facility_name: POLARIS TEEN CENTER II

summary: Facility Evaluation

raw_content:
Narrative:
On Thursday, October 28, 2021 at 9:15am Licensing Program Analyst (LPA) Bernice Karnsrithong arrived at the above facility, for the purpose of conducting an annual inspection. LPA met with Ari Brown, Administrator who provided accessed to the facility. The facility is licensed to care for up to six (6) children ages 12-17 years, ambulatory only. LPA Bernice Karnsrithong had observed the following: This facility is a two (2) story home. There is a long driveway from the street to a giant electric fence. The home opens into a grand foyer and a circular staircase with marble flooring throughout with carpet in the bedrooms. The closet under the circular staircase is being used to store emergency supplies and sports equipment. There are no firearms or dangerous weapons in the home. Medicines are inaccessible to children and are stored in a locked cabinet in an office room. All smoke detectors were tested and are operating properly in the home at the time of visit. Carbon Monoxide alarms were observed and functional in the home at the time of the visit. There are three (3) operable fire extinguishers in the facility. Two first aid kits were checked (one on each floor) and complete with scissors, tweezers, thermometer, gauzes, antiseptic and First Aid Manual. Licensing postings (i.e. Facility License, Fire Clearance, Personal Rights, Emergency Disaster Plan) are located downstairs next to the staircase. Cleaning supplies and chemicals are stored in locked storage downstairs and some in the laundry room. There is a fenced in pool located in front of the staff office which is accessible from the driveway of the home and from inside the home. When pool is in use by children, the Licensee ensures that staff supervising children in the pool area is Water Safety trained. The facility's water heater is locked in a basement room that is inaccessible to clients. Utility shut off valves are clearly marked in the emergency floor plan sketches posted around the facility. Staff were aware were the electrical and gas utility shut off valves are located. There are two (2) common rooms, one is located downstairs which has a large sectional seating area and a coffee table. The upstairs common room has seating area, books, television, and video game console to be used by clients. The downstairs has a nook counter area which has a coffee maker and a small refrigerator that staff can used. The backyard has a seating area, and a fountain that is non-functional. All crawlspaces are locked. There are two (2) covered fireplaces upstairs that are locked and non-operable. The entire facility perimeter is fenced in. Therapy Room: Is located downstairs and includes one walk-in closet, two (2) desks, a sitting area, and a bathroom that can be used by staff or clients. Staff Office: Is currently used for admissions, that includes two (2) desks, a table with four (4) chairs. Program Aide Office: This office is used to store facility logs (Day/Swing/Overnight Facility Checklist, Medication Logs) and medications; including refrigerated medication for clients. Medication logs are reviewed by the facility health care staff. First Aid Kit Supplies, Defibrillator, and hygiene and toiletries are also stored in this room. Kitchen: This area includes a large built-in refrigerator, a functional six (6) burner stove, microwave, and toaster. LPA observed a menu posted for three (3) meals. There are enough supplies of staple perishable and nonperishable food for clients. Dining Room: It is located next to the kitchen area and has two (2) bench seats and a large table that can sit up to eight (8) people. The dining room has a sliding door that leads to the upstairs outdoor area. The upstairs outdoor area has patio seating, rocking chairs, table, and a Ping-Pong table to be used by clients. There is stairwell in the upstairs outdoor area that leads to side of the house and to the pool area. There is door that leads to the pool area from the side of the home. Garage: This area is locked, finished, and converted into an office space. It has a long table with eight (8) chairs, and four (4) desks. It is used as a conference room. There are cabinets to be used for storing extra food and hygiene supplies. This area is used for intake purposes. Laundry Area: This area is locked, and equipped with a washer and dryer, a cabinet space to store laundry and cleaning supplies and linens. Pantry: This area is locked which stores non-perishable food items for clients. Bathrooms: There are two (2) bathrooms downstairs. Bathroom#1 downstairs is a 3/4 bath with shower for only staff and guests. Clients will not be allowed in this bathroom because it can be locked from the inside and has access to the front yard. Bathroom #2 downstairs is located in the therapy room and can be used by staff or clients who are currently in the therapy room. There is one (1) common full bathroom used by clients located upstairs. Each bedroom also has their own bathroom. Bedrooms: 3 bedrooms each have its own bathroom and observed with sufficient lighting, drawer and closet space, desk, chair, comfortable mattresses, clean linens, blankets and pillows. • Master bedroom- is equipped with three (3) full sized beds, and two (2) walk-in closets, a full bath and lock and key on doors that access to a balcony overlooking the driveway. (These doors are kept locked at all times) • Blue Room- is equipped with two (2) full sized beds and a 3/4 bath • Yellow Room - is equipped with one (1) full sized bed, a 3/4 bath and lock and key on doors that access a balcony overlooking the front yard swimming pool (These doors are kept locked at all times) LPA reviewed four (4) staff files and conducted two (2) staff interviews. Staff records are stored in an online portal but can be accessed during inspection. There are no clients at the time of the inspection. There are no deficiencies observed or cited at the time of this inspection. Exit interview conducted, and a copy of this report will be emailed to the facility.

met_with: Administrator


state: CA

summary: Facility Evaluation

raw_content:
Narrative:
On 10/19/2023 at 09:00AM Licensing Program Analyst (LPA) Nancy O'Connell arrived at the above facility, for the purpose of conducting an Annual/ Required inspection. LPA O'Connell met with Ari Brown, Facility Administrator, Michelle Butle COO, Lisa Rodriguez, Administrative Coordinator, Stephanie Guttierez Assistant Program Director, and Jessica Meyer, Program Director. FA granted access into the home, and provided a tour of the entire physical plant inside and out. The facility is licensed to care for a capacity of six (6) ambulatory only children. This program is designed to accept private placements and there are currently no clients in placement at the time of the visit. General overview: There is a long driveway from the street to a giant electric fence. The home opens up into a foyer and a circular staircase with marble flooring throughout and carpet in the bedrooms. The closet under the circular staircase is used to store exercise/recreational equipment. There are no security bars on the windows. There are no firearms or dangerous weapons in the home. Medicine office is located on the first floor and is locked, ensuring medications are inaccessible to children when they are in care. All smoke detectors were tested and are operating properly in the home at the time of visit. Carbon Monoxide alarms were observed and functional in the home at the time of the visit. There are operable fire extinguishers available throughout. Outdoor activity space was clean, and free of obstructions. First aid kit is located within the medication office and was checked and complete with scissors, tweezers, thermometer, gauzes, antiseptic and 1st Aid Manual. All posting requirements were observed and Emergency Plan was observed and posted on first floor. There are covered fireplaces in the home that will not be used. The Exterior consists of the following: POOL: Located in the front yard, which is accessible from the driveway of the home and from inside the home. There is a fenced and gated pool on the premises that meets regulations. Licensees have installed a pool fence that meets standards. The pool gate has a lock on it, ensuring that the body of water is inaccessible to clients when they are in care. Pool area also has space for lounging and access to a BBQ that is not currently in use. (Continued on page LIC809-C) 1st Floor: The first level of the home includes the following: Garage: locked, finished, and converted garage with cabinets, a long table with chairs, and staff desks to be used as a conference/training room. No clients will be allowed in this garage. Pantry: also locked with a dumbwaiter which can store non-perishable foods. Another Pantry: also locked, and stores extra supplies Storage Closets: is unlocked with nothing in it at this time originally a kitchen. Has one small refrigerator. Living Room: with plenty of seating for clients, and with locked doors that open up to the front yard. Bathroom#1: 3/4 bath with shower for only staff and guests. (Clients will not be allowed in this bathroom because it can be locked from the inside, and has access to the front yard). Laundry Area: locked, and equipped with a washer and dryer, and cabinet space to store detergent, and cleaning solutions. Therapy Room: used for clinical work that includes one walk-in closet, desks, and a sitting area. Staff Office: used for admissions, that includes 2 desks, printer, and office supplies. Bathroom#2: full bath located in the Staff Office. Back Staircase: located next to the Staff Office. 2nd Floor: The second level of the home includes the following: Living Room: with plenty of seating, television, locked doors that open up to the balcony overlooking the front yard, and a covered fireplace. Kitchen: includes a large built-in refrigerator, a functional 6-burner Viking stove on the island, and plenty of cabinet space. Knives / Sharp objects were not present in the facility due to no clients being in care and FA reports that the staff cook retains knives in their possession. Chemicals are kept in one of the locked storage closets downstairs in the laundry room, when not in use. Dining Room: next to the kitchen that has a dining area, 2 bench seats, 2 chairs, that seats up to 8 people. 3 bedrooms that each have its own bathroom, and observed with sufficient lighting, drawer and closet space, comfortable mattresses, and clean lines, blankets, and pillows. · Bedroom # 1- (Master bedroom) equipped with 3 queen beds, 2 walk-in closets, a full bath (Bathroom#3), and lock and key on doors that access to a balcony overlooking the driveway. · Bedroom # 2 - equipped with 2 full beds, a 3/4 bath (Bathroom#4). · Bedroom # 3 - equipped with 2 full beds, a 3/4 bath (Bathroom#5), and lock and key on doors that access a balcony overlooking the front yard swimming pool. (Continued on page LIC809-C) LPA observed locks on all bathrooms in bedrooms for the purpose of supervising all clients, including but not limited to those with eating disorders. All clients reportedly require permission before using the bathroom, so staff are aware of each use. Bathrooms located in the main hallway are available for use at any time. LPA reviewed staff record for FA (admin cert/renewal, TB screening, and CPR recert). LPA reviewed resources related to CARE Tool, required documents. LPA reviewed the Disaster Plan, Operations, and Emergency Intervention Plan. The home is clean, safe & in good repair. Per California Code Regulations, TITLE 22, DIVISION 6, CHAPTERS 1 & 5, there are no deficiencies observed or cited at the time of this inspection. Exit interview conducted, and a copy of this report was sent to the FA.

report_type: Facility Evaluation

visit_type: Annual

met_with: Ari Brown, Facility Administrator (FA)


facility_name: POLARIS TEEN CENTER III

summary: Facility Evaluation

raw_content:
Narrative:
On June 24, 2021 @ 9AM Licensing Program Analyst (LPA) Kathy Landry made an unannounced site inspection to facility above for the purpose of conducting a Required Annual evaluation. LPA Kathy Landry met with CEO, Facility Administrator and Program Director. Facility was toured @ 9:20AM inside and out. There were 5 clients residing in the home. Home is set up as follows: Downstairs has 1 conference room, 3 clinical offices, group room, family room, art room, kitchen, dining room, and 2.5 bathrooms. Upstairs consists of 3 bedrooms, clinical office, program aid-nurse office (where medications are stored) and 3 bathrooms. Facility excepts children ages 12-17, Private Placement. Master bedroom has 3 full size beds. The other upstairs bedrooms each have two full size beds. Home has no fire arms. There is an inground swimming pool/spa with 5' mesh fence and a self latching gate with latch at the top. Gateway opens outward. Children are supervised all the times and treated with dignity. Facility is clean, safe and in good repair. No passage ways, inclines, stairways, ramps or open porches are obstructed. Disinfectants/poisons are inaccessible. There is an adequate food supply (2 day perishable and at least 7 day non-perishable). Nutritious snacks are served between meals. Medication is locked except to supervising employees. Personal Rights is posted, upheld and staff instructed to report violations. Children are not restricted to telephone use except by court order and can contact Foster Care Ombudsman without threats or punishment. Children have extracurricular activities, attend school and have enrichment studies. Childrens records were reviewed for Cash Resources, Emergency Consent & Appraisal Needs & Services. Facility operates within its licensed conditions & limitations, including capacity. There are no excluded persons on premises. LPA requested Administrator to submit an updated LIC Personnel form for LPA Landry to review All Criminal Record Clearances. Facility has a current Plan of Operation. Disaster Plan is on file and posted at facility along with Indoor/Outdoor Sketch Administrator meets qualifications. Licensee/Admin have been instructed to report changes in the plan of operation which affects clients. Facility Rep has been reminded to report client injuries requiring medical treatment and other special incidents. Both Administrator, Program Director and clients records were reviewed. Covid signs were posted. First Aid Kit is complete with all required items. Smoke detectors/Carbon Monoxide equipment was tested Fire Extinguishers are up to date and have been serviced. Facility is within Title Regulations at this time. There were no violations observed and no citations issued. Exit interview conducted. Copy of Report given

met_with: CEO, Ari Brown, Admn Michelle Butler & Program Director Jessica Meyer


summary: Facility Evaluation

raw_content:
Narrative:
On June 24, 2021 @ 9AM Licensing Program Analyst (LPA) Kathy Landry made an unannounced site inspection to facility above for the purpose of conducting a Post Licensing Evaluation. LPA Kathy Landry met with CEO, Facility Administrator and Program Director. Facility was toured @ 9:20AM inside and out. There were 5 clients residing in the home. Home is set up as follows: Downstairs has 1 conference room, 3 clinical offices, group room, family room, art room, kitchen, dining room, and 2.5 bathrooms. Upstairs consists of 3 bedrooms, clinical office, program aid-nurse office (where medications are stored) and 3 bathrooms. Facility excepts children ages 12-17, Private Placement. Master bedroom has 3 full size beds. The other upstairs bedrooms each have two full size beds. Home has no fire arms. There is an inground swimming pool/spa with 5' mesh fence and a self latching gate with latch at the top. Gateway opens outward. Children are supervised all the times and treated with dignity. Facility is clean, safe and in good repair. No passage ways, inclines, stairways, ramps or open porches are obstructed. Disinfectants/poisons are inaccessible. There is an adequate food supply (2 day perishable and at least 7 day non-perishable). Nutritious snacks are served between meals. Medication is locked except to supervising employees. Personal Rights is posted, upheld and staff instructed to report violations. Children are not restricted to telephone use except by court order and can contact Foster Care Ombudsman without threats or punishment. Children have extracurricular activities, attend school and have enrichment studies. Childrens records were reviewed for Cash Resources, Emergency Consent & Appraisal Needs & Services. Facility operates within its licensed conditions & limitations, including capacity. There are no excluded persons on premises. LPA requested Administrator to submit an updated LIC Personnel form for LPA Landry to review All Criminal Record Clearances. Facility has a current Plan of Operation. Disaster Plan is on file and posted at facility along with Indoor/Outdoor Sketch Administrator meets qualifications. Licensee/Admin have been instructed to report changes in the plan of operation which affects clients. Facility Rep has been reminded to report client injuries requiring medical treatment and other special incidents. Both Administrator, Program Director and clients records were reviewed. Covid signs were posted. First Aid Kit is complete with all required items. Smoke detectors/Carbon Monoxide equipment was tested Fire Extinguishers are up to date and have been serviced. Facility is within Title Regulations at this time. There were no violations observed and no citations issued. Exit interview conducted. Copy of Report given

met_with: CEO Ari Brown, Admn Michelle Butler & Program Director Jessica Meyer


summary: Facility Evaluation

raw_content:
Narrative:
On 12/01/23 at 09: AM Licensing Program Analyst (LPA) Jhane Haynes and Licensing Program Manager (LPM) Bernice Karnsrithong arrived at the above facility, for the purpose of conducting Annual/Random inspection. LPA met with Ari Brown (CEO) who granted access into the facility. Program Director (PD) Jessica Meyers, LPA and LPM toured the home both inside and out. This is a two-story home located in a residential area. There is a swimming pool on the premises. LPA observed the following during facility tour: First Floor: Foyer contains required postings listed; License, personal rights, accreditation, and certifications and hallway to conference room, clinical office, and half bathroom that staff uses. Group Area #1 is empty. Group Area #2 contains a couch with ample seatings, mounted TV and an area rug. Hallway #2 contains locked laundry room with washer, dry and extra laundry supplies, locked storage room equipped with cleaning supplies and clinical office in use at time of inspection. Living Space contained mounted TV, rug, grievance box, two giant bean bags, ample seating, and activity equipment such as a piano. Backyard contained additional seating, exercise, and activity equipment and in ground pool. Pool was enclosed with locked gate at a minimum of 5ft. Exterior door led to hallway containing two clinical offices. Each office contained a desk, couch, and chair. (Continued on LIC809-C Page 1 of 3) Kitchen/Dining area observed to have adequate seating for clients to have meals. Adequate dinnerware, and pantry with non-perishables for one week and perishables for two days and dated. Snacks are available to clients in between meals. All kitchen appliances in working condition. Refrigerator operating below 45 degrees. Weekly menu is posted on board in dining area. Facility utilizes chef that prepares food in another facility so sharp knives are inaccessible to clients in care. Facility has a working landline available to clients. Dining Area #2 contains ample seating and table in good repair. Second Floor: Gathering Space upon entry from the stairs, gives access to clinical offices and bedrooms as well as additional storage for extra linen. Contained adequate seating. Bedroom #1 is occupied by C1; it has three full size beds, adequate closet space with shelving and center dresser, drawers and 3 desks. There is door that leads to balcony that is inaccessible to clients. It contains full bathroom equipped with two toilet rooms on opposite sides of the tub, shower and two sinks with running water not exceeding maximum temperature. Clinical Office #5 is located adjacent to bedroom #1 equipped with couch, chairs, and a desk. Bedroom #2 is occupied by C2; it has two full size beds, adequate closet space, two drawers and two desks. There is also a door with balcony access inaccessible to clients. Bathroom is equipped with a function toilet, sink, separate shower, and running water not exceeding maximum temperature. Bathroom #3 contains functioning toilet, two sinks, separate shower and running water not exceeding maximum temperature. There's extra storage closet that's kept locked. It contains decorations. Only three staff have keys to the storage closet. Bedroom #3 is occupied by C3 and C4; it has two full size beds, adequate closet space, two drawers and two desks. Room has balcony access inaccessible to clients. Med Room has split door that is kept locked. It contains double locked storage cabinet for medications, refrigerator, desk, first aid kit with required supplies, extra toiletries and first aid supplies. Med log is stored electronically. (See LIC809-C Page 2 of 3 ) Garage converted to a clinical office. Fire extinguishers are found throughout the facility. Fire alarms and carbon monoxide were tested and in working condition. Utility shutoff valves are located are located on the exterior. Interior temperature is within regulation of no more than 80 degrees. Facility vehicle is a Honda Odyssey in good repair with current registration and insurance. LPA and LPM reviewed three client and five staff files. LPA conducted confidential interviews with [C1, C2, AC, PD, APD]. (See LIC811 [Confidential Names]) Facility is clean, safe, and in good repair. No deficiencies will be cited at this time. An exit interview was conducted, and a copy of this report was provided to program director (LIC809-C Page 3 of 3)

met_with: Ari Brown (CEO)


facility_name: POLARIS TEEN CENTER, LLC

summary: Facility Evaluation

raw_content:
Narrative:
On November 29, 2021 at 10am, Licensing Program Analyst (LPA) Donald Martin arrived at the Polaris Teen Center (PTC) facility for the purpose of conducting an pre-licensing inspection. LPA met with Chief Executive Officer, Ari Brown, and was granted access to the facility. The facility serves 6 ambulatory clients with ages ranging from 12-17 years of age. LPA inspected the entire facility inside and out and observed the following during the inspection. PTC is a two story home located in a residential neighborhood. The home contains three bedrooms, four offices, 7 bathrooms, kitchen, dining room, living room and garage. The living room: Very spacious TV room with couches and book shelves. The living room has a dining area adjoining with enough seating for clients and staff. The Kitchen: The kitchen has a refrigerator filled with enough perishable and non-perishable food. The kitchen also contains different appliances labeled for clients who may have food allergies. A chef prepares the meals daily for the clients. The Garage: The garage is used for classroom activities for all three facilities. There are several desks for the clients in the room. There is a locked storage closet with PPE supplies and internet routers for the home. There is a side by side freezer for additional food storage. There are two locked offices on the first floor for staff use only. The upstairs has Bedrooms. All three bedrooms have two beds, two, dressers and enough closet space for two clients. All three rooms have bathrooms in them. The bathrooms in the rooms are locked for safety. Cont. 809-C There are two offices upstairs. The offices upstairs are used for therapeutic services. Both were occupied during the inspection. Bathrooms: All 7 bathrooms are kept locked throughout the facility. They are all clean and in order. The disinfectants and sharps are kept in the pantry directly off of the kitchen. The facility had plenty of cleaning supplies. This room is kept locked and cannot be accessed by the clients. All smoke detectors and carbon monoxide and properly working. All fire extinguishers are full and have been currently inspected. First Aid kit is fully stocked with all the essentials. Hot water temperature is within regulation standards. Medication: The medication is kept in a locked room with a pony door, inside of a locked cabinet. No clients are allowed in this room nor do they have access. All common areas of the facility are clean and in good repair. Passageways, stairways, inclines are clean and in good repair. Outdoor ground pool has regulation fencing and self closing door. Front and back patio area clean of debris and is in good repair. Child rights are posted and accessible to all clients. The home has cameras attached to the facility, but as stated by the CEO, none of them work. Staff Files: Two staff files were reviewed by LPA. Both files contained all documents and training required by CCL. Client Files: Two Client files were reviewed by LPA. Both files contained all required signed documents. LPA interviewed two staff. LPA attempted to interview two clients but they both refused. No deficiencies were found at the time of the visit. A copy of this report will be emailed to Ari Brown, CEO.

met_with: Ari Brown-CEO


summary: Facility Evaluation

raw_content:
Narrative:
On 10/24/23 at 09:00am, Licensing Program Analyst (LPA) Nancy O'Connell arrived at Polaris Teen Center facility for the purpose of conducting an Annual inspection. LPA O'Connell was me by Ari Brown, Facility administrator who granted access to the facility and provided a tour, inside and out. The facility serves 6 ambulatory clients with ages ranging from 12-17 years of age. The facility is a two story home located in a residential neighborhood. The home contains three bedrooms located upstairs, four offices, 7 bathrooms, kitchen, dining room, living room and garage. All smoke detectors and carbon monoxide and properly working. All fire extinguishers are full and have been currently inspected. First Aid kit is fully stocked with all the essentials. Hot water temperature is within regulation standards. There are cameras installed throughout the facility grounds but the cameras are non-functional. There are external and internal door censors on windows and bedroom doors which FA communicates are installed for safety reason and in alignment with the program design. FA confirms that door sensors do no supplant staff supervision. LPA observed the required postings near the main entrance of the facility. Fire alarms were tested and functional. The living room: one living room is located by the front entrance as well as adjacent to the kitchen. The rooms are very spacious with plenty of seating for all clients The living room has a dining area adjoining with enough seating for clients and staff. The Kitchen: The kitchen has a refrigerator filled with the required perishable food. Non-perishables were available for the required amount of time frame. Appliances were observed to be in working condition. There was a menu with a date posted. A chef prepares the meals daily for all of the clients. The Garage: The garage is used for classroom activities for all three facilities. There are several desks for the clients in the room. It's also utilized for exercise/recreational activities. Cont. 809-C Administrator office: located on the first floor, near the pantry. This office is reserved as a staff office and does not allow for client access. It has an adjoining bathroom. The upstairs has Bedrooms. All three bedrooms have two beds, two dressers and enough closet space for two clients. All three rooms have adjoining bathrooms in them. The bathrooms in the rooms are locked for safety and clients are allowed to use the main bathroom located in a staff office on the the second floor Two offices upstairs: The offices upstairs are used for therapeutic services. One office has an adjoining bathroom and the other office has a connected balcony that is kept locked at all times. Bathrooms: All bathrooms were inspected throughout the facility. They are all clean and in order. As part of the program design, bathrooms located inside of the clients bedrooms are kept locked and clients have access to common bathrooms located on both floors of the facility. Upstairs laundry room: room is locked and located near top of stairwell. It contains a washer/dryer, locked detergents and detergent soaps. Food pantry: this room is locked and located adjacent to the kitchen. This room contains the disinfectants and sharps. The facility had plenty of cleaning supplies. This room is kept locked and cannot be accessed by the clients. Medication: The medication is kept in a locked room with a pony door, inside of a locked cabinet. No clients are allowed in this room nor do they have access. Exterior (backyard/frontyard): The facility has a large backyard which has a basketball hoop, recreational games, and a pool. The pool meets all regulatory requirements and was observed to be locked during the time of inspection. The backyard also has a meeting area towards the back of the property that can be utilized as a group/meeting space. Front patio area was clean, free of debris and in good repair. Client Files: One client file was reviewed for C1. File contained all required documentation. Per California Code of Regulation, Title 22, there are no deficiencies cited at this time. An exit interview was conducted and a copy of this report was emailed to the facility administrator.


facility_name: PROJECT SIX

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13On 7/11/25, at 1:15 pm, Licensing Program Analyst (LPA) Nestor Gomez made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegations and deliver the findings. LPA spoke with therapist (S1), Emily Larrimore, and together, discussed the investigative findings. During the investigative process by Licensing program Analyst (LPA), Nestor Gomez, all relevant parties have been accounted for. Supporting evidence includes: Head Checks log (10/2024-3/2025), parent emails to facility, emails/texts of facility communication with parent, Medical visit paperwork, mileage log, therapist emails with parent, Client file, internet usage policy, emergency intervention plan, service records, weight log, Emergency Response Referral Information, and SIRs. The validity of the allegations could not be determined. The parties interviewed either confirmed or denied the allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted and report will be emailed to Facility Administrator (FA), Elin Bradley. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nestor Gomez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

report_type: Complaint Investigation

met_with: Emily Larrimore - Therapist

complaint_status: unsubstantiated


raw_content:
Narrative:
There are no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was left with the Facility Administrator Elin Bradley.

Investigation Findings:
13On November 26, 2024, at 10: AM Licensing Program Analyst (LPA), Rosslyn Gray made an unannounced visit to conclude the complaint investigation. LPA previously conducted a health and safety assessment prior to entering facility. During the investigation, LPA Gray interviewed all available parties. Confidential statements did not corroborate the allegation. Statements indicated that in 2022, Child 1 (C1) was touched inappropriately by Child 2 (C2) on the buttocks while on a group outing to the pool. The iIncident was not reported to staff until July 2023. Statements indicated that staff were present at the time incident reportedly occurred and children in care were supervised during outing. There was no evidence that C1 reported the incident to staff at the time it occurred. There were no statements or documentary evidence to support that incident was observed by staff or clients in care. Due to a lack of evidence obtained during the investigation, LPA determined that the allegation is Unsubstantiated. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray 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: PROJECT SIXFACILITY NUMBER: VISIT DATE: 11/26/2024

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

met_with: Facility Administrator Elin Bradley


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

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

met_with: Elin Bradley - Facility Administrator

complaint_status: SUBSTANTIATED


raw_content:
Investigation Findings:
13On 8/28/2025, at 12:35 pm, Licensing Program Analyst (LPA) Nestor Gomez made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation(s) and deliver the findings. LPA spoke with Facility Administrator (FA), Elin Bradley and together, discussed the investigative findings. During the investigative process by Licensing program Analyst (LPA), Nestor Gomez, all relevant parties have been accounted for. Supporting evidence includes: emails, SIRs, statements, and client rosters. The validity of the allegations could not be determined. The parties interviewed either confirmed or denied the allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nestor Gomez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


raw_content:
Investigation Findings:
13On 9/26/25, at 2:42 pm, Licensing Program Analyst (LPA) Nestor Gomez made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation(s) and deliver the findings. LPA spoke with Intake Coordinator (S1), Karina Luna and together, discussed the investigative findings. During the investigative process by Licensing program Analyst (LPA), Nestor Gomez, all relevant parties have been accounted for. Interviewed parties could not identify the client involved nor the incident when questioned. Also, LPA was unable to contact the reporting party due to the complaint being anonymous. The validity of the allegations could not be determined. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nestor Gomez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Karina Luna - Intake Coordinator


raw_content:
Investigation Findings:
13On 10/9/2025, at 11:18 am, Licensing Program Analyst (LPA) Nestor Gomez made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation(s) and deliver the findings. LPA spoke with Facility Administrator (FA), Elin Bradley and together, discussed the investigative findings. During the investigative process by Licensing program Analyst (LPA), Nestor Gomez, all relevant parties have been accounted for. The validity of the allegations could not be determined. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nestor Gomez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


summary: Facility Evaluation

raw_content:
Narrative:
On 05/10/ Licensing Program Analyst (LPA) Bernice Karnsrithong arrived at the facility at 9:30am for the purpose of conducting a Pre-Licensing Inspection. Health and safety risk assessment were conducted upon arriving the facility. LPA Karnsrithong met with Elin Bradley, Administrator who granted access and tour to the facility. The facility is located in a residential neighborhood and is in a 2.5-acre gated campus. The campus also has a Non-Public School, Outpatient Clinic and Wraparound Program. The facility has sixteen (16) bedrooms. There are no pool or bodies of water in the facility. The facility is located in a two-story building at the south side of the campus. During the inspection LPA Karnsrithong has observed the following: Nurse Station: There is a nurse onsite that is typically here Mondays thru Fridays and are on-call on weekends. The Nurse Station is used to store medication, COVID-19 tests, Personal Protective Equipment (PPE), medication logs, vitamin supplements, and other medical supplies. This room is maintained by the facility nurse. If the nurse is unavailable the facility manager provides the clients with medications as needed. All medications are stored accordingly, labeled, and includes the prescribing pharmacy, the type of medication, and the physician who prescribed the medication. This room is kept locked when the facility nurse is not present. Therapy Rooms: There are two (2) in-house therapists in the facility. It has a couch, desk, computer, and coffee table. One of the therapy room is being used by the psychiatrist when meeting with clients. Therapy rooms are also used for private meetings with clients and families. There is a total of four (4) therapy rooms. (Page 1 of 3) Bedrooms: There are sixteen (16) bedrooms. Each bedroom is equipped with twin sized bed, closet space, adequate lightning and two (2) dressers. Each bedroom has the emergency disaster plan and facility sketch plan posted. Each bedroom has its own smoke alarm. Each bedroom also has one (1) window with blinds. The temperature in all bedrooms were observed to be in the safe range during inspection. Bathrooms: Clients have accessed to five (5) bathrooms that have showers, sinks, toilet that are in good working condition. Only one (1) client at a time is permitted to use the bathroom. Staff uses separate bathrooms that is kept locked and inaccessible to clients. Water temperature in the bathrooms are in the safe range. Bathrooms were observed to be clean and free of any debris. Recreational Area: This area is used for activities for clients. It has a television, couches. There is an art room and a music room. There are musical instruments, computer and other music equipment found inside the music room. A music teacher works directly with the clients. There is ample supply of arts and craft materials for clients to use as well. The Activities Coordinator Office is also located in this area. There is a desk, computer, and chair at the Activities Coordinator Office. Study Lounge: This room is used by clients for educational purposes. It has computers, desks, couches, and tables. Outside the study room there are also tables and chairs for clients to use when doing schoolwork. Kitchen/Dining Area: There is a dining hall located in this area. The facility serves meals family style and there is ample seating for clients. There are dining tables and chairs throughout. Menu is posted in the dining area. The kitchen area is spacious and is equipped with stoves, refrigerators, dishwasher, and sinks. Sharp items are stored away and locked in a drawer. All kitchen items and utensils are well organized and labeled. A kitchen island is located in the center and is used for preparing food. Small kitchen appliances (coffee maker, two (2) microwaves, air fryer, pressure cooker) is also available to use. There is a separate pantry across the kitchen which stores extra perishable and non-perishable food items. This room is kept locked at all times. (Page 2 of 3) Laundry Room: There are two (2) laundry rooms located on each side of the hall. Clients may use the laundry room. Laundry supplies are also stored in this room and are provided to clients when needed. Cabinets are kept locked and it stores cleaning supplies as well. Girls Lounge: There is a private lounge area in the other side of the facility. It has television, couches, board games and computer that are designated to be used by the female clients only. Storage Room: There is a room designated for storing emergency food supplies, hygiene supplies, linens, client's luggage, and other facility supplies and equipment. This room is kept locked and inaccessible to clients. Telephone Room: There is one (1) designated private room for clients to use when making phone calls. There is a comfortable chair, table and a house phone in this room. Office Rooms: There are three (3) staff office throughout the facility. Office room are used by the facility manager, program director, and direct care staff. It has a desk, chairs, computers. The main staff office has cabinets that stores client files and hygiene supplies. It also has licensing postings and schedules. Staff has a designated breakroom that has a refrigerator, microwave, dining table, and chairs. Staff office and staff breakrooms are kept locked and inaccessible to clients. Outside Area: The facility has patio seating outside the main door. It has tables and chairs. There are plants and trees surrounding the facility. The facility has working carbon monoxide alarms and fire extinguishers throughout. The utility shut off valves are located inside and outside the premises. There are four (4) facility vehicles that are parked inside the campus. All vehicles have COVID-19 supplies, first aid, and fire extinguishers. There are no deficiencies cited at this time. Exit interview was conducted with Jerry Majewsky, Program Director. A copy of this report will be provided to the facility. (Page 3 of 3)

visit_type: Prelicensing

met_with: Elin Bradley, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 07/29/2022 at 9am Licensing Program Analyst (LPA) Bernice Karnsrithong arrived at the facility for the purpose of conducting a Post-Licensing Inspection. Health and safety risk assessment was conducted upon arriving at the facility. COVID- Symptom Checks are done by the facility as well. LPA Karnsrithong met with Gerardo Majewsky, Program Director for the facility. The facility is located inside a gated compound that has four (4) separate buildings. The main gate for the group home is secured. The group home is located on the 2nd floor of the back building. The Commission on Accreditation of Rehabilitation Facilities (CARF) Accreditation for the facility is valid until June 2025. The campus also has a Non-Public School, Outpatient Clinic and Wraparound Program. The facility has sixteen (16) bedrooms. The current census is eleven (11) which includes one (1) Non-Minor Dependent who is offsite participating in a summer bridge program at California Polytechnic University in Pomona, California. During the time of visit, the minor clients were in summer school. There are three (3) staff currently in the facility. Cleaning and maintenance staff for the campus was also present at the time of visit to conduct deep cleaning for the facility while clients are away. During the visit LPA Karnsrithong reviewed two (2) staff files and five (5) client files. LPA Karnsrithong conducted two (2) staff interviews and one (1) client interview. Majority of the clients were still in summer school at the time of visit. LPA Karnsrithong has observed the following during the visit: Outside Area: The facility has patio seating outside the main door. There are two (2) patio umbrellas as well. There are plants and trees surrounding the facility. The outside area is gated. Phone Room: There is a designated room for clients to make phone calls. This room has two (2) lounge chairs and a coffee table. Clients may also use the facility cellphone in case the facility phone is in use (Page 1 of 4) Medication Room/Nurse Station: This room is used to store medication, COVID-19 tests, Personal Protective Equipment (PPE), medication logs, vitamin supplements, and other medical supplies. This room is maintained by the facility nurse. If the nurse is unavailable the facility manager provides the clients with medications as needed. All medications are stored accordingly, labeled, and includes the prescribing pharmacy, the type of medication, and the physician who prescribed it. This room kept locked when not in use or when nurse is unavailable. Bedrooms: There are sixteen (16) bedrooms equipped with one (1) twin-sized bed, closet space, adequate lightning and two (2) dressers. Each bedroom has the emergency disaster plan and facility sketch plan posted. Each bedroom has its own smoke alarm. Each bedroom also has one (1) window with blinds. All bedrooms were observed to have clean linens and floors. All bedroom furniture and furnishings were observed to be in good working condition. Bathrooms: Clients have accessed to five (5) bathrooms that have showers, sinks, toilet that are in good working condition. There are two (2) staff bathrooms. Only one (1) client at a time is permitted to use the bathroom. Larger bathrooms have shower areas and multiple toilets. Each shower space has its own shower curtain for privacy. Each toilet in these bathrooms have their own separate doors for privacy as well. Water temperature in the bathrooms are in the safe range. Bathrooms were observed to be clean and free of any debris. Staff bathrooms are kept locked and inaccessible to clients. Therapy Rooms/Office: There are four (4) offices located close to the boy's hallway. These offices are mainly used for therapeutic services and private meetings. The in-house therapist has their own office room which is equipped with small couch, office desk, and computer. The other offices that are used for therapy services also have a small couch, office desk, chair, rugs and coffee table. Staff Office Space: There are three (3) staff office rooms throughout the facility. One office is designated for the Program Director, one for the Facility Manager and one office room is for the direct care staff. The main staff office has cabinets that stores client files and hygiene supplies. It also licensing postings and schedules. Staff has a designated breakroom that has a refrigerator, microwave, dining table, and chairs. Staff office and staff breakrooms are kept locked and inaccessible to clients. (Page 2 of 4) Kitchen/Dining Area: The facility serves meals family style and there is ample seating for all clients. There are dining tables and chairs throughout. Dining area was observed to be clean and free of debris during the visit. Menu is posted in the dining area. There are two refrigerators and four-burner gas stove in the kitchen area. Sharp items are stored away and locked in a drawer. All kitchen items and utensils are well organized and labeled. A kitchen island is located in the center and is used for preparing food. Small kitchen appliances (coffee maker, two (2) microwaves, air fryer, pressure cooker) is also available to use. Food preparation area was observed cleaned by LPA Karnsrithong. There is a separate pantry across the kitchen which stores extra perishable and non-perishable food items. There is also another refrigerator for food supply overflow. The pantry room is kept locked at all times. There are trash cans with tight fitting lid in the kitchen and dining area. Laundry Room: There are two (2) laundry rooms located in the facility on each side of the hallway. The Boys' laundry room stores linens, laundry supplies and toiletries. The girls have their own separate laundry room which is smaller than the boys and is also equipped with a washer and dryer. Common Rooms: There are four (4) common areas that are utilized by clients. There is milieu area that is in the lobby that is used for studying, tutoring and therapy. There is aquarium for their pet fish in the milieu. It also has wooden chairs and tables. The study lounge is located next to the milieu and has couches, television, video games, books, board games, and five (5) computers. This room is locked when not in used and computer used is being monitored and supervised by staff. There is an art room that has chairs, tables, art supplies, television, and video games for clients to used. The activity coordinator's office is also located next to the art room. There is a music room that is equipped with musical instruments, couches, and digital music equipment that clients can used. The girl's lounge area is located at the end of the girl's hallway and is equipped with a couch, television, and two (2) computers and an exercise bike. (Page 3 of 4) The facility has working carbon monoxide alarms and fire extinguishers throughout the facility. The utility shut off valves are located inside and outside the main building. All staff have recently been train on how to access all utility shut off valves during an emergency. During the visit, LPA observed four (4) facility vehicles that are parked inside the campus. There are two cars and two vans. All facility vehicles have working lights, seat belts, and air condition. LPA Karnsrithong observed the front bumper for the cars has a dent and one of the AC Vent (Right Side) is broken. Program Director has submitted a work order to their maintenance department during the visit and the repairs are scheduled to be done on Monday, August 1, 2022. Each car has its own designated gas card. Clients are transported to and from their appointments and school using the facility vehicles only. The entire facility has an alarm system. The facility conducts safety drills once a month and is recorded in a log. The facility maintains a log of the client's cash resources. Allowances for clients are provided every Friday and are documented. There are no deficiencies cited at this time. Exit interview was conducted with Gerardo Majewsky, Program Director. A copy of this report will be provided to the facility. (Page 4 of 4)

met_with: Gerardo Majewsky


summary: Facility Evaluation

raw_content:
Narrative:
On 04/29/26, Licensing Program Analyst (LPA) Andrea Aceves made an unannounced visit to Project Six- STRTP for the purpose of a follow up in a Case Management visit regarding an incident report that was received on 04/07/26. LPA Andrea met with Administrator Elin Bradley. During the investigation, LPA Andrea interviewed all available parties, requested and received LIC500-Personnel Report and client roster. The incident occurred on 12/11/25 and the report was received on 04/07/26. LPA Andrea spoke with Elin regarding the late reporting. LPA determined that the report was sent late to licensing agency. Due to facility failing to report the incident in a timely manner per regulations a deficiency is being cited. See LIC 809D. Exit interview completed and copy of the report and appeal rights were provided to Administrator Elin Bradley.

visit_type: Case Management

met_with: Administrator Elin Bradley


summary: Facility Evaluation

raw_content:
Narrative:
On 04/29/26, Licensing Program Analyst (LPA) Andrea Aceves made an unannounced visit to Project Six- STRTP for the purpose of a follow up in a Case Management visit regarding an incident report that was received on 04/21/26. LPA Andrea met with Administrator Elin Bradley. LPA obtained copy of LIC 500-Personnel Report, client roster and 20-day notice for client. All available parties were interviewed. Based on interviews, LPA Andrea was able to confirm that an incident occurred in the kitchen involving S1 and C1 but there were conflicting statements regarding S1 pushing C1. Based on the information obtained, further information is not needed, and this incident is being closed. No deficiencies were cited at this time. Exit interview was conducted and a copy of this report was provided to Administrator Elin Bradley.


summary: Facility Evaluation

raw_content:
Narrative:
On 05/13/26, Licensing Program Analyst (LPA) Andrea Aceves arrived at the facility for the purpose of conducting an Annual/Required Inspection. LPA met with Administrator, Elin Bradley, who granted access to the facility and provided a tour of the entire interior physical plant. At the time of the inspection, the census was 15. There is no pool or bodies of water on the premises. Facility overview: The Facility is located on gated campus. The residential facility is on the 2nd floor of a two-story building. The facility has nineteen (19) Bedrooms, five (5) Bathrooms, Kitchen, Dining Hall, two (2) Laundry Rooms, Telephone Room, Staff Offices, Nurse Station, Therapy Rooms, Milieu Lounge, Recreational Area and Storage Room. During the inspection LPA observed the following: Bedrooms: Eighteen (18) bedrooms contain one (1) twin bed and one (1) bedroom currently not in use; all rooms are equipped with closet space, adequate lighting, dressers, a window, and clean linen. Bathrooms: three (3) bathrooms are for the clients and contain multiple toilet stalls, showers with individual shower curtains, and sinks; two (2) bathrooms are for the staff. The water temperature was tested and found to be between 105 - 120 (F). Kitchen: is equipped with two (2) refrigerator/freezers, two (2) stoves each with an electric cook top (all burners were operational at the time of inspection), two (2) microwaves, a blender, two (2) dishwashers, two (2) toasters, a toaster oven, ample plates, cups, and eating utensils, and a trash can with a tight-fitting lid. Report continued on LIC 809C (Page 1 of 3) The kitchen cabinets are labeled, and sharp items are stored in a locked drawer near the sink. LPA observed the weekly sample menu posted on the bulletin board in dining area.The facility has a separate pantry on the opposite of the dining room that stores extra food supplies and a refrigerator. LPA observed the facility to have ample perishable food items in the refrigerator and the pantry is fully stocked with non-perishable food items. Dining Hall: is equipped with five (5) tables and multiple chairs. Laundry Rooms: the laundry room located on the girl's side of the hallway is equipped with one (1) washer and one (1) dryer; the laundry room located near the boy's side of the hall is equipped with two (2) washers, two (2) dryers, and multiple locked cabinets which store extra linens, laundry supplies and extra hygiene products for all clients. Phone Room: It is equipped with chairs and a phone for clients to make confidential calls. Staff Offices/Staff Break room: one is designated for the Facility Manager. Each office has a desk, chair, and a computer. The staff break room is equipped with a small refrigerator, a microwave, a table, and chairs. All staff offices are kept locked and made inaccessible to clients in care. Nurse Station: is used to store medication, medication logs, vitamin supplements, and first aid kits. The room is maintained by the facility nurse. This room is kept locked when the facility nurse is not present. Therapy Rooms: They are used for private meetings and for in house therapist. The rooms are equipped with couches, office desk, and a computer. Common Areas: The facility has four (4) common areas utilized by clients. A milieu area used for studying, tutoring and therapy equipped with chairs, tables and TV. A group room is equipped with couches, a television, video games, books, board games, and desk. An art room is equipped with chairs, tables, and art supplies. A music room equipped with musical instruments and chairs. The facility also has a girls lounge area which is located in the girls' hallway. The room is equipped with couches, a television, bookshelves and books. Report continued on LIC 809C (Page 2 of 3) Storage Room: has emergency food supplies, hygiene supplies and other facility supplies. The room is kept locked and inaccessible to clients. Miscellaneous: Smoke and Carbon Monoxide combination detectors were tested and found to be in working order. Fire extinguishers, located throughout the facility, were observed and fully charged. The facility has a separate fire alarm system. The following posting requirements were observed and posted in a public area: Grievance Procedures, Personal Rights, the facility license, the food menu, the daily activity schedule. Transportation: The facility has a total of 4 vehicles to transport clients. LPA inspected all 4 vehicles and found seat belts, horns, and lights in working order. All vehicles have current registration and insurance. Overall LPA observed the facility to be clean, safe, and in good repair. The facility operates within license conditions and limitations including capacity limitations. LPA will return at a later date to review client and staff records, as well as conduct client and staff interviews. There are no deficiencies observed during this inspection. Exit interview was completed and a copy of this report was emailed to the Administrator Elin Bradley.


facility_name: PTS FIVE

summary: Facility Evaluation

raw_content:
Narrative:
On 06/10/21 at 8: AM, Licensing Program Analysts (LPA) Pamela Silva and Zeyda Loera conducted an unannounced required annual inspection at the above facility and met with the Arturo Gonzalez, Facility Manager. This is a 24-hour facility which offers services and supervision to disabled, ambulatory and non-ambulatory clients. The facility is licensed for a capacity of four (4) clients, male or female ages 7 to 17 years old. There are currently three (3) clients in placement (See Client/Resident's Records Review - LIC858 dated 06/10/21). At 8: AM, LPA sconducted a walk-through of the facility with the Facility Manager. The facility is clean, safe and in good repair. All exits and hallways were observed to be free and clear of hazards and obstruction. There are no bodies of water on the premises. There are no weapons or firearms in the facility. Smoke detectors and carbon monoxide alarms were tested and are operable at the time of the inspection. Hot water temperatures are maintained between 105 and 120 degrees (F). Temperature in clients' rooms are maintained between 68 and 75 degrees (F). All sinks, showers and toilets were clean and in working order. First aid kit was readily available and complete. Medications were observed to be centrally locked and are accessible only to staff responsible for stored medications. Psychotropic Medication Administration Records (PMAR) versus medication logs were checked. The facility has perishable food supplies for at least 2 days and non-perishable food supplies for two weeks. The facility provides nutritious snacks between meals. Food menu is posted in the kitchen. Activity schedule is posted. Knives and other sharps were observed to be locked and inaccessible to clients in hallway closet near the entrance of the facility. Cleaning solutions and toxins were observed to be locked and inaccessible to clients in a closet inside the garage. Children live in a safe, healthy and comfortable home. All children attend school when school is in session. The facility's Emergency Disaster Plan needs to be updated per PIN 21-03-CRP. Facility operates within license capacity and limitations. Children's Personal Rights, facility license, facility sketch, emergency phone numbers, emergency disaster form are all prominently displayed in the home. All facility staff or other individuals who require caregiver background checks have received DOJ/FBI criminal record and child abuse index check clearances or exemptions. LPAs reviewed three (3) client files (See Client/Resident's Records Review- LIC858- dated 06/10/21) and three (3) facility staff files (See Review of Staff/Volunteer Records- LIC859 dated 06/10/21). At the time of this inspection, there were no deficiencies observed or citations assessed to the facility. An advisory note to update the Emergency Disaster Plan was issued. An exit interview was conducted. A copy of this report, the LIC858 and LIC859 were provided to the Facility Manager.

met_with: Arturo Gonzalez


summary: Facility Evaluation

raw_content:
Narrative:
On 04/17/ LPA's Demetris Teal and Johanna Lofton went to the facility to perform an unannounced Case Management. Met with Arturo Gonzalez-Assistant Administrator. Case Management was to review program statement to assist facility with education of CCL rules and regulations. Facility will follow instructions and become up to date with CCL rules and regulations. LPA's will work with Assistant Administrator to become compliant. LPA's will provide all necessary PINS to assist facility in becoming compliant. Exit interview was conducted and a copy of this report was given. Copy of Appeal Right provided

met_with: Arturo Gonzalez-Assistant Admin


summary: Facility Evaluation

raw_content:
Narrative:
This is an amended report to the report dated 7/27/2023. Licensing Program Analyst (LPA) Carrie Palmer conducted an unannounced visit to the above facility on 7/27/2023 at 10: AM for the purpose of conducting a required annual inspection. LPA met with Administrator, Arturo Gonzalez. LPA reviewed a copy of an updated Personnel Report (LIC 500), The Register of Facility Clients/Residents listing 3 child and the Emergency Disaster Plan for Children's Residential Facilities prior to arriving to conducted the annual review. Upon arrival to the facility, LPA Palmer, along with the administrator conducted a tour of the facility inside and outside of the home. The following was observed during the inspection: Physical Plant/Personal Accommodations (Buildings and Grounds) - The facility is a one story home. LPA observed the following on the first floor: Four (4) bedrooms, 1 kitchen which includes an area with a table, 1 storage area for medications and knives, 2 bathrooms, 1 living room, backyard, hallway leading to the door , a hallway leading to the bedrooms, and a garage. The facility license and personal rights are posted in plain view in the hallway at the entrance to the home. There were no fire arms present. There were thermometers in both the refrigerator and freezer. Knives were in the closet under lock and key, but there was a pizza cutter that was not under lock and key, which was present with other non-sharp kitchen utensils. The first aid kit was reviewed and requires adhesive tape. The fire place was observed, but was not covered and/or inaccessible to clients in care. During an interview with the administrator, LPA Palmer was informed that it was a gas fire place and is always turned off. There were no paper towels in bathroom #1 or 2 to dry your hands after hand washing. Both medicine cabinets in both bathrooms appeared to have chipped paint and rust on the inside surface. LPA observed one client dry their hands using a towel from the cabinet outside of the bathroom and place it back into the cabinet for someone else to use. When LPA Palmer informed the administrator, he appeared to be okay with the process and stated the client was used to those procedures. LPA observed the 2nd sink in bathroom number 1 was not in good repair. Bathroom 1 has chipping paint in the shower and bathroom 2 has a shower door that is in need of repair; as the door is hard to open and close and is coming off of the hinges and appears not to be secure at both the top and bottom hinges. Several windows do not have window screens. LPA Palmer observed the backyard. The outdoor backyard porch ceiling is chipping and appears to have plywood exposed. Per the administrator, the clients do not go in the backyard because clients can jump the fence, so instead they are taken to the park. The following sleeping arrangements were noted: Bedroom # 1 sleeps 1 client and has 1 bed, 1 closet, but the dresser is in bedroom number Bedroom # 2 sleeps 1 client and has 1 bed, 1 closet, but the dresser is in bedroom number 4. Bedroom # 3 sleeps 1 client and has1 bed, 1 dresser and a closet Bedroom # 4 sleeps 1 client and has 1 bed, 1 dresser and a closet. The room has its own bathroom (Master), but is not being occupied by a client at this time. Operational Requirements: The staff schedule demonstrated client/staff ratios were sufficient for the number of children in care. Staff unable to provide fire clearance. Staff states a copy of the fire clearance is with the CEO. An exit interview was conducted. A copy of the LIC 809, 809C, and appeal rights were provided to the facility representative. Page 2 of 2

met_with: Arturo Gonzalez - Administrator


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
This is an amended report to the report dated 7/28/2023. Licensing Program Analyst (LPA) Carrie Palmer conducted a Case Management - Annual Continuation visit to the above facility on 7/28/2023 at 11: AM for the purpose of conducting a required annual inspection. LPA met with Administrator, Arturo Gonzalez. There are 3 clients in care. Physical Plant (continued): Kitchen drawers are missing knobs, there is a hole in the wall of the counter top, no lid on the trash can and the freezer handle on the door is not in good repair. Operational Requirements (continued): The licensee was able to provide a schedule of indoor and outdoor activities to include karaoke and outings at the park. However, during and interview with the staff and the client, the scheduled of activities is not implemented often. Board meeting minutes were not provided by the licensee; as the staff reports the board meeting minutes are at the CEOs home office. Disaster Preparedness: Fire drills are being conducted once a month, but there was no Mass Casualty Plan of Action in place to ensure staff understand how to prepare, plan and practice keeping staff and clients safe in the event of an emergency or disaster. The administrator was able to provide individual treatment plans for every child, a medication list for all children in care and 3 sets of keys that shall be used in the event of an emergency. While the licensee was able to show the provisions of some training's, the licensee was unable to show that staff were being trained annually on disaster preparedness and therefore does not meet the training requirement. Emergency Intervention: Upon interviewing the administrator, LPA Palmer was informed that staff implement CPI only when children are a danger to themselves and others. However, the staff was unable to show a system in place to capture the restraint occurrence in the event staff would need to implement restraint methods. Staff Records: Upon the review of staff records and staff associations, it was determined that one staff was not associated with PTS 5, but was present and working at the facility on the day of the review. The staff was associated with PTS 1 and a transfer request was present in the staffs file, but was not processed. During the review of job descriptions, it was determined that the facility designated a House Manager to provide oversight. During an interview with the administrator, it was determined that the staff has been a House Manager for 6 months, and has worked with the company for approximately 3 years. There was no evidence of a job description in the staffs file and while the administrator states the staff was trained on how to be a House Manager, the Administrator was unable to provide evidence of the training. During an initial interview with the staff designated to be the House Manager, it was determined that she was unaware of her position. During a 2nd interview with the staff, the staff stated she was the House Manager. Staff was unable to provide transcripts for the House Manager to ensure qualifications were met to hold the position. No training on the understanding of a House Manager to the staff was presented during the review. All other job descriptions were present. Staff exemptions were reviewed. The facility has two administrators. One certification expires on 8/3/23 and the administrator is in the process of taking the class to renew the certification. The other certification expired in 2015. A renewal application has been submitted in March of 2023 and all renewal classes have been completed evidenced by a completion certificate. Educational backgrounds of administrators were reviewed. LPA was able to review the staff schedule. There was no position titles or days off listed. The Page 2 of 3 (Cont 809c) administrator wrote in the position titles during the inspection. There were no performance evaluations for any staff at the facility. The staff stated that the performance evaluations are kept at the CEOs home office. During an observation with staff and clients, it was determined that effective communication was lacking and staff are in need of training. LPA recommends all staff and administrators be trained on how to communicate and listen to clients in care. Additionally, there was no evidence of training in the staff files regarding Care and Supervision to include communication, Early Signs of Illness and the Need for Professional Assistance, Availability of Community Services and Resources. There was no evidence of a written plan for facility managers. During and interview with the staff, some children see their doctors monthly and some children see their doctors quarterly. Children are required to meet with their doctors monthly; therefore staff will need to consult with the doctors and/or regional center to ensure compliance. Client Records: The needs and services plan does not have to be completed by the facility social worker or administrator since children are placed by the regional center. Staff Interviews: LPA was able to interview 2 staff. During the interview, it was determined that some staff were familiar with reporting in the case of child abuse or neglect, but may need training on emergency preparedness. Client interviews: LPA was able to interview one client. The client stated he was very happy with the program. And is excited about his upcoming day program. The client was able to explain the phone policy and expressed that the staff understands him and his needs. LPA was unable to interview the other clients; as they were non-verbal. An exit interview was conducted. A copy of the LIC 809, 809C, 809Ds was provided to the facility representative. At the time of this inspection there are Type B Citations, Technical Violations and Technical Assistance cited per Title 22 regulations

Deficiencies:
84361(f): Documentation and Reporting Requirements

(f) The licensee must maintain a monthly log of each use of manual restraints. The log must include


summary: Facility Evaluation

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Narrative:
On January 18, 2023 at 4: P.M. Licensing Program Analyst (LPA) Demetris Teal conducted an unannounced case management inspection at PTS FIVE. LPA met with Arturo Gonzalez- Administrator. Purpose of the visit was to follow up on a incident report. LPA requested SIR's from November to December, Needs and Services plans, address of schools/day care, if any, copy of LIC 500, copy of current client roster Interviews will be conducted as necessary. Additional time is needed to resolve this case. An exit interview was conducted and a signed copy of this report along with 811 (Confidential Name List), was left with administrator.

met_with: Arturo Gonzalez-Administrator


summary: Facility Evaluation

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Narrative:
On March 6 ,2024 at 3: P.M., Licensing Program Analyst (LPA) Demetris Teal conducted an unannounced case management follow up at the above named facility. LPA met with Arturo Gonzalez-Administrator. Purpose of the visit was to deliver findings based on the case management investigation. On December 1, 2023, it was reported to Community Care Licensing (CCL) via email that staff at PTS 5 had taken C1's (see confidential names list dated March 6, 2024) television from him because he had stolen something. C1 reported that staff 1 had taken a shower head hose and sprayed C1 with cold water, for taking money from staff in the home. C1 reported he usually takes a shower independently but staff assisted him with his shower. It was later reported that C1 recanted his statements. Interviews were conducted with C1, C2 on January 30, 2024, reporting party on January 30, 2024, facility staff 1 on February 6, 2024 and social worker on February 8, 2024. Based on these interviews, it appears that C1's personal rights were not violated. C1 reported that he did not have a television taken from him. C1 did not have a television in his room. C1 was not assisted with his shower and cold water from a shower head was not sprayed on him. Staff had been removed for safety reasons, until investigation was completed. No further investigation will be conducted at this time. No citation is issued at this time. Exit interview conducted. A copy of this report, and appeal rights will be left with Administrator.

met_with: Arturo Gonzalez- Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On July 31, 2024 at 1: P,M., Licensing Program Analyst (LPA) Demetris Teal conducted an unannounced Annual Inspection at the above named facility. LPA met with Arturo Gonzalez-Administrator. The facility currently has a Group Home (GH) license. The GH is licensed to serve up to four (4) clients ages 7 to 17. The facility serves ambulatory and non-ambulatory developmentally disabled clients, level 4I Regional Center Clients and provide one on one care. There are currently three (3) clients in placement. The LPA requested the following: Personnel Report LIC500, Client Roster, Board of Meeting Minutes, Clients and Staff Files. The facility is a single-story home with 4 bedrooms, living room, kitchen, backyard and one (2) full bathrooms with two toilets. There are no firearms or ammunition in the facility. There are no bodies of water on the facility premises. At 1: P.M., LPA conducted a walk-through of the entire facility. Physical Plant The license, facility sketch, personal rights, emergency disaster form, complaints poster, emergency phone numbers and food menu are posted in a prominent, publicly accessible location in the facility. Disinfectants and cleaning solutions are kept inaccessible and locked in a cabinet located in the garage. Sharps/knives are inaccessible and stored in a locked cabinet in the hallway. Facility has non-perishable food for at least one week and perishable food for at least two days. Medications are centrally stored in a locked room in the hallway. Smoke and carbon monoxide detectors were tested and in proper working order. Fire extinguisher was fully charged. First Aid Kits were checked and found to be complete. Room temperatures are maintained at 75 degrees F. The hot water temperature was tested and measured at 118 degrees F. All sinks, showers and toilets are in working order. No more than 1 children share a bedroom. All beds are in good repair; equipped with good springs, clean mattresses and pillows. Continued.... ...Continued Adequate supply of beddings and linens were observed. Facility provides age-appropriate clothing items and hygiene products. Overall, facility is clean, safe, sanitary and in good repair. Operations Facility maintains a register of clients and the register is available upon request. The board of directors regularly conduct meeting to review and discuss the GH's operation. The facility administrator is responsible and capable for communicating with staff and emergency personnel in the facility. License is posted in a prominent location Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill quarterly and fire drill monthly for each shift. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Individual Treatment Plan for each client, medication records, and contact information for each client's responsible party and physician. Emergency Intervention Plan Facility does not use manual restraints. However, all three (3) staff members are trained on emergency intervention procedures. Client Records LPA reviewed three (3) client records. All client records are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, individual treatment plans, medical assessment, safeguards for cash resources, personal property and valuables, education records; personal rights forms; and medication administration records. Continued..... .....Continued Staff Records LPA reviewed two (2) staff records. All staff have been subjected to criminal records review and have been fingerprinted and cleared with DOJ, FBI and CACI. The administrator will send proof that he meets administrator required qualifications and/or experience. Documentation of the required education and experience will be sent to LPA. LPA verified at least 20 hours of annual training for direct care staff. Clients with Special Health Care Needs There are currently no clients in care with special health care needs. LPA interviewed one (1) client. Citations were issued during this inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On July 28, 2025 at 1: P,M., Licensing Program Analyst (LPA) Demetris Teal conducted an unannounced Annual Inspection at the above named facility. LPA met with Arturo Gonzalez-Administrator. The facility currently has a Group Home (GH) license. The GH is licensed to serve up to four (4) clients ages 7 to 17. The facility serves ambulatory and non-ambulatory developmentally disabled clients, level 4I Regional Center Clients and provide one on one care. There are currently three (3) clients in placement. All clients are non-minor dependents. The LPA requested the following: Personnel Report LIC500, Client Roster, Board of Meeting Minutes, Clients and Staff Files. The facility is a single-story home with 4 bedrooms, living room, kitchen, backyard and two (2) full bathrooms with two toilets. There are no firearms or ammunition in the facility. There are no bodies of water on the facility premises. At 1: P.M., LPA conducted a walk-through of the entire facility. Continued.... Continued... Physical Plant The license, facility sketch, personal rights, emergency disaster form, complaints poster, emergency phone numbers and food menu are posted in a prominent, publicly accessible location in the facility. Disinfectants and cleaning solutions are kept inaccessible and locked in a cabinet located in the garage. Sharps/knives are inaccessible and stored in a locked cabinet in the hallway. Facility has non-perishable food for at least one week and perishable food for at least two days. Medications are centrally stored in a locked room in the hallway. Smoke and carbon monoxide detectors were tested and in proper working order. Fire extinguisher was fully charged. Room temperatures are maintained at 75 degrees F. The hot water temperature was tested and measured at 120 degrees F. All sinks, showers and toilets are in working order. No more than 1 client share a bedroom. All beds are in good repair; equipped with good springs, clean mattresses and pillows. Adequate supply of beddings and linens were observed. Facility provides age-appropriate clothing items and hygiene products. Overall, facility is clean, safe, sanitary and in good repair. Operations Facility maintains a register of clients and the register is available upon request. The board of directors regularly conduct meeting to review and discuss the GH's operation. The facility administrator is responsible and capable for communicating with staff and emergency personnel in the facility. License is posted in a prominent location Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill quarterly and fire drill monthly for each shift. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Individual Treatment Plan for each client, medication records, and contact information for each client's responsible party and physician. Facility did not have an updated emergency and disaster plan training log. Administrator will conduct training's and send proof to LPA Continuation.... Continuation.... Emergency Intervention Plan Facility does not use manual restraints. However, all three (3) staff members are trained on emergency intervention procedures. Client Records LPA reviewed three (3) client records. All client records are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, individual treatment plans, medical assessment, safeguards for cash resources, personal property and valuables, education records; personal rights forms; and medication administration records. Staff Records LPA reviewed four (4) staff records. All staff have been subjected to criminal records review and have been fingerprinted and cleared with DOJ, FBI and CACI. Documentation of Administrator qualifications were reviewed. LPA verified at least 20 hours of annual training for direct care staff. LPA observed one (1) out of four (4) staff that did not have TB clearance. Clients with Special Health Care Needs There are currently no clients in care with special health care needs. LPA interviewed two (2) client. Citations were issued during this inspection A copy of the 809, 809D's, 9102's, and appeal rights were left with the administrator. Exit Interview conducted.


facility_name: PTS ONE

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Narrative:
continued from pg. It was alleged that C1 sustained bruises and scratches on his shoulders and arms while in care. All the facility staff interviewed denied the above allegations. Based on confidential interviews C1 sustained the injuries due to self-harming behaviors. Confidential interviews also revealed that C1 throws himself on the floor, twist his body, puts himself in awkward positions and stims daily which results in bruising/scratches. Based on confidential interviews, staff will re-direct C1 when exhibiting self-harming behaviors. Based on a record reviewed, C1 has a history of the above behaviors mentioned above. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted and a copy of this report as well as the LIC 811 was provided to the facility.

Investigation Findings:
13On January 12, 2022 at 3: PM Licensing Program Analyst (LPA) Jenny Mundo conducted a follow-up complaint inspection to deliver the findings of a complaint investigation concerning the allegation above. LPA Mundo met with the facility Administrator named above and discussed the findings. During the investigation, LPA Martin conducted a record review and obtained copies of client's needs and services plan (NSP), special incident reports (SIRs), medical body chart form and daily shift notes. LPA requested copies of the LIC 500, staff contact information, staff daily shift schedule, staff trainings and photographs. LPA Martin conducted confidential interviews with Administrator on 10/13/21, Reporting Party (RP) on 12/9/21, Staff 1 (S1) and Staff 2 (S2) on 12/28/21 (See Confidential Names List Form LIC 811 dated January 12, 2022). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Jenny Mundo 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: PTS ONEFACILITY NUMBER: VISIT DATE: 01/12/2022

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

met_with: Judith Gonzalez, Administrator


raw_content:
Narrative:
It was alleged that C1 suffered a bruise on the right thigh due to neglect and lack of supervision by the facility staff. S1, S2, and S3 denied the alleged allegation further indicating that there are two to three staff members present at the facility depending on the needs of the facility. Staff further indicated that one of the staff works one on one with C1 while the other staff member supervises the other two clients. S3 indicated that on October 16, 2022, while getting C1 ready for school no marks or bruising was observed on C1's body, and therefore a body check chart was not completed. Information obtained from S1 indicated while helping C1 off the school bus she was informed by the bus driver (name not known) that three staff members needed to help get C1 on the bus due to C1 continuously dropping to the floor. S1 indicated that no marks were observed due to the type of clothing that C1 was wearing at the time C1 was dropped off from school. S1 further disclosed that two to three hours later while assisting C1 with their hygiene needs she observed a bruise greenish/blueish in color the size of an adult's closed fist and immediately reported it to the facility Administrator (S2). S2 indicated that once she received the call and observed the bruise S2 advised S1 to get C1 ready to transport C1 to Urgent Care to be further medically evaluated for any internal injuries. S2 indicated that X-rays were taken of C1's right hip and no signs of internal injuries. S2 indicated that a SIR was completed and all the appropriate agencies were notified in a timely manner. Information obtained from the Kern County Regional case worker TC, revealed that C1 has been diagnosed with anemia and therefore will bruise easily. TC indicated that C1 also has a habit of hitting herself in the hip area with the base of the palm which has also caused bruising in the past just not as severe. Furthermore, C1's support team has approved for C1 to wear protective pants and a padded vest (both non-restrictive) to help protect C1 and reduce future injuries. In addition to protective clothing, C1's school has agreed to keep a daily log of C1's behavior and communicate with the facility and the Regional Center to help deter some of the self-harming behaviors. TC further indicated that the Regional Center staff found no wrongdoing by the facility staff and indicated that the staff has done an exceptional job providing care for C1 and being in communication with C1's support team. Therefore, based on the information received, the above allegation is determined to be unsubstantiated. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is found to be unsubstantiated. Appeal Rights were provided and discussed with the Facility Administrator. There are no deficiencies to be cited at this time. An exit interview was conducted and a copy of the report along with the (LIC 811) was left with the Facility Administrator.

Investigation Findings:
13On March 8, 2023, at 11: AM, Licensing Program Analyst (LPA) Winston Moroney conducted a complaint inspection of the above Facility and met with the Facility Administrator Judith Gonzalez. The purpose of the inspection was to deliver the finding for the above complaint allegation. On October 19, 2022, the California Department of Social Services Community Care Licensing Division received a complaint from Centralized Complaint and Information Bureau (CCIB) with the following allegation: An unexplained bruise found on the client. The investigation of the above allegation was conducted by this LPA and it consisted of, but was not limited to a review of records, including the client's needs and services plans, medical records, and interviews with three staff members (S1, S2) on 10/21/22, staff (S3) on 11/2/22, and one Kern County Reginal Caseworker on 11/9/23. No statement was obtained from C1 due to being developmentally disabled. Reference Confidential Names Form LIC 811, dated March 8, 2023). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Winston Moroney 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 LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: PTS ONEFACILITY NUMBER: VISIT DATE: 03/08/2023

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

met_with: Judith Gonzalez - Administrator


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
However, the statements obtained from other confidential interviews did not provide sufficient information to corroborate the allegations. Based on the information gathered, although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that alleged violations occurred, therefore the allegations are unsubstantiated. There were no deficiencies cited during this inspection. An exit interview was conducted. A copy of this report, Confidential Names Form, and Appeal Rights were provided to the facility representative via electronic mail.

Investigation Findings:
13On March 16, 2023, at PM, Licensing Program Analysts (LPA) Karen Suh and Joe Martinez conducted a follow-up complaint inspection to deliver the findings of an investigation concerning to the allegations above. LPAs met with the representative named above and discussed the findings. During the investigation, LPA Suh conducted a record review and obtained copies of Individual Program Plan, Daily Notes of September, and October. LPA also conducted confidential interviews with Administrator, two staff on October 19, 22 and March 8, 2023, Kern Regional Center Case Manager on March 7, 2023, and Reporting Party (RP) on March 8, 2023. It was alleged that Ref. #1 (see Confidential Names, LIC Ref. #1 dated March 16, 2023) was left soiled for an extended period of time. The facility Administrator and staff denied the allegation stating clients are sent to school with five diapers. When facility receives a call from school requesting more diapers, a package of diapers are dropped off at school immediately by a staff. The school has the Administrator's telephone number and facility number. All staff responds to school whenever they receive a call from school. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Karen Suh 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: PTS ONEFACILITY NUMBER: VISIT DATE: 03/16/2023

met_with: Judith Gonzalez