any clients; food and snacks are always available to clients; and clients are provided with daily activities, weekend outings and follow a monthly activity calendar. (see continuation form LIC9099-Cdated 08/05/2022) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Marisol Lopez 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 CCLD Regional Office, METROPOLITAN DR. # FACILITY NAME: FIRST STEP TREATMENT HOMEFACILITY NUMBER: VISIT DATE: 08/05/2022

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

met_with: Deanna Mellos


raw_content:
Narrative:
Confidential interviews stated it was unknown what provoked C1 to contact law enforcement, however when law enforcement arrived, C1 was put on a 5150 due to threats of self-harm. Confidential interviews denied C1 was bullied by other minors or staff however, C1 was unable to be interviewed for further information. Based on confidential interviews, although the allegations that staff is allowing C1 to be bullied by other minor(s) in care, may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of this signed report was provided to Facility Manager Antonio Tucker.

Investigation Findings:
13On 12/02/2022, at 1:25 p.m. Licensing Program Analyst (LPA) Marisol Lopez arrived at the facility unannounced and met with Facility Manager Antonio Tucker, of First Step Treatment Home to discuss the investigative findings for the allegation noted above. On 03/01/2022 at 2:00PM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez conducted an unannounced complaint investigation at the above facility and met with Facility Manager (FM) Antonio Tucker. LPA conducted a safety inspection, and no deficiencies were observed at that time. The investigation consisted of confidential interviews with one facility administrator, three facility staff, one service worker and review of incident reports. LPA attempted to interview client #1 (C1) however C1 was unable to be interviewed. On 02/24/2022, the Department received an allegation that staff is allowing C1 to be bullied by other minor(s) in care. Confidential interviews stated C1 was not bullied however, C1 called law enforcement on multiple occasions stating C1 was being hurt. (see continuation form LIC9099-C dated 12/02/22) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Marisol Lopez 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 CCLD Regional Office, METROPOLITAN DR. # FACILITY NAME: FIRST STEP TREATMENT HOMEFACILITY NUMBER: VISIT DATE: 12/02/2022

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

met_with: Antonio Tucker


summary: Complaint Investigation - Substantiated - 3 allegations

raw_content:
Narrative:
Based on confidential interviews, the allegation that S1 handled C1 in a rough manner is SUBSTANTIATED because the preponderance of evidence standard has been met. This posed an potential Health, Safety, or Personal Rights risk to children in care, the facility will be cited for violating Interim Licensing Standards STRTP, Article 06. Continuing Requirements, Personal Rights (c)(10)To be accorded dignity in their personal relationships with staff and other persons. An exit interview was conducted, and plan of corrections was developed with Deanna Mellos, Director and Amber Jansen. A copy of this report and appeal rights were provided to Deanna Mellos, Director.

Investigation Findings:
13On October 12, 2023, at 10: AM, Licensing Program Analyst (LPA) Lucero Jauregui conducted an unannounced complaint inspection at the facility's corportate office. The purpose of the inspection is to deliver the findings for the above allegation and met with Deanna Mellos, Director. LPA Jauregui conducted an inspection of the facility on August 2, 2023, and no deficiencies were noted. During the investigation, LPA conducted three staff (S1-S3) interviews and three client (C1-C3) interviews. On July 28, 2023, Community Care Licensing (CCL) received the allegation that staff handled minor in a rough manner. Confidential interviews indicated C1 had escalated inside the facility, went outside to the front of the facility, and began hitting staff's vehicle with their casted arm. To prevent C1 from causing damage to staffs vehicle S1 grabbed C1's arm to move C1 away from the vehicle causing C1 to fall to the ground. S1 grabbing C1's arm leading C1 to fall to the ground did not accord C1 dignity in their personal relationships with staff. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela 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 SO. Cal Sc/res, Metropolitan Dr. # FACILITY NAME: FIRST STEP TREATMENT HOMEFACILITY NUMBER: VISIT DATE: 10/12/2023

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- Estimated Days of Completion: 0

met_with: Deanna Mellos, Director

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Narrative:
Continued... Based on confidential interviews the allegation alleging Staff made an inappropriate comment to youth on multiple occasions may have occurred, however it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of the report was provided along with appeal rights to Antonio "Shawn" Tucker.

Investigation Findings:
13On January 23, 2024, at 8: AM, Licensing Program Analyst (LPA), Jacob Salem met with Antonio "Shawn" Tucker, Adminstrator of First Step Treatment Home to deliver the finding for the above stated allegation. LPA Salem conducted an inspection of the facility on 10/23/23 and no deficiencies were observed. LPA Salem conducted interviews with Staff (S1-4) and Clients (C1-C6). In addition, LPA reviewed C1's Appraisal/Needs and Services Plan and Child and Family Team meeting notes. On October 16, 2023, Community Care Licensing (CCL) received an allegation alleging Staff made an inappropriate comment to youth on multiple occasions. Specifically, it was reported that S2 called C1 a "bitch" repeatedly during the morning of 10/13/23. Confidential interviews revealed conflicting statements of whether S2 used profanity towards C1 and what language S2 specifically used. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Jacob Salem 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. # San Diego, CA Facility Name: First Step Treatment Homefacility Number: Visit Date: 01/23/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32continued... Based on confidential interviews the allegation alleging Staff made an inappropriate comment to youth on multiple occasions may have occurred, however it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of the report was provided along with appeal rights to Antonio "Shawn" Tucker. SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Jacob Salem LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of 2

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

met_with: Antonio "Shawn" Tucker, Administator


raw_content:
Narrative:
...CONTINUED A conflicting confidential interview disclosed that S1 and S2 did not yell at or approach C1 aggressively during this incident, but S1 did get in C1's face in a threatening manner on separate occasions. Confidential interviews indicate that S1 "matches clients' energy" and goes "chest to chest" with clients when they are escalated. Conflicting confidential interviews indicates that C1 would get in S1's face while living at the facility, and that S1 does not yell at clients or make them uncomfortable. Confidential interviews and a record review of special incident reports reveal that C1 became escalated during a therapy session with S2, leading to C1 punching out the kitchen window and being placed on a psychiatric hold. A confidential interview indicates that S2 was heard yelling back and forth with C1 during the therapy session and calling C1 a liar. A conflicting confidential interview indicates that S2 was using an assertive tone rather than yelling and was instructing C1 to leave their office for being vulgar and unruly. A confidential interview with C1 indicates that S2 treated C1 respectfully during the therapy session. Confidential interviews indicate that S2 is respectful towards clients during therapy sessions and has not been seen yelling at or calling clients names. Based on confidential interviews and records reviewed, the allegation that staff members (S1 and S2) spoke inappropriately to youth in care (C1) is unsubstantiated. The allegation may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted, and a signed copy of this report and appeal rights were provided to Antonio "Shawn" Tucker, Facility Manager.

Investigation Findings:
13On July 11, 2024 at 11: AM, Licensing Program Analyst (LPA) Jacob Salem met with Antonio "Shawn" Tucker, Facility Manager of First Step Treatment Home to deliver the findings for the above-stated allegation. LPA Salem initiated a complaint inspection at the facility on 1/23/2024 at 8: AM and no immediate deficiencies were observed. During the investigation, LPA Salem interviewed Clients (C1-C4), Staff (S1-S5). LPA Salem obtained and reviewed pertinent records. On January 19, 2024, Community Care Licensing (CCL) received an allegation that staff members (S1 and S2) spoke inappropriately to youth in care (C1). Confidential interviews and record review of special incident reports indicate that C1 became escalated during a house meeting by threatening staff and peers. A confidential interview indicates that S1 and S2 responded by yelling in C1's face, causing C1 to escalate further. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Jacob Salem 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. # San Diego, CA Facility Name: First Step Treatment Homefacility Number: Visit Date: 07/11/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32...CONTINUED A conflicting confidential interview disclosed that S1 and S2 did not yell at or approach C1 aggressively during this incident, but S1 did get in C1's face in a threatening manner on separate occasions. Confidential interviews indicate that S1 "matches clients' energy" and goes "chest to chest" with clients when they are escalated. Conflicting confidential interviews indicates that C1 would get in S1's face while living at the facility, and that S1 does not yell at clients or make them uncomfortable. Confidential interviews and a record review of special incident reports reveal that C1 became escalated during a therapy session with S2, leading to C1 punching out the kitchen window and being placed on a psychiatric hold. A confidential interview indicates that S2 was heard yelling back and forth with C1 during the therapy session and calling C1 a liar. A conflicting confidential interview indicates that S2 was using an assertive tone rather than yelling and was instructing C1 to leave their office for being vulgar and unruly. A confidential interview with C1 indicates that S2 treated C1 respectfully during the therapy session. Confidential interviews indicate that S2 is respectful towards clients during therapy sessions and has not been seen yelling at or calling clients names. Based on confidential interviews and records reviewed, the allegation that staff members (S1 and S2) spoke inappropriately to youth in care (C1) is unsubstantiated. The allegation may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted, and a signed copy of this report and appeal rights were provided to Antonio "Shawn" Tucker, Facility Manager. SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Jacob Salem LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of 2

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


raw_content:
Narrative:
...CONTINUED However, a conflicting confidential interview stated that after attempts at redirection failed, S1 tried to position themself in front of the door, which inadvertently struck S1's foot. As a result, C1 took a step back, but the door did not hit C1. A confidential interview with C1 indicated that S1 did put their foot in the door, but the door did not hit C1. Other confidential interviews with witnesses present during the incident indicated that although S1 did push back on the door as C1 was closing it, C1 was not hit by the door and was not injured during or after the incident. During an inspection of C1's bedroom door, LPA Salem observed two medium-sized holes toward the bottom on the bedroom side of the door. Confidential interviews and a review of an incident report suggest that C1 barricaded themself in the bedroom after the back-and-forth with S1 by pushing the bed against the door, which may have caused the holes. Additionally, confidential interviews indicated that S1 is not perceived as aggressive or threatening toward clients when they are misbehaving or not following instructions. Based on confidential interviews and records reviewed, the allegation that Staff (S1) engaged in an inappropriate interaction with a youth (C1), resulting in the youth (C1) getting hit by a door is 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. An exit interview was conducted, and a signed copy of this report and appeal rights were provided to D'Andre James, Administrator.

Investigation Findings:
13On September 6, 2024 at 4: PM, Licensing Program Analyst (LPA) Jacob Salem met with D'Andre James, Administrator of First Step Treatment Home to deliver the finding for the above-stated allegation. LPA Salem initiated a complaint inspection at the facility on 3/5/2024 at 3: PM and no immediate deficiencies were observed. During the investigation, LPA Salem interviewed Clients (C1-C5), Staff (S1-S4), and a Court Appointed Child Advocate. LPA Salem obtained and reviewed pertinent records. On February 28, 2024, Community Care Licensing (CCL) received an allegation that Staff (S1) engaged in an inappropriate interaction with a youth (C1), resulting in the youth (C1) getting hit by a door. It was reported that S1 placed their foot in C1's door while C1 was closing it, causing the door to bounce back and strike C1. A confidential interview indicated that after a back-and-forth exchange involving C1 slamming and S1 opening the bedroom door, reportedly, S1 admitted to pushing the door, which hit C1 and caused C1 to lose balance. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Jacob Salem 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. # San Diego, CA Facility Name: First Step Treatment Homefacility Number: Visit Date: 09/06/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32...CONTINUED However, a conflicting confidential interview stated that after attempts at redirection failed, S1 tried to position themself in front of the door, which inadvertently struck S1's foot. As a result, C1 took a step back, but the door did not hit C1. A confidential interview with C1 indicated that S1 did put their foot in the door, but the door did not hit C1. Other confidential interviews with witnesses present during the incident indicated that although S1 did push back on the door as C1 was closing it, C1 was not hit by the door and was not injured during or after the incident. During an inspection of C1's bedroom door, LPA Salem observed two medium-sized holes toward the bottom on the bedroom side of the door. Confidential interviews and a review of an incident report suggest that C1 barricaded themself in the bedroom after the back-and-forth with S1 by pushing the bed against the door, which may have caused the holes. Additionally, confidential interviews indicated that S1 is not perceived as aggressive or threatening toward clients when they are misbehaving or not following instructions. Based on confidential interviews and records reviewed, the allegation that Staff (S1) engaged in an inappropriate interaction with a youth (C1), resulting in the youth (C1) getting hit by a door is 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. An exit interview was conducted, and a signed copy of this report and appeal rights were provided to D'Andre James, Administrator. SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Jacob Salem LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of 2

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

met_with: D'Andre James, Administrator


raw_content:
Narrative:
Continued... During the investigation, LPA Saeteurn interviewed clients (C2-C6), Staff (S1-S2), one witness (W1), and reviewed facility pertinent records. Confidential interviews revealed an incident in which C1 became upset with S1. Confidential interviews indicated that while C1 and other clients were being transported to school, S1 requested C1 to fill in open seats in the back of the facility van after C1 sat between two clients in the middle row, leaving minimal space between them. A confidential interview indicated that although there are no rules regarding client seating, C1 was asked to leave space after both clients sitting next to C1 complained about there not being enough room and to prevent clients from touching each other due to the lack of space. Confidential interviews revealed that C1 became upset and began to yell at S1. Confidential interviews revealed S1 asked C1 multiple times to stop their behavior due to C1 yelling. Confidential interviews revealed that S1 did not yell at C1 and was not disrespectful while addressing C1. Confidential interviews did not reveal any additional information on how S1 interacts with C1 or other clients in care, and due to C1 refusing an interview, LPA was unable to receive additional information regarding the way S1 treats C1. During the investigation a confidential interview revealed that C1 later expressed not wanting their video games taken away. Confidential interviews revealed that the facility wi-fi is disconnected from clients' personal devices as a form of consequence. Additionally, confidential interviews revealed that the disconnection from Wi-Fi prevents clients from playing games online. Confidential interviews revealed that all clients, including C1, are aware of this consequence. Additionally, confidential interviews revealed there was no specific time frame of how long these consequences can last however, confidential interviews revealed the length depends on the severity of the clients' actions. Confidential interviews did, however, reveal that in situations in which clients need to utilize the internet to complete homework or other important needs, facility staff will provide internet connection. A review of the facility's Program Statement revealed that when consequences are given to clients their privileges are limited. The program statement includes that appropriate forms of limiting privileges include, limiting radio, TV, and outings, however, there is no information on the disconnection of Wi-Fi. Continued... Continued... Based on interviews conducted and record review, the allegations that staff did not treat minor with dignity and staff used inappropriate forms of punishment are unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove the alleged violations occurred. An exit interview was conducted with Robyn Reyes, Residential Director. A copy of this report and appeal rights were provided and reviewed with Robyn Reyes, Residential Director, whose signature on this report confirms receipt of these documents.

Investigation Findings:
13On December 5, 2024 at 9: AM. Licensing Program Analyst (LPA) Abby Saeteurn made an unannounced visit to First Step Treatment Home and met with Robyn Reyes, Residential Director to deliver the findings for the above-stated allegations. LPA Saeteurn initiated a complaint inspection at the facility on September 25, 2024, at 1: PM and no immediate deficiencies were observed. On September 19, 2024, Community Care Licensing (CCL) received a complaint alleging that staff did not treat a minor in care with dignity and staff used inappropriate forms of punishment. It was reported that S1 treats C1 unfairly and C1 is the only client that gets in trouble when bringing up concerns about other clients in care to S1. It was reported that S1 threatens to take away C1's games and Wi-fi as a form of punishment. It was also reported that S1 raises their voice and is rude and does not treat C1 with respect and C1 believes it us due to their race. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Abby Saeteurn 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. # San Diego, CA Facility Name: First Step Treatment Homefacility Number: Visit Date: 12/05/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32continued... During the investigation, LPA Saeteurn interviewed clients (C2-C6), Staff (S1-S2), one witness (W1), and reviewed facility pertinent records. Confidential interviews revealed an incident in which C1 became upset with S1. Confidential interviews indicated that while C1 and other clients were being transported to school, S1 requested C1 to fill in open seats in the back of the facility van after C1 sat between two clients in the middle row, leaving minimal space between them. A confidential interview indicated that although there are no rules regarding client seating, C1 was asked to leave space after both clients sitting next to C1 complained about there not being enough room and to prevent clients from touching each other due to the lack of space. Confidential interviews revealed that C1 became upset and began to yell at S1. Confidential interviews revealed S1 asked C1 multiple times to stop their behavior due to C1 yelling. Confidential interviews revealed that S1 did not yell at C1 and was not disrespectful while addressing C1. Confidential interviews did not reveal any additional information on how S1 interacts with C1 or other clients in care, and due to C1 refusing an interview, LPA was unable to receive additional information regarding the way S1 treats C1. During the investigation a confidential interview revealed that C1 later expressed not wanting their video games taken away. Confidential interviews revealed that the facility wi-fi is disconnected from clients' personal devices as a form of consequence. Additionally, confidential interviews revealed that the disconnection from Wi-Fi prevents clients from playing games online. Confidential interviews revealed that all clients, including C1, are aware of this consequence. Additionally, confidential interviews revealed there was no specific time frame of how long these consequences can last however, confidential interviews revealed the length depends on the severity of the clients' actions. Confidential interviews did, however, reveal that in situations in which clients need to utilize the internet to complete homework or other important needs, facility staff will provide internet connection. A review of the facility's Program Statement revealed that when consequences are given to clients their privileges are limited. The program statement includes that appropriate forms of limiting privileges include, limiting radio, TV, and outings, however, there is no information on the disconnection of Wi-Fi. SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Abby Saeteurn LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 3 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. # San Diego, CA Facility Name: First Step Treatment Homefacility Number: Visit Date: 12/05/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32continued... Based on interviews conducted and record review, the allegations that staff did not treat minor with dignity and staff used inappropriate forms of punishment are unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove the alleged violations occurred. An exit interview was conducted with Robyn Reyes, Residential Director. A copy of this report and appeal rights were provided and reviewed with Robyn Reyes, Residential Director, whose signature on this report confirms receipt of these documents. SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Abby Saeteurn LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of 3

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

met_with: Robyn Reyes, Residential Director


raw_content:
Narrative:
It was reported C1 and the other client were throwing sand at each other when S1 called C1 over to a table. It was reported C1 tried to explain the situation to S1 when S1 used profanity while responding to C1, causing C1 to feel uncomfortable. Confidential interviews and a review of pertinent facility records confirmed that on September 28, 2024, the facility hosted an outing to Mission Beach. Confidential interviews revealed all clients attended the outing which was supervised by S1 and S2. In addition, confidential interviews revealed that W1 also attended the event. A confidential interview and review of pertinent facility records revealed that during the outing, C1 and C2 engaged in an inappropriate conversation which led to C1 throwing sand at C2. A confidential interview and review of records confirmed that staff prompted both clients to stop, resulting in C1 becoming upset and punching C2. Confidential interviews and a review of pertinent facility records revealed that staff intervened by putting separation between clients and prompting both clients to stop, however, C1 proceeded to hit C2 a second time and C2 defended their self. Confidential interviews revealed that C1 was upset at staff intervening and was reported to be defiant in their behavior by arguing with staff. A confidential interview indicated that S1 used profanity when addressing C1, and one confidential interview confirmed that S1 used a profane word while in the proximity of C1. The confidential interview revealed that the word was said under S1's breath and was not directed at C1 or any other client. The confidential interview revealed that C1 mistakenly thought S1 told C1 to shut up and S1 clarified they did not. An attempt to complete an interview with S2 who was reported to be present during this interaction was unsuccessful. Based on conflicting interviews and records review, the allegation that staff spoke to minor in an inappropriate manner is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation occurred. An exit interview was conducted with Antonio "Shawn" Tucker, Facility Manager. A copy of this report and appeal rights were provided and reviewed with Antonio "Shawn" Tucker, whose signature on this report confirms receipt of these documents.

Investigation Findings:
13On January 10, 2025 at 11: AM. Licensing Program Analyst (LPA) Abby Saeteurn made an unannounced visit to First Step Treatment Home and met with Antonio "Shawn" Tucker, Facility Manager to deliver findings to for the above stated allegation. LPA Saeteurn initiated a complaint inspection at the facility on October 11, 2024, at 12: PM and no immediate deficiencies were observed. During the investigation, LPA Saeteurn interviewed clients (C1-C6), staff (S1 and S3), witnesses (W1-W2), and reviewed pertinent facility records. On October 4, 2024, Community Care Licensing (CCL) received a complaint alleging that staff spoke to a minor in an inappropriate manner. It was reported that while at the beach on an outing, C1 and another client were involved in an altercation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Abby Saeteurn 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: FIRST STEP TREATMENT HOMEFACILITY NUMBER: VISIT DATE: 01/10/2025

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


facility_name: FIVE ACRES

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Licesning Program Analyst Connie Jones-Steward investigated the above allegation. LPA spoke to staff and Child #1. LPA also reviewed the records of Child #1. There was no DCFS investigation to review. Based on the available information, the allegation is resolved as unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Alan Henry LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Jalisa McFee


raw_content:
Investigation Findings:
13On 06/02/2021, Licensing Program Analysts (LPA) Meghan McGee contacted Five Acres via telephone for the purpose of concluding the investigation on the above allegation and to deliver the findings. LPA McGee spoke with Claudia Rice, Division Manager and together discussed the investigation details. Based on the interview information obtained and review of facility documentation, the allegation(s) are concluded as unsubstantiated meaning that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Interviews conducted and video footage confirmed there was not enough evidence to prove that a child was hit while in care or inappropriately restrained. C1 and C2 were out of the facility. S1 had ran after C1 and put her in a wall restraint as S2 came to assist with the restraint. While trying to walk C1 to the CIS office, C1 was put back in a wall restraint a few times due to her dragging her feet or not complying with the walking restraint. Exit interview was conducted, Appeal Rights were issued, and a copy of this report was emailed to Claudia Rice Division Director for signature due to COVID- Public Health Crisis. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Alan Henry LICENSING EVALUATOR NAME: Meghan McGee LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Claudia Rice, Division Director


raw_content:
Investigation Findings:
13On August 12, 2021 at 2: PM Licensing Program Analyst (LPA) Meghan McGee made an unannounced visit to Five Acres for the purpose of concluding the investigation on the above allegation and to deliver the findings. LPA McGee spoke with Claudia Rice Division Director and together discussed the investigation details. An investigation was completed on 08/31/2020, control number 34-CR-20200413120730, referencing the same allegation. From the referenced complaint, based on the interview information obtained and review of facility documentation, the allegation(s) are concluded as unsubstantiated meaning that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Due to the complaint already being investigated, no more interviews needed to be conducted; therefore, this complaint will be closed out due to a prior investigation being completed. Exit interview was conducted, Appeal Rights were issued, and a copy of this report was emailed to Claudia Rice Division Director due to COVID- Public Health Crisis. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Meghan McGee LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


raw_content:
Investigation Findings:
13This an amended report from the original date of 5/26/2021. On January 6, 2022 at 11:40am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres and spoke with Administrator, Claudia Rice. The purpose of this visit was to deliver the findings for the above complaint allegations. During the course of the investigation, a total of four (4) clients and two (2) staff were interviewed. Interviews conducted confirmed there was not enough evidence to prove that a child was threatened by a staff member or staff member had another resident beat up child. Child 1 (C1) is known to be aggressive and has fought staff and clients when C1 was a resident at the facility. Staff 1 (S1) denied the allegations. S1 stated that C1 had fought a staff member and when a client saw, the client started to fight C1. S1 stated that C1 thought S1 had the client do so and apologized when realized it did not happen. County Social Worker (CSW) stated that C1 can be impulsive. Based on the interview information obtained and review of facility documentation, the allegation(s) are concluded as unsubstantiated meaning that although the allegation(s) may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. No deficiencies were observed or cited at the time of this investigation. Exit interview was conducted, and a copy of this report will be emailed to the Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

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

met_with: Claudia Rice -Division Director


raw_content:
Narrative:
Based on the interviews conducted, the information gathered did not produce corroborating evidence to support the above said allegations. Due to inconsistent statements and documentary evidence obtained, LPA Edison 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. No deficiencies were observed or cited at the time of this investigation. Exit interview was conducted, and a copy of this report will be emailed to the Division Director.

Investigation Findings:
13On January 6, 2022 at 12:11pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres and spoke with Division Director, Claudia Rice. The purpose of this visit was to deliver the findings for the above complaint allegations. During the course of the investigation, a total of three (3) clients and four (4) staff were interviewed. Interviews conducted confirmed there was not enough evidence to prove that the facility is not adhering to staffing ratios, facility is preventing minors from participating in extracurricular activities, and minors do not have access to their funds. Documentary evidence as well as confidential interviews confirm that the ratio of staff to clients meet licensing regulations as required. LPA obtained copies of the LIC 500 to confirm staffing ratios. LPA also obtained copies of the activity schedule and allowance logs for the clients in care. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRESFACILITY NUMBER: VISIT DATE: 01/06/2022

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

met_with: Claudia Rice - Division Director


raw_content:
Investigation Findings:
13On January 18, 2022 at 1:25pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres and spoke with Claudia Rice, Division Director. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation, LPA interviewed a total of three (3) staff and one (1) witness. LPA was unable to interview Client #1 (C1) who refused to participate in the interview process to discuss the allegations. Interviews conducted confirmed there was not enough evidence to prove that staff stepped on youth's hand, staff locked youth in a room, staff denied youth access to a restroom, and staff spoke inappropriately to youth. Video evidence reviewed by the LPA, confidential interviews conducted, and C1's refusal to discuss the allegations provided conflicting information that staff locked youth in a room. LPA observed the video footage which revealed that the door of the room in which C1 was located in does not have a lock and therefore allowing C1 to exit the room if necessary. Based on the interviews conducted, the video footage reviewed, and the information gathered, the allegation has been 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. No deficiencies were observed or cited at the time of this investigation. Exit interview was conducted, and a copy of this report will be emailed to the Division Director. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


raw_content:
Narrative:
The matter was brought to the attention of Facility Administration and upon facility internal investigation, it was discovered that S1 was communicating with C1 via text message and Instagram. It was also discovered that S1 had purchased gifts for C1. When confronted by facility Administration, S1 denied buying gifts or texting C1; however, facility obtained proof to support the claims that S1 was communicating with C1 and had purchased gifts for C1. On May 26, 2021, S1 was terminated from employment for reasons including, but not limited to, having inappropriate unauthorized communication and purchasing various gifts for C1. The Department has investigated the complaint and found that the allegation is Unsubstantiated at this time meaning, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove sexual abuse by S1 on C1. There were no deficiencies cited at this time. The text messages contained messages alluding to inappropriate content by S1. It was further revealed that S1 had purchased various gifts for C1 that were against facility gift policy. An interview with S1 by CCL Investigator Seng revealed admission by S1 of sending text messages to C1 and purchasing various gifts for C1. Based on information obtained from interviews and documentary facts, the preponderance of the evidence standard has been met. The Department has determined former staff member S1 engaged in inappropriate conduct with C1 while in care. The allegation is deemed substantiated at this time and thus poses potential Health, Safety or Personal Rights risk to children in care. The following citation is issued in accordance with the Health and Safety Code 1550(c) Conduct Inimical. An exit interview was conducted, and appeal rights were discussed. A copy of this report, Confidential Names List and appeal rights emailed to Facility Administrator Claudia Rice. (Continued on page LIC9099-D)

Investigation Findings:
13On January 28, 2022 at 1: PM, Licensing Program Analyst Regina Martin conducted a subsequent complaint inspection to conclude and deliver findings concerning the allegation as mentioned above. LPA Martin met with Oscar Menendez, Crisis Intervention Specialist and advised that the Complaint Investigation investigated by Community Care Licensing Division (CCLD) Investigations Bureau, Investigator Dennis Seng has been completed. On June 10, 2021, CCLD received a complaint referral alleging sexual abuse on Child #1 (C1) as C1 reportedly sustained explicit relations/contacts with former Staff Member #1 (S1) [see LIC811, dated January 28, 2022]. It was further reported that S1 continued having inappropriate interaction with C1 after being terminated from the facility. The investigation including interviews and review of related reports from the Department of Children and Family Services and the County of Los Angeles Sheriff's Department Incident Report revealed a lack of evidence to support alleged sexual abuse by S1 on C1. (Continued on page LIC9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRESFACILITY NUMBER: VISIT DATE: 01/28/2022

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

visit_type: Complaint Investigation


raw_content:
Narrative:
No deficiencies were observed or cited at the time of this investigation. Exit interview was conducted, and a copy of this report will be emailed to the Division Director.

Investigation Findings:
13On February 4, 2022 at 11:46am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres and spoke with Julian White, Crisis Intervention Specialist (CIS). The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation, LPA interviewed a total of three (3) staff and four (4) clients. Confidential Interviews conducted did not substantiate the allegations. Confidential interviews and documentary evidence revealed that clients are provided with personal hygiene products for each client and that staff assist clients with hygiene care if needed. Confidential interviews and documentary evidence also revealed that each client is responsible for their own laundry with assistance by staff if needed. Confidential interviews did not reveal that staff pinched client in care. LPA Edison was not able to determine if the above said allegations occurred. Based on the interviews conducted, the documentary evidence reviewed, and the information gathered, the allegations have been 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. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRESFACILITY NUMBER: VISIT DATE: 02/04/2022

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


facility_name: FIVE ACRES - SOLITA HOME

raw_content:
Narrative:
Statements indicate that on the day of the incident, staff conducted a room check of the bedroom that Client #1 (C1) and Client #3 (C3) share. Statements indicate room checks consist of staff searching under clients' beds and searching client closet in the bedroom. Statements indicated that during the room check, staff discovered Client #2 (C2) hiding in the closet. Consistent statements indicated that Client #2 (C2) was previously placed at Five Acres (Solita) but was no longer in placement. Documentary evidence indicate C AWOL'd from current placement. LPA obtained Special Incident Report (SIR) #844753. Statements indicate C2 returned to Five Acres (Solita) with C1. Statements indicate that C2 climbed through the bedroom window which was left open. Statements indicated C1 had returned from AWOL and Pasadena Police Department was present at the facility when C2 was found by staff in the bedroom. Statements did not indicate facility staff are not adequately supervising minors. Documentary evidence indicates adequate direct care staff and client ratio on the date of the incident. LPA obtained email documentation from Division Director of staff schedule dated 2/17/2023-2/19/2023. Division Director stated that there is no paper documentation of staff schedule for the requested dates. LPA also obtained documentary evidence: Special Incident Reports (SIR), and Pasadena Police Report. LPA reviewed video footage of the exterior of the facility on the date of the incident. LPA observed C2 knock on the bedroom window. LPA observed someone opening the bedroom window and C2 climbed through the window. LPA was unable to identify who opened the window. Based on the interviews conducted, documentary evidence and LPA video footage review, the information gathered did not produce corroborating evidence to support the above said allegations. LPA 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 the Division Director.

Investigation Findings:
13On March 5, 2024, at 9:57am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres (Solita) and spoke with Claudia Rice, Division Director. The purpose of this visit was to deliver the findings regarding the above complaint allegations. During the investigation LPA Edison interviewed and accounted for all available relevant parties and gathered pertinent information regarding the allegations. Based on the documentary evidence, interviews, LPA video footage review and statements obtained during the investigation process, LPA was unable to corroborate the allegations, facility staff are not adequately supervising minors and facility staff are not conducting room checks. Consistent statements and documentary evidence indicate facility staff are conducting room checks of client bedrooms every 15 minutes. LPA obtained facility supervision log of room checks dated 2/17/2023-2/19/2023. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Bernice Karnsrithong LICENSING EVALUATOR NAME: Daphne Edison 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: FIVE ACRES - SOLITA HOMEFACILITY NUMBER: VISIT DATE: 03/05/2024

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

met_with: Claudia Rice-Division Director


summary: Facility Evaluation

raw_content:
Narrative:
On June 24,2021 at 9:30AM Licensing Program Analyst (LPA) Meghan McGee arrived at the above facility, for the purpose of conducting an Annual Inspection for Five Acres Solita Home. LPA met with On Call Staff Jesus Lozano who granted access into the home and Sarah Carretino Residential Treatment Counselor conducted a tour of the facility. Facility provides care and supervision to 6 children, ages 12-17 years old ambulatory only and provide services to non-minor dependents. Currently residing in the facility are 4 clients. Facility was set up as follows:4 bedrooms, 4 bathrooms, Living room, TV room/game area, dining room and kitchen. There was a fireplace in the home with a secure screen. There are no bodies of water on the premises. Kitchen: There is a stove/oven with four (4) burners. There is a microwave and refrigerator/freezer. Bedroom # Occupied by client #4, has two twin size beds and adequate drawer and closet space. Bedroom # Occupied by client #1, has two twin size beds and adequate drawer and closet space. Bedroom # Occupied by client #2 & #3, has two twin size beds and adequate drawer and closet space. Bedroom door is missing. LPA McGee let staff know that door needs to replaced. LPA McGee let staff know to follow up with clients completing daily chores ie. taking out trash and monitoring food in the bedrooms. Bedroom #4 is being occupied as the staff office. Bathrooms: All are operating properly. The home was inspected, and the following was observed: Facility is safe, sanitary, and in good repair. Passageways, stairways and open porches are unobstructed. Knives, disinfectants, cleaning solutions, and poisons are made inaccessible to clients. Facility has non-perishable foods for one week and perishable foods for two days. Facility provides nutritious between meal snacks. Medications are locked/accessible only to employees responsible for stored medications. Smoke detectors/ carbon monoxide were working properly in the home. Fire extinguisher were available and working properly in the home. There were no bars on the windows at the time of the visit. There are cameras outside in the walkway with censored lights. There is a monitor in the staff office where you can see camera footage. There are no firearms or weapons on the premises. Facility operates within license conditions and limitations including capacity limitations. Facility posts child's rights if licensed to provide foster care for six or more clients. Clients are not restricted in telephone use except by court order. Clients in care are supervised and always protected. Clients can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. Clients attend school, extracurricular, cultural, and personal enrichment activities. Facility personnel instructed to report violations of personal rights. Caregiver(s)/adults working/residing in the home have DOJ/FBI criminal record clearances and Child Abuse Index Checks. LPA McGee will follow up regarding staff 1, staff 2, and staff 3 to ensure they are cleared to work at the facility. LPA McGee will come back at a later date to complete a records review. LPA McGee collected a copy of the personnel report and client roster. There were no deficiencies cited at this time. Exit Interview was conducted, and a copy of this report was left at the facility.

report_type: Facility Evaluation

visit_type: Annual

met_with: Sarah Carretino, Residential Treatment Counselor


summary: Facility Evaluation

raw_content:
Narrative:
On 08/12/2021 at ___ Licensing Program Analyst (LPA) Meghan McGee made an announced visit to Five Acres-Solita Home for Annual Continuation licensing inspection. LPA met with Cathy Pidfigurny, STRTP Manager who granted access to the facility. LPA reviewed the following during the inspection: Staff records review, client records review, and facility vehicle. Facility vehicle was operable, clean, free of damage and had current registration and insurance. LPA reviewed Criminal Records and confirmed that all current staff were cleared. LPA reviewed staff records and client records. There were no deficiencies cited at this time. Exit interview was conducted and a copy of this report will be emailed to the facility.

visit_type: Case Management

met_with: Cathy Pidfigurny, STRTP Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 9/9/2021 at 12:08 pm, Licensing Program Analyst (LPA), Dahl Larios conducted a Case Management - Law Enforcement Contacts inspection at the above-named facility, and met with STRTP Manager, Cathy Pidfigurny, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 4 out of Direct Care Staff and 4 out of 4 youth files were reviewed. 3 out of Direct Care Staff and 4 out of 4 youth were interviewed. [see LIC Confidential Names List form (LIC811), dated 9/9/2021, for names]. The Plan of Operation including policies and procedure were reviewed. A copy of this report was discussed and provided to Jennifer Woolery, Program Manager.


summary: Facility Evaluation

raw_content:
Narrative:
On November 2, 2021, at 8:50am Licensing Program Analysts (LPAs), Emelyn Sanchez P. and Olivia Rosas arrived at the above facility unannounced for the purpose of conducting a SB Psychotropic Medication Case Management- Medication Inspection Visit. LPAs Sanchez P. and Rosas met with Cathy Pidfigurny, Facility Administrator. LPAs Sanchez P. and Rosas reviewed three (3) client file and three (3) staff files. LPAs Sanchez P. and Rosas conducted two (2) staff interviews. Currently there are five (5) clients residing in the above facility. This is a facility located in a residential area and equipped with three (3) bedrooms, one (1) staff office, four (4) bathrooms, living room, TV room/game area, dining room and kitchen, and laundry room. There was a fireplace in the home with a secured screen. There are no bodies of water on the premises. Common areas area clean and in good repair. Rooms are fully furnished with two beds, closet space and bathroom. Outdoor space is free of obstructions. LPAs Sanchez P. and Rosas observed the facility to be clean, safe, sanitary and in good repair. LPAs Sanchez P. and Rosas observed adequate staffing in the facility to provide care and supervision to children in care. LPAs Sanchez P. and Rosas also observed medication to stored in the staff office, triple locked and inaccessible to clients and unauthorized staff members. There were no deficiencies cited at this time. Exit interview was conducted, and a copy of this report was left at the facility.

met_with: Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On April 5, 2022 at 9:40am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres (Solita) for the purpose of conducting a Case Management Incident Inspection in response to Special Incident Report (SIR) #802331 dated 03/16/ Assaultive Behavior (Caregiver). LPA met with Cathy Pidfigurny, STRTP Manager. During this visit, LPA Edison conducted confidential interviews. Additional confidential interviews will be conducted on a later date. LPA requested a copy of the LIC 500, Needs and Services Plan for Client #1, and a copy of the police report. STRTP Manager provided a copy of the LIC 500 to LPA and stated will email Needs and Services Plan for Client #1 to LPA Edison. STRTP Manager provided law enforcement contact information to LPA to obtain a copy of the police report filed. STRTP Manager stated that they do not have a copy of the police report. Based on the interviews and information gathered, this incident needs further investigation. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the STRTP Manager.

met_with: Cathy Pidfigurny-STRTP Manager


summary: Facility Evaluation

raw_content:
Narrative:
On May 10, 2022 at 9:56am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres Solita Home for the purpose of conducting an Annual Required Inspection. LPA met with Cathy Pidfigurny, Administrator who granted access into the home and together a tour of the facility was conducted. This facility is licensed to provide care and supervision to six (6) children, ages 12-17 years old, ambulatory only. The facility also provides services to non-minor dependents. There are no bodies of water on the premises. The census on the date of this visit is two (2). Facility is set up as follows: Three (3) bedrooms, four (4) bathrooms, Living room, TV room/game area, staff office, dining room and kitchen. Living Room: Equipped with a sofa, table, and TV. All furniture is in good repair. TV Room/Game Area: Equipped with 2 chairs, books, TV, and table. All furniture in good repair. Dining Room: Equipped with a table and seven (7) chairs. All furniture is in good repair. Staff Office: All office furniture and equipment is in good repair. Staff Bathroom: Equipped with a toilet and shower. Clean, sanitary, and in good operable condition. Basement: Equipped with a hot water heater. Continued on LIC 809-C Kitchen: Equipped with a stove/oven with four (4) burners, microwave oven, and a refrigerator/freezer. Bedroom #1: Occupied. Equipped with two (2) twin size beds. There is adequate lighting, drawer and closet space. Bathroom #1: Located inside of Bedroom #1. Equipped with a toilet and shower. Clean, sanitary, and in good operable condition. Bedroom #2: Vacant. Equipped with two (2) twin size beds. There is adequate lighting, drawer and closet space. Bathroom #2: Located inside of Bedroom #2. Equipped with a tub/shower combination. Clean, sanitary, and in good operable condition. Bedroom #3: Vacant. Equipped with two (2) twin size beds. There is adequate lighting, drawer and closet space. Bathroom #3: Located inside of Bedroom #3. Equipped with a toilet and shower. Clean, sanitary, and in good operable condition. Backyard: Clean and free from hazardous items and debris. Garage: Clean and used for storage. Equipped with two (2) refrigerator/freezers for extra food storage. The home was inspected, and the following was observed: Facility is safe, sanitary, and in good repair. Passageways, stairways, and open porches are unobstructed. Knives, disinfectants, cleaning solutions, and poisons are kept locked in the staff office and made inaccessible to clients. Facility has non-perishable foods for one week and perishable foods for two (2) days. Facility provides nutritious between meal snacks. Continued on LIC 809-C Medications are kept locked/accessible only to employees responsible for stored medications. Smoke detectors/ carbon monoxide tested audible and were working properly in the home. The facility is equipped with two (2) regulation fire extinguishers. Hot water was tested and found to be within a safe temperature range. First Aid kit is complete with scissors, tweezers, thermometer and First Aid Manual. Facility vehicle is in good repair with valid and current California vehicle registration and insurance. LPA will review client records and conduct client interviews on a later date. Children in care are supervised and protected at all times. Children are accorded dignity in personal relationships with staff and others. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. It was reported that children attend school, extracurricular, cultural, and personal enrichment activities. LPA reviewed two (2) staff records and conducted one (1) staff interview. Additional staff interviews will be conducted on a later date. Caregiver(s)/adults working/residing in the facility have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. The facility is operating within the capacity and limitations of the license. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit Interview was conducted, and a copy of this report will be emailed to the Administrator.

met_with: Cathy Pidfigurny-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On May 19, 2022 at 9:36am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres Solita Home for the purpose of a Case Management for an Annual Required Inspection which took place on May 10, 2022. LPA met with Cathy Pidfigurny, Administrator who granted access into the home and together a tour of the facility was conducted. This facility is licensed to provide care and supervision to six (6) children, ages 12-17 years old, ambulatory only. The facility also provides services to non-minor dependents. There are no bodies of water on the premises. The census on the date of this visit is three (3). Facility is set up as follows: Three (3) bedrooms, four (4) bathrooms, Living room, TV room/game area, staff office, dining room and kitchen. The home was inspected, and the following was observed: Facility is safe, sanitary, and in good repair. Passageways, stairways, and open porches are unobstructed. Knives, disinfectants, cleaning solutions, and poisons are kept locked in the staff office and made inaccessible to clients. Facility has non-perishable foods for one week and perishable foods for two (2) days. Facility provides nutritious between meal snacks. Medications are kept locked/accessible only to employees responsible for stored medications. Smoke detectors/ carbon monoxide tested audible and were working properly in the home. The facility is equipped with two (2) regulation fire extinguishers. Hot water was tested and found to be within a safe temperature range. First Aid kit is complete with scissors, tweezers, thermometer, and First Aid Manual. LPA reviewed two (2) client records and attempted to conduct one (1) client interview. Client did not want to participate in the interview process. Children in care are supervised and protected at all times. Children are accorded dignity in personal relationships with staff and others. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. It was reported that children attend school, extracurricular, cultural, and personal enrichment activities. Caregiver(s)/adults working/residing in the facility have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. The facility is operating within the capacity and limitations of the license. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit Interview was conducted, and a copy of this report will be emailed to the Administrator.


facility_name: FIVE ACRES STRTP COLBY

raw_content:
Narrative:
During confidential interviews, it was revealed that staff mishandled a minor in care by "dragging" Client #1 (C1) out of bed to give C1 their medication, however, inconsistent statements did not corroborate the allegation. Additional confidential interviews revealed C1 had a history of medication refusal. LPA obtained a copy of C1's medication log and Needs and Services Plan. Documentary evidence and consistent statements revealed that staff do not force but instead encourage clients to take their medication as prescribed. LPA obtained Five Acres policy on client medication. Inconsistent statements and documentary evidence did not corroborate C1 had visible marks or bruises on their neck. LPA obtained Special Incident Report #815299 (SIR). Based on the interviews conducted, the information gathered did not produce corroborating evidence to support the above said allegation. LPA Edison was unable to determine if the above said allegation occurred, therefore the allegation is determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. If any additional information is received, this complaint can be amended, and the finding can be changed. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Division Director.

Investigation Findings:
13On April 13, 2023, at 9:47am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres (Colby) and spoke with Jalissa McFee, Crisis Intervention Specialist (CIS). The purpose of this visit was to deliver the findings for the above complaint allegation. During the investigation LPA Edison interviewed and accounted for all available relevant parties; and gathered pertinent information regarding the allegations. LPA made several unsuccessful attempts to speak with Staff #2 (S2) regarding the allegations. Based on the interviews and statements obtained during the investigation process, the allegation could not be corroborated. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRES STRTP COLBYFACILITY NUMBER: VISIT DATE: 04/13/2023

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

met_with: Jalissa McFee-Crisis Intervention Specialist


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
This is an amended report from the original dated 5/4/2023. LPA obtained Special Incident Report #822278, S1 termination report, and Needs and Services Plan for C1. LPA requested video footage of the incident but was informed by Division Director that Five Acres (Colby) does not have cameras, therefore, video is not available for LPA review. Based on the interviews conducted and documentary evidence, the preponderance of standard has been met, therefore the above allegation is found to be substantiated. Facility cited on the attached LIC 9099-D for violation of Interim Licensing Standards(v4), Article 06, 87072(c)(11) Personal Rights. Staff used inappropriate language towards C1 and handled C1 in a rough manner. Appeal rights were discussed with Division Director. Exit interview was conducted, and a copy of this report will be emailed to the Division Director.

Investigation Findings:
13On May 4, 2023, at 11:21am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres (Colby) and spoke with Claudia Rice, Division Director. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation LPA Edison interviewed and accounted for all available relevant parties; and gathered pertinent information regarding the allegations. Based on the documentary evidence, interviews, and statements obtained during the investigation process, LPA was able to corroborate the allegations, Staff member handled minor in a rough manner and Staff member used inappropriate language toward minor. Although Client #1 (C1) threw the remote control at the television because staff threw away C1's cereal, confidential interviews, consistent statements, and documentary evidence revealed S1 grabbed C1 by their neck and pushed C1 to the floor. S1 used inappropriate language toward C1 while holding C1 on the back of the neck on the floor. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRES STRTP COLBYFACILITY NUMBER: VISIT DATE: 05/04/2023

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


raw_content:
Narrative:
Based on records review and confidential statements, the allegation cannot be substantiated due to a lack of evidence. Information obtained revealed inconsistencies as confidential statements indicate admission of making false statements in efforts to get a minor in trouble. Law enforcement report determined no abuse occurred and results from DCFS determined inconclusive findings. Records reviewed indicate the facility is operating within appropriate staff to client ratios. The investigation found no evidence at this time to support neglect/lack of supervision leading to C1 being sexually assaulted by another minor; therefore, the allegation is determined Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There are no deficiencies cited per California Code of Regulations, Title 22 at this time. Exit interview completed. A copy of this report and LIC811 was provided to Facility Administrator.

Investigation Findings:
13On May 24, 2023, at 12: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection to deliver findings concerning the above-mentioned allegation. LPA met with Angie Wilbur, Residential Supervisor, to discuss the outcome. The investigation was referred and conducted by Community Care Licensing Investigations Bureau, Investigator Peter Zertuche. On April 26, 2023, the El Segundo Children's Residential Program Regional Office received a complaint referral alleging neglect/lack of supervision as C1 was reportedly sexually assaulted by another minor while in care [see Confidential Names form, LIC 811, dated 5/24/2023]. On May 3, 2023, LPA Regina Martin met with Facility Director, Claudia Rice, informed receipt of allegation and obtained client/facility records. The investigation further included review of associated Los Angeles Sheriff's Department report, related reports from the Department of Children and Family Services (DCFS), client file history and confidential interviews with related parties including, but not limited to C1. (Continued on page LIC9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRES STRTP COLBYFACILITY NUMBER: VISIT DATE: 05/24/2023

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

met_with: Angie Wilbur, Residential Supervisor


raw_content:
Narrative:
It was reported that staff yelled at children, however, confidential interviews and documentary evidence revealed that on the day of the incident, children were being disruptive and chaotic, and staff used verbal re-direction to restore order among the children in the cottage. LPA obtained a copy of Special Incident Report # 816605 and Client #1 (C1) Needs and Services Plan. Based on the interviews conducted and documentary evidence, the information gathered did not produce corroborating evidence to support the allegations, Staff handled minor in a rough manner resulting in injury to minor and Staff yelled at children. LPA was unable 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. If any additional information is received, this complaint can be amended, and the finding can be changed. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Division Director.

Investigation Findings:
13On June 13, 2023, at 1:04pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres (Colby) and spoke with Claudia Rice, Division Director. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation LPA Edison interviewed and accounted for all available relevant parties; and gathered pertinent information regarding the allegations. Based on the documentary evidence, interviews, and statements obtained during the investigation process, the allegations, Staff handled minor in a rough manner resulting in injury to minor and Staff yelled at children could not be corroborated. Although it was reported that staff grabbed and banged minor's head against a wall and pulled minor's arm back, there was insufficient evidence to support the allegation, Staff handled minor in a rough manner resulting in injury to minor. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: FIVE ACRES STRTP COLBYFACILITY NUMBER: VISIT DATE: 06/13/2023

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


raw_content:
Narrative:
LPA Edison was not able to determine if the above said allegation occurred, therefore the allegation is determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. There were no witnesses or physical evidence to corroborate that the allegation 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 the Division Director.

Investigation Findings:
13On February 1, 2024, at 1: PM, Licensing Program Analyst (LPA) Deborah Lee made an unannounced visit to Five Acres (Colby) and spoke with Claudia Rice, Division Director. The purpose of this visit was to deliver the findings regarding the above complaint allegation. During the investigation, inconsistent statements and documentary evidence did not produce corroborating evidence to support staff hit child and caused injury. Documentary evidence and statements indicate the client became upset at staff and began destroying property. LPA obtained Special Incident Report #831049. Statements indicate the client ran into the bedroom after grabbing a necklace from around the staff's neck. Statements indicate the client was throwing objects at staff and staff tried to use the bedroom door as a barrier to avoid being hit by the objects. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Bernice Karnsrithong LICENSING EVALUATOR NAME: Deborah Lee 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: FIVE ACRES STRTP COLBYFACILITY NUMBER: VISIT DATE: 02/01/2024

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

met_with: Claudia Rice, Divison Director


raw_content:
Narrative:
LPA Edison 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. There were no witnesses or physical evidence to corroborate that the allegations 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 the Division Director.

Investigation Findings:
13On March 5, 2024, at 10:49am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Five Acres (Colby) and spoke with Claudia Rice, Division Director. The purpose of this visit was to deliver the findings regarding the above complaint allegations. During the investigation, consistent statements and documentary evidence did not produce corroborating evidence to support facility is isolating minor from family, facility is withholding records from minor's mother, facility forced minor to get vaccinated, facility is making decisions on behalf of minor without obtaining consent, facility did not notify parent of minor's removal from school, and minor's mental health needs are not being met. LPA Edison conducted confidential interviews and reviewed documentary evidence: Client Needs and Services Plan (NSP), Child and Family Team (CFT) notes, Special Incident Reports (SIR), client Individualized Education Program (IEP), client Authorization for General Medical Care, and Superior Court of California documentation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Bernice Karnsrithong LICENSING EVALUATOR NAME: Daphne Edison 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: FIVE ACRES STRTP COLBYFACILITY NUMBER: VISIT DATE: 03/05/2024

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