raw_content:
Narrative:
continued from The investigation revealed that the initial allegation did not occur at Agape Homes Orcutt but occurred at Changing Faces. While C1 was placed at her previous facility, a safety plan was put in place and C1 was subsequently removed and placed at Agape Homes. In confidential interviews, C1 did not disclose any abuse or altercations occurring at her current placement, and she feels safe in the home. However, C2 admitted there were a few times that C1 was assaulted and two of the times were by C2. Based on confidential interviews and review of supportive documentation, AGPA Woodard determined the preponderance of standard has not been met, therefore the personal rights allegation is unsubstantiated. A copy of this report was left with facility representative.

Investigation Findings:
13On May 14, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted a follow-up inspection at the facility for the purpose of delivering findings on the above allegations. Upon arrival, AGPA Woodard was greeted by Jesse Alvarado, Facility Manager. On February 3, 2022, Community Care Licensing Division (CCLD) received a call from reporting party that when C1 was placed at Changing Faces she was physically assaulted by her roommate C3 and other girls (names unknown) in the home. C1 did not feel safe in the home. Although staff separated the girls in the home, the physical assault continued to occur. C1 was removed from the home and placed at Agape Homes Orcutt. On February 7, 2022 a CAHL referral was received with additional information. According to the referral: C2 assaulted and threatened C1. Staff reported they were not aware of the assaults or threats and when C1 was asked she denied it. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: AGAPE HOMES ORCUTTFACILITY NUMBER: VISIT DATE: 05/14/2022

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


state: CA

facility_name: AGAPE HOMES ORCUTT

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
continued from Licensing Program Analyst (LPA) Enrique Hernandez and Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted the investigation into the personal rights and lack of supervision allegations. LPA Hernandez conducted the initial 10-day complaint inspection on February 24, 2022 and conducted confidential interviews with one client and one staff. Both LPA Hernandez and AGPA Woodard conducted subsequent visits to the facility on March 16, 2022, April 9, 2022 and May 1, 2022; confidential interviews were conducted with seven staff members, and five clients. Additional phone interviews were conducted on April 23, April 25, April 27, and May 12, 2022. The investigation revealed through confidential interviews and a review of supportive documentation that on December 8, 2021 three clients engaged in property destruction and law enforcement was called to avoid the youth from receiving serious criminal charges. Charges were pressed against two clients for $400 worth of damage. Licensee stated that for the next 60 days, if there are no more property damages, then he will go ahead and drop the charges. In other interviews clients were told that they would not be 14-day or press charges if they help with repairs, be on their best behavior and help clean up or were told charges were going to be pressed for property destruction and they were going to pay for putting sugar in the facility vehicle's tank. Also disclosed was that Licensee will make promises, offer different incentives, or reward a client to motivate them and let them know it's up to them. Based on interviews and review of supportive documentation, AGPA Woodard determined that the preponderance of evidence standard was not met and did not prove that the alleged personal rights violation occurred, therefore the allegation is found unsubstantiated. A copy of this report was left with facility representative

Investigation Findings:
13On May 14, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted a follow-up inspection at the facility for the purpose of delivering findings on the above allegations. Upon arrival, AGPA Woodard was greeted by Jesse Alvarado, Facility Manager. On February 16, 2022, Community Care Licensing Division (CCLD) received a report that on December 8, 2021, police were called to Agape Home Orcutt because four youths were vandalizing the home. The report indicated that the Licensee was intentionally attempting to blackmail the youth by stating he wanted to file charges but wouldn't if the youth behaved. It was believed that it sounded like the Licensee was trying to coerce the youths into behaving by threatening criminal charges. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: AGAPE HOMES ORCUTTFACILITY NUMBER: VISIT DATE: 05/14/2022

report_type: Complaint Investigation

met_with: Lexie Trice

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Based on the interviews conducted and documents obtained, the above allegations are found to be Unsubstantiated, meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. A tour of the facility was conducted with CM and there are no deficiencies to be cited at this time. Exit interview conducted and a copy of this report was left at the facility.

Investigation Findings:
13On June 27, 2022, at 2:00pm, Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegations and deliver the finding. LPA spoke with Breanna McCormick (FA) and together, discussed the investigative finding. During the investigative process by Licensing Program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. Supporting evidence includes: review of LIC500, client roster, interviews with the reporting party, staff, and clients. Although there are multiple statements confirming allegations, reports are inconsistent and non-specific. Further, evidence was obtained that confirms basic needs are being met, structure is being provided in the home, and clients are being afforded with basic personal rights. Statements related to staff yelling or demonstrating inappropriate conduct or mistreatment could not be corroborated by clients or staff. Continued on LIC9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: AGAPE HOMES ORCUTTFACILITY NUMBER: VISIT DATE: 07/27/2022

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

met_with: Breanna McCormack Facility Admin (FA), and Skyler Stewart Case Manager (CM)


summary: Complaint Investigation - Substantiated - 2 allegations

raw_content:
Narrative:
to medical information and immunization records for residents in care. Needs and Services Plans did not contain immunization information or medical history information. LPA received a Health and Education Passport for 1 out of 5 residents. FA reported that documents are not consistently provided by placing County agencies and agreed to develop policy and procedure to address needed documentation during intake process and during initial Child and Family Team Meeting (which typically occurs within intiial 30days of a youth placement). PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Chapter 7. Version 4, a deficiency will be cited at this time. Exit Interview conducted, and due to technical difficulties with LPAs printer, a copy of this report was left at the facility with FA.

Investigation Findings:
13On 10/13/2022 at 11:15am, Licensing Program Analyst (LPA) Nancy O'Connell, made an unannounced inspection to the above-listed facility, and met with FA, who granted access to the facility. The purpose of this inspection is to conduct an initial complaint investigation inspection regarding the above allegations. During the time of the inspection, LPA conducted confidential interview with FA. [See Confidential Names form (LIC811), dated 10/13/22, for name]. During the course of the investigation, LPA conducted a record review and request relevant records for residents (Needs and Services Plans, immunizations, past medical appointments, emergency information, doctor contact information, etc.) and FA was unable to provide records related Continued on Lic9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: AGAPE HOMES ORCUTTFACILITY NUMBER: VISIT DATE: 10/13/2022

Allegations:
- SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: Based on interview and record review, the licensee did not ensure that required immunizations and records were obtained for
- out of 5. Licensee did not ensure that records could be provided to paramedics upon request. how immunization and medical information will be collected upon intake. FA will create form that will be filled out at intake which addresses plan to obtain immunization records, Medi-cal card, and medical history. FA will provide policy and updated intake forms to LPA by 10/21/22 to nancy.oconnell@dss.ca.gov.

met_with: Breanna McCormick, Facility Administrator (FA)

complaint_status: SUBSTANTIATED


raw_content:
Investigation Findings:
13On 10/13/22, at 11:15am, Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation and deliver the findings. LPA spoke with FA and together, discussed the investigative findings. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. Supporting evidence includes: review of LIC 500, staff roster, Needs and Services Plan for residents, facility policies, and interviews from clients and staff. Record reviews reflect that the facility is in compliance with staffing ratios, supervision requirements, and provision of basic hygiene needs for residents. Further, statements gathered by clients and staff reflect that staff target hygiene routines for all clients, and implement person-centered approaches for residents who demonstrate difficulty in maintaining personal hygiene. Additionally, the facility maintains appropriate clinical documentation to reflect person-centered, and trauma informed interventions that effect implementation of program policies. 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 allegations are unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and due to technical difficulties with LPAs printer, a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell 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: BreAnna McCormick, Facility Administrator (FA)


raw_content:
Investigation Findings:
13On October 13, 2022, at 11:15am, Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation and deliver the findings. LPA spoke with FA and together, discussed the investigative findings. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. Supporting evidence includes: review of LIC 500, staff roster, and interviews from clients and staff. Interviews reflect conflicting information related to witnessing staff entering a client bathroom. Statements obtained from staff and house residents reflect inconsistent reports of seeing a male staff enter a client bathroom without permission. Further, FM2 denies the allegation and a house resident provided a statement indicating that she was present during the alleged incident and did not witness staff enter the bathroom where client was showering. Lastly, the policy to ensure continuous supervision was obtained, and the program maintains a safety policy that directs staff to conduct room observations with notice in order to ensure client safety. Regarding the secondary allegation related to staff allowing clients to enter minor's room to assault minor, statements gathered reflect extensive efforts on behalf of staff members to prevent clients from entering bedroom to assault minor. Statements corroborate corroborate staff presence and attempts to block clients from entering C7's bedroom. 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 allegations are 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: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


raw_content:
Narrative:
The investigation, including review of facility file history, Youth's file, related reports from the Santa Barbara County Sherriff's Department, as well as confidential interviews with, complainant, two Youth residents and five staff members, revealed a lack of evidence to prove the alleged. Confidential statements and records reviewed indicate inconsistencies in the timeline and details of alleged sexual assault toward Y1 by another youth while in care. Claims of the sexual assault was reported to the sheriff's department. Facility staff learned about the alleged incident when Y1 reported the incident to the sheriff's deputy. Once the staff learned about the incident, Y1 was moved to a different room. The facility took measures to address the alleged incident. Based on gathered information, the findings concerning neglect/lack of supervision are determined Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies cited per Short-Term Residential Therapeutic Program Interim Licensing Standards or California Code of Regulations, Title 22, at this time. Exit interview completed. A copy of this report and LIC811 was provided to the Facility Representative.

Investigation Findings:
13On June 15, 2023, at 4: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection to deliver findings concerning neglect/lack of supervision by facility staff members as reported claims indicate staff failed to supervise a youth while in care resulting in youth being sexually assaulted. LPA Martin met with Brianna Irene Leon, Facility Manager to discuss the outcome. On January 26, 2023, CCL, El Segundo Children's Residential Program Regional Office received a complaint referral claiming Youth #1 (Y1) was reportedly sexually assaulted by another minor in care. The investigation was referred and conducted by Community Care Licensing (CCL) Investigations Bureau, Investigator Heidy Bendana. On January 31, 2023, LPA Martin initiated the complaint investigation obtained and reviewed requested records. (Continued on page LIC9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: AGAPE HOMES ORCUTTFACILITY NUMBER: VISIT DATE: 06/15/2023

met_with: Brianna Irene Leon, Facility Manager


raw_content:
Narrative:
Confidential statements and records reviewed revealed not enough evidence to support the allegation. Gathered information produced no witnesses to the alleged abuse and confidential statements could not be verified. Statements obtained established and further supported by the law enforcement records, that the subject Youths do not get along and one Youth seems to bully the other. Confidential interviews produced no witnesses or corroborating evidence to alleged sexual abuse. The findings, concerning neglect/lack of supervision is therefore determined Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There were no deficiencies cited per Short-Term Residential Therapeutic Program Interim Licensing Standards or California Code of Regulations, Title 22, at this time. Exit interview completed. A copy of this report and LIC811 was provided to the Facility Representative.

Investigation Findings:
13On June 15, 2023, at 4: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection to deliver findings concerning neglect/lack of supervision by facility staff members as reported claims indicate staff failed to supervise a youth while in care resulting in youth being sexually assaulted. LPA Martin met with Brianna Irene Leon, Facility Manager to discuss the investigative outcome. On February 8, 2023, Community Care Licensing (CCL), El Segundo Children's Residential Program Regional Office received a complaint referral alleging that facility staff did not prevent minors from being sexually assaulted by another minor in care. The investigation was referred and conducted by CCL Investigations Bureau, Investigator Douglas Real. On February 15, 2023, LPA Enrique Hernandez initiated the complaint investigation, informed receipt of allegation and obtained records. The investigation further included confidential interviews and review of facility file history, Client's file, and related reports from the Santa Barbara County Sherriff's Department. (Continued on page LIC9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: AGAPE HOMES ORCUTTFACILITY NUMBER: VISIT DATE: 06/15/2023

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


raw_content:
Investigation Findings:
13On June 21, 2023 at 2:30pm, Licensing Program Analyst (LPA) Enrique Hernandez made an unannounced inspection to the above-listed facility, Agape Homes Orcutt Short Term Residential Therapeutic Program (STRTP) for the purpose of concluding the investigation on the above allegations, and to deliver the findings. Based on the confidential interviews with the relevant parties conducted during the investigation process, record review, and documents obtained by Licensing Program Analyst (LPA) Christine Wilson, LPA Wilson concluded the allegations are unsubstantiated. There is evidence of measures to ensure clients understand chores, meal schedules and transport times. There are no witnesses that can corroborate the observance of clients having food withheld, and/or transportation denied as a form of discipline while in the facility. The allegations may have happened, and, but there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the finding is unsubstantiated. There are no deficiencies to be cited, at this time, regarding the above allegations. Exit interview was conducted and a copy of this report will be emailed to the Facility Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Enrique M Hernandez 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 3

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

met_with: Rosalie Romero


raw_content:
Investigation Findings:
13On June 21,2023 at 2:30pm, Licensing Program Analyst (LPA) Enrique Hernandez made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation and deliver the findings. LPA spoke with Rosalie Moreno (Lead facility manager) and Skyler Stewart (Case manager) and together, discussed the investigative findings. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. Supporting evidence includes interviews with house residents and staff denying any observance of staff handling minors inappropriately. Further, interviews reveal that staff have been trained in the use of physical redirection when clients engage in physical aggression towards each other/staff, and though staff have been observed to make physical contact with clients as a means to deescalate a crisis, there is no actual report of witnessing a staff handle the minors inappropriately. Although the allegation 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. No deficiencies are being cited at this time. Exit interview was conducted and a copy of this report will be emailed to the Facility Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Enrique M Hernandez 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 3

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


raw_content:
Investigation Findings:
13On June 28,2023 at 9:40am, Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation and deliver the finding. LPA spoke with Skyler Stewert and together, discussed the investigative finding. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. Supporting evidence includes: interviews with house residents and staff denying any observance of clients consuming alcohol while in the facility. Further, it has been reported that minors may have access to the alcohol while out in the community, but possession of alcohol within the facility has not been observed or reported. There are no witnesses that can corroborate the observance of clients consuming alcohol while in the facility. Lastly, staff confirm that room checks for contraband and alcohol are completed daily and alcohol has not been located/observed. Although the allegation 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. 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: Nancy O'Connell 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 3

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

met_with: Skyler Stewert, Case Manager (CM)


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13On 7/27/23 at 10:30am, Licensing Program Analyst (LPA) Nancy O'Connell made unannounced inspection to the above-listed facility for the purpose of conducting an investigation on the above allegation and deliver the finding. LPA O'Connell met with the facility administrator and discussed the investigative finding. On 7-20-23, the Department received a complaint alleging that a client was dragged out of a bedroom. During the investigative process, LPA O'Connell conducted confidential interviews with all relevant parties and collected information on the above allegation. After reviewing all the statements and the information obtained, the above allegation is supported, as the confidential interviews confirmed that S1 and S2 removed C3 from bedroom #1 against her will, while C3 was on top of a mattress. Evidence obtained includes video footage showing C3 being forcibly moved out of the bedroom by S2. Further confidential interviews revealed that interventions used to remove C3 from bedroom #1 are not approved behavioral redirection/intervention techniques utilized by the program. Based on LPA's observations and interviews which were conducted, along with record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC 9099D. An exit interview was conducted and a copy of this report was emailed to the FA. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: AGAPE HOMES ORCUTTFACILITY NUMBER: 428209702

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

met_with: Adrian Cooks, Facility Administrator (FA)


raw_content:
Investigation Findings:
13On October 09, 2023 at 3:10pm Licensing Program Analyst (LPA) Nancy O'Connell and LPA Jhane Haynes made an unannounced visit to AGAPE HOMES ORCUTT and spoke with S1. The purpose of this visit was to deliver findings for the complaint allegations. Staff slapped youth in care on the arm. Staff denied food to youth in care. Staff did not provide hygiene products to youth in care. Staff did not provide clean clothing for youth in care. During the investigation, Confidential interviews were conducted, facility files reviewed, Child & Family Team Meeting notes and documentary evidence did not substantiate the allegations listed above. Staff deny that youth was slapped on the arm by staff. It was reported to LPA Phillips that staff would not slap a youth in care on the arm. It was reported to LPA Phillips youth was not slapped on the arm. Confidential interviews reveal children are provided three (3) meals a day and available snacks. An alternate meal can be cooked if children want something different. It was reported to LPA Phillips there is plenty of food and children can ask for food not on the weekly menu. LPA Phillips observed fresh fruit on the counter, fully stocked refrigerator with adequate food supply, and additional food items in cupboards. Staff deny that hygiene products are denied youth in care. LPA Phillips observed large bottles of hygiene products in each bathroom and hall closet with additional supply of products. Staff deny that clean clothes were not provided to youth in care. It was reported to LPA Phillips laundry is assigned by room during the week with staff assisting youth. On the weekend laundry is being completed by staff and residents all day. It was reported to LPA Phillips that when a youth awol all personal items are removed from room for safe keeping until youth returns. Documentary evidence reviewed confirmed facility procedure on removal of personal items for safe keeping. Based on the interviews conducted and documentary evidence, the information gathered did not produce corroborating evidence to support the allegations listed above. Due to inconsistent statements LPA was unable to determine if the above said allegations occurred, therefore the allegations are determined to be unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report was provided to S1 via email. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell 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: Marisol Roland, residental staff (S1)


raw_content:
Investigation Findings:
13On 10/9/23 at 3:10pm-, Licensing Program Analysts (LPA) Nancy O'Connell and LPA Jhane Haynes made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation and deliver the finding. LPA spoke with S1 and together, discussed the investigative finding. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. Supporting evidence includes: conflicting interviews with house residents and staff attesting to the denial of access to medical treatment in a timely manner. Further, evidence reveals that staff implement policies and procedures that aim to de-escalate physical aggression between clients in care. LPA O'Connell obtained and reviewed documentation which reflects program efforts to maintain required amount of supervision of clients in care. 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 a copy of this report was provided to the facility via email. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell 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 3

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

met_with: Marisol Roland, residential staff (S1)


raw_content:
Investigation Findings:
13On 10/9/23 at 3:10pm, Licensing Program Analysts (LPA) Nancy O'Connell and LPA Jhane Haynes made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegations and deliver the finding. LPA spoke with S1 and together, discussed the investigative findings. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. Supporting evidence includes: conflicting interviews obtained from staff and residents attesting to the occurance of identified allegations. Futher, a records review was conducted ad evidence reflects that staff conduct required supervision checks on residents in care, clients are accroded with dignity during interactions with staff, required amount of food is provided to clients during meal times, telephone calls are alllowed during timeframes established by program policies, and communications with authorized representatives are allowed during approved phone call timeframes. 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 allegations are unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was provided to the facility staff. . UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell 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 3

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


raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegation by speaking with staff, social worker, client #1, client #2 and client #1's family. LPA also reviewed incident reports related to the allegation as well as Needs and Services Plans and CFT notes for clients # 1, 2, and 4. Based on the interviews and review of incident reports, it was determined that on two separate occasions, facility staff did not notify the social worker of C1 of injuries to C1 in a timely manner. In both instances the social worker had to learn of the injuiries via other sources. The allegation that staff failed to report injuries in a timely manner is substantiated.This is a violation of Title Section 80061(f) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B This is an official report of an unannounced visit/investigation of a complaint received in our office on 10/16/2023 and conducted by Evaluator Connie Jones-Steward COMPLAINT CONTROL NUMBER: 34-CR- FACILITY NAME:AGAPE HOMES ORCUTTFACILITY NUMBER: ADMINISTRATOR:BREANNA MCCORMICKFACILITY TYPE: ADDRESS: MOONCREST LANETELEPHONE: (805) 937- CITY:SANTA MARIASTATE: CAZIP CODE: CAPACITY:6CENSUS: 6DATE: 11/02/ UNANNOUNCEDTIME BEGAN: 09: AM MET WITH:Breanna Irene LeonTIME COMPLETED:10: AM -Clients educational needs are not being met INVESTIGATION FINDINGS: 13Licensing Program Analyst Connie Jones- Steward investigated the above allegation. LPA interviewed staff C1 and C1's family members. LPA also reviewed the Needs and Services Plans for C1 and CFT notes regarding her struggles with school. All parties denied that staff does not assist C1 with her school work or provide resources. Staff and client also denied that client only receives 30 minutes per day to complete her homework, A records review revealed that C1 receives tutoring and has in-school resources to assist her. However it is not clear when these resources were made available or if they had to be demanded by C1's family as was alleged. Therefore this allegation is resolved as unsubstantiated. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 3 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: AGAPE HOMES ORCUTTFACILITY NUMBER: 428209702

met_with: Breanna Irene Leon


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Investigation Findings:
13On 05/24/2024 at 10:15AM Licensing Program Analyst (LPA) Jhane Haynes made an unannounced visit to the above facility for the purpose of concluding the investigation on the above allegation. LPA spoke with Program Manager(PM) and together discussed the investigative findings. During the investigation LPA Haynes interviewed and accounted for all relevant parties. Conflicting interview reflect severity of incident may delay being reported to authorized representative. Based on records recieved, it was found that staff did not report incidents to client's authorized representative timely. The preponderance of evidence standard has been met; therefore the above allegation is found to be SUBSTANTIATED. Per CCR Title Chapter 1, one deficiency will be cited today. See LIC9099-D for details. An exit interview was conducted, and a copy of this report was left at the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Jhane Haynes 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 WOODLAND HILLS S.Ro, Ventura Blvd., STE. WOODLAND HILLS, CA FACILITY NAME: AGAPE HOMES ORCUTTFACILITY NUMBER: 428209702

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

met_with: Brianna Irene Leon Program Manager(PM)


raw_content:
Investigation Findings:
13The purpose of this report is to amend the 05/24/ LIC9099 report from Substantiated complaint finding to an Unsubstantiated complaint finding. On 05/24/2024 at 10:15AM Licensing Program Analyst (LPA) Jhane Haynes made an unannounced visit to the above facility for the purpose of concluding the investigation on the above allegation. LPA spoke with Facility Administrator(FA) and together discussed the investigative findings. During the investigation LPA Haynes interviewed and accounted for all relevant parties. Interviews reflect clients are restricted to activities on site for the purpose of increased supervision following behavioral incident. Additional interviews posed whether actions of facility exercised prudent parenting. Statements to corroborate aforementioned allegation could not be obtained. 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 allegations are UNSUBSTANTIATED. No deficiencies will be cited at this time. An exit interview was conducted, and a copy of this report and appeal rights was emailed to the administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Jhane Haynes 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 WOODLAND HILLS S.Ro, Ventura Blvd., STE. WOODLAND HILLS, CA FACILITY NAME: AGAPE HOMES ORCUTTFACILITY NUMBER: 428209702

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

met_with: Aysia Reiwaldt(FA)


raw_content:
Investigation Findings:
13On 05/24/2024 at 10:15AM Licensing Program Analyst (LPA) Jhane Haynes made an unannounced visit to the above facility for the purpose of concluding the investigation on the above allegation. LPA spoke with Program Manager(PM) and together discussed the investigative findings. During the investigation LPA Haynes interviewed and accounted for all relevant parties. Based on interviews conducted, it was reported that staff will pick up youth after exhausting attempts to keep youth at school if possible. Staff will communication with youths' school when prompted. Statements to corroborate aforementioned allegations could not be obtained. 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. There are no deficiencies to be cited at this time. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Jhane Haynes 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 10/16/2024 at 10:15AM Licensing Program Analyst (LPA) Enrique Hernandez made an unannounced visit to the above facility for the purpose of concluding the investigation on the above allegation. LPA spoke with Rosali Romero Program Manager (PM) and together discussed the investigative findings. During the investigation LPA Haynes interviewed and accounted for all relevant parties. Based on interviews conducted,there were not enough interviews to substantiate the allegation. Based on interviews conducted during the investigation. No interviews revealed that staff #1 (S1) hit client #1 (C1) with the phone cord or said inappropriate things to C1. S1 denied hitting C1, and the only thing S1 told C1 it was time to return the Chrome book, which C1 refused. it was also revealed that no witneses were present at the time of the incident between C1 and S1.LPA Haynes did not obtained statements to corroborate the above allegation. Although the allegation 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. No deficiencies will be cited at this time. An exit interview was conducted, and a copy of this report and appeal rights was emailed to the administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Enrique M Hernandez 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: Rosali Romero/Program Manager


raw_content:
Investigation Findings:
13On 1/16/25 at 11:00am, Licensing Program Analyst (LPA) Nancy O'Connell, made an unannounced complaint inspection to the above-listed facility, and met with Marizol Roland, counselor, and Alyssa Laron,Facility Manager (FM), who granted access to the facility. The purpose of this visit is to conduct a complaint investigation inspection regarding the above allegations. During the time of the inspection LPA conducted confidential interviews with FM, S1, FA, and C1 [See Confidential Names form (LIC811), dated 1/16/25, for names]. LPA O'Connell also retained picture evidence of bedrooms #1, #2, #3, refrierator contents, menu, and available snacks/food. Photo evidence reflects that beds are in good condition, snacks/food is readily avaialble to clients, and the weekly menu is posted in the kitchen. Interviews conducted reveal that clients have access to food based on regulatory guidelines, beds are in good repair and equipped with all required bedding materials. 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. There are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was sent to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell 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: Alyssa Laron, Facility Manager (FM)


raw_content:
Investigation Findings:
13On 1/16/25 at 11:00am, Licensing Program Analyst (LPA) Nancy O'Connell, made an unannounced complaint inspection to the above-listed facility, and met with Marizol Roland, counselor, and Alyssa Laron,Facility Manager (FM), who granted access to the facility. The purpose of this visit is to conduct a complaint investigation inspection regarding the above allegations. During the time of the inspection LPA conducted confidential interviews with FM, S1, FA, and C1 [See Confidential Names form (LIC811), dated 1/16/25, for names]. Interviews conducted reveal that all clients in the facility are provided with access to similar opportuniteis and rewards. The facility employs a behavior modification system which is utilized to determine "levels" of access to rewards based on the client's engagement in pro-social behaviors. Passes out into the community are monitored and approved by the program and clients are only allowed to conduct visits with approved individuals/family members. Although the allegation 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. There are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was sent to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell 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 October 12, 2021 at 9: AM, Licensing Program Analyst (LPA) Enrique Hernandez conducted an unannounced case management inspection at the above facility. Upon arrival, LPA Hernandez was greeted by Breanna Mccormick who granted access in to the home. During today's inspection, LPA discussed the exemptions of the following staff members: Staff #1, and Staff #2 with the facility Administrator (listed on LIC 811-Confidential Names List dated 10/12/2021) At this time, the Department has made no determination on whether a violation has occurred. PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Chapter 7. Version 3.1, there are no deficiencies to be cited at this time. Exit interview was conducted and a copy of this report was left with the facility administrator whose signature on this form confirm receipt of this document.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 10/27/2021, at 11:00am Licensing Program Analyst (LPA) Enrique Hernandez conducted a Case Management - Incident inspection at Agape STRTP, and met with Amber Green Case manager (CM) Breanna Mccormick Facility Administrator (FA), During the facility inspection, an incident has just occurred at the facility. Clients entered the facility office, and items were taken out of the office. Clients also broke the door of the pantry door. Client #1 (C1) punched the office window and the client had to be taken to the emergency room for cuts on C1's hand. During the inspection, the facility was making the repairs to the facility from the earlier incident. The facility conducted a complete security check on the entire facility. FA will send the incident report to our Department today with additional information of the incident. LPA conducted confidential interviews [see LIC Confidential Names List form (LIC811), dated 10/27/2021, for names]. At this time, the Department has made no determination on whether a violation has occurred. PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Chapter 7. Version 4.0, there are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was left with the facility administrator (FA).


summary: Facility Evaluation

raw_content:
Narrative:
On December 8, 2021 at 11:45am Licensing Program Analysts (LPA) Enrique Hernandez arrived at the Agape homes Orcutt Group Home, for the purpose of conducting Annual/ Required LPA Hernandez met with the Adrian Cook Acting Administrator who granted access into the home. LPA toured the home both inside and out with Adrian Cook. The facility is licensed to care for 6 children ages 12-18 years, Ambulatory only. The facility also provides services to Non-Minor Dependents. This is a one-story home, located in a residential area. There is no bodies of water in the facility. During the toured LPA observed the following: Bedroom #1 is vacant, it has two twin size beds, adequate closet and drawer space and a private bathroom. Bedroom #2 is occupied by one male client, it has two twin size beds, adequate closet and drawer space. Master Bedroom #3 is occupied by one male client, it has two twin size beds, adequate walking closet and drawer space. Bathroom is located in the master bedroom with two sinks toilet bathtub and shower. Bedroom # Is utilized as staff office it has a desk and a computer Bathroom: The home is equipped with three (3) Bathrooms. Bathroom one (1) is located next to bedroom #1 is equipped with two sinks, shower and a toilet. Bathroom two (2) is located in the master bedroom with two sinks toilet bathtub and shower. Bathroom three (3) is located by the laundry room that is use only for staff. The bathroom is equipped with a sink and a toilet. All bathrooms were operable at time of inspection. Continue on LIC809C Living Room: There was an attached room space which will be utilized as game room/study room. There is a fireplace with the cover on. There is a rug, TV and two lounge chairs. There is a tv room with a large sofa. Hallway: linen closet for extra storage. The three-car garage: It is attached to the home is where the water heater is located, also an extra refrigerator with additional food for the clients. Kitchen: There was one (1) refrigerator, one (1) stove one (1) microwave and a dishwasher all operable at the time of the inspection. LPA observed adequate non-perishable foods and perishable food. Laundry Room: There was a laundry room equipped with a sink, one (1) washer and one (1) dryer. and bathroom next to the laundry room. The upper cabinets have a magnetic lock where they storage all the chemicals. Passageways, stairways, inclines, ramps, and open porches are unobstructed. Rules, menu, regulations, licenses, emergency disaster plan and personal rights are posted at the facility. Outdoor space is free of debris and hazard. Hazardous and cleaning solutions, disinfectants, poisons, medication and sharp knifes are inaccessible to the clients. Meds are locked and accessible only to employees supervising stored medications. The home is clean, safe, sanitary, and in good repair. Outdoors activity space free of obstructions. The front and backyard is cleared from hazards. LPA will return to continue the annual/ required inspection to review personnel and client's files to ensure it meets regulatory requirements. LPA also will conduct interviews with clients and staff at a later date. Based on today's inspections PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Chapter 7. Version 4, a deficiency was cited See 809D An exit interview was conducted, and Plans of Corrections were reviewed and developed with the licensee.

visit_type: Annual

met_with: Adrain Cook


summary: Facility Evaluation

raw_content:
Narrative:
On 10/14/2022 at 10:40am, Licensing Program Analyst (LPA) Nancy O'Connell, made an unannounced collateral visit to the above-listed facility, and met with the Facility Administrator (FA), who granted access to the facility. The purpose of this visit is to conduct a collateral interview with a resident that currently resides in the facility. During the collateral visit, LPA O'Connell conducted a confidential interview with C1 [See Confidential Names form (LIC811), dated 10/14/22, for names]. PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Chapter 7. Version 4, there are no deficiencies to be cited at this time. Due to technical difficulties, a copy of this report will be emailed to FA and the signed document with all signatures will be kept in file.


summary: Facility Evaluation

raw_content:
Narrative:
On 3/16/23, and 10:00am Licensing Program Analyst (LPA) Nancy O'Connell and LPA Christine Wilson made an unannounced inspection to the Agape Homes, for the purpose of conducting a Case Management inspection to address concerns regarding in incident report that was from Santa Barbara County Sheriff's Department. On 3/10/2023, the Department received an incident report communicating the following: On 3-4-23, at approximately 8:00pm, a client at Agape Home called Santa Barbara County Sheriff's Department (SBCS) to report she was assaulted by another resident on January 15th. Upon SBCS arrival, interviews were conducted by officers and information was obtained that alleged a staff member assaulted one of the residents in care. SBPD interviewed residents and staff and submitted an independent incident report. During the time of inspection, LPA O'Connell interviewed: FA, FM, C1, C4, and C6 in person. [See Confidential Names form (LIC811), dated 03/16/2023, for names]. Further investigation is required in order to resolve the investigation; once completed, LPA will return to deliver and discuss the finding. Statements were obtained and details about the incident were gathered. Based on the interviews conducted and information obtained during today's inspection, further investigation is needed in order to determine whether a violation occurred. PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Chapter 7. Version 4, there are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was left at the facility.

met_with: Adrian Cooks, Facility Admin (FA)


summary: Facility Evaluation

raw_content:
Narrative:
On 8-8-23 at 11:00am, Licensing Program Analyst (LPA) Nancy O'Connell conducted an unannounced case-management deficiency visit at the facility. LPA met with Tory Doyle, Program Manager (PM), who granted access to the facility. LPA informed PM about the reason for visit and suggested that the facility administrator be informed of visit. On 8/8/23, the Department received a Serious Incident Report (SIR) indicating that a client (C1) was found in her bedroom closet, semi-concious, with a shoelace placed around her neck. The SIR indicates that staff S1 initially found C1 and assisted with intervening and initiating the emergency response protocol by contacting 911. The SIR reflects that C1 was transported to the emergency room and remains under medical observation. During the time of inspection, LPA O'Connell interviewed PM and C2 to gather additional details [See LIC811, dated 8/8/23, for confidential names). Further investigation is needed to determine outcome. No deficiency will be cited today. An exit interview was conducted a copy of this report was provided to the PM/administrator via email.

met_with: Tory Doyle, Program Manager (PM)


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Raymond Canal and Licensing Program Manager Angela King conducted a case management inspection on 9/14/23 at 10:40 am based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 5 out of Direct Care Staff and 5 out of 5 youth files were reviewed. 2 out of Direct Care Staff and 2 out of 5 youth were interviewed. (See the Confidential Names List, LIC 811, 9/14/23). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, youth case plans, and Trauma informed safety plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Canal observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Administrator Adrian Cooks.

met_with: Adrian Cooks, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 12/27/23 at 02:33 pm Licensing Program Analyst (LPA) Jhane Haynes arrived at the above facility, for the purpose of conducting Annual/Random inspection. LPA met with Facility Manager (FM) Marizol Roland who granted access into the facility. Together LPA and FM toured the facility. It is a one-story home in a residential area licensed to care for children ages 12-17, ambulatory only. LPA observed the following during facility tour: Entry contains required postings not limited to operational license and personal rights. Visitor check-in station. Living Room equipped with adequate seating for clients; two couches, TV, and bookcase. Game Room is equipped with couch, TV, game table, shelf with various game activities and incentive board. Dining Area is equipped with a large table, two benches and two chairs: adequate seating for clients. Kitchen is equipped with functional refrigerator, stove, oven, microwave, and toaster. There are snacks for in-between meals. Refrigerator operating temperature does not exceed 45 degrees and freezer at 0 degrees. There are perishables for two days and non-perishables for up to a week. There is adequate dinnerware for clients. Bedroom #1 is equipped with two twin beds, eight dresser drawers and closet. It rooms C1. Bedroom #2 is equipped with two twin beds, two dressers and closet. It rooms C2. Bedroom #3 is equipped with two twin beds, two dressers and walk-in closet. It rooms C3 and C4. A hole in wall was found above bed closest to door. FM was unaware of hole. There is an ensuite bathroom equipped with functioning toilet, sink, shower, and tub. Cabinet door for under the sink was missing due to repair at time of inspection. Work order was provided and sent for repairs. Bathroom contained functioning sink, toilet, and shower. Staff Office is equipped with desk and chairs. It contains first aid kit, locked file cabinets, closet with secured sharps, facility vehicle keys, staff personal items and cameras. See LIC 809-C Page 1 of Med Room is equipped with desk, chairs, and secured closet where client medications are stored. Hallway contained secured closet for client toiletries, extra supplies, and linen storage draped with curtains. Fire alarm was tested and in working order. Facility temperature did not exceed 85 degrees. Laundry contains washer, dryer, and sink. A fire extinguisher is located adjacent to appliances. Extra secured storage cabinets for chemicals, door leading to garage and half bathroom for staff use. Garage inaccessible to clients, it contains additional non-perishables and extra fridge for overstock, decoration storage and door to exterior where trash cans are kept. Exterior contains seating and grill. LPA and FM observed empty wine bottle on walkthrough. FM immediately disposed of bottle. Pathways were free of any obstructions. Due to time constraints, LPA will return to continue annual inspection. No deficiencies will be cited at this time. An exit interview was conducted, and a copy of this report was left the facility manager.

met_with: Marizol Roland Facilit Manager (FM)


summary: Facility Evaluation

raw_content:
Narrative:
On 12/28/23 at 09: Licensing Program Analyst (LPA) Jhane Haynes made an unannounced visit to the above facility for the purpose of continuing facility annual inspection. LPA met with Facility Administrator (FA) Aysia Riewaldt who granted access to the facility and provided a room for file review. LPA reviewed files of FA, FM, S1 and all clients currently in placement. See LIC811 for names. Client files contained all required documents not limited to needs and service plans, admissions agreement, cash resources and medical assessments. Staff files included current training, personnel records, education background and health screening. All files are maintained and contained required documents. Staff associated to facility have obtained criminal record clearance from DOJ, FBI and CACI. In addition to file review, LPA conducted interviews with FA, C1, and C4. No deficiencies will be cited today. An exit interview was conducted and copy of this report was left with facility administrator.

met_with: Aysia Riewaldt Facility Administrator (FA)


summary: Facility Evaluation

raw_content:
Narrative:
On 01/24/24 at 11: AM Licensing Program Analyst (LPA) Jhane Haynes made an unannounced visit to the above facility for the purpose of conducting a case management inspection regarding the incident report received on 07/18/23. An incident between staff and former client in the facility and the minor sustained an injury. LPA met with Executive Director (ED) Adrian Cooks who granted access to the facility. LPA conducted confidential interviews with ED, PM, S1, C1 ,C2 and obtained hospital record of P1. Further investigation is needed to determine if possible personal rights violation occurred. There are no deficiencies to be cited at this time. An exit interview was conducted, and a copy of this report was left at the facility.

met_with: Executive Director (ED) Adrian Cooks


summary: Facility Evaluation

raw_content:
Narrative:
On 02/14/24 at 01:54PM Licensing Program Analyst (LPA) Jhane Haynes made an unannounced visit to the above facility for the purpose of conducting a case management inspection regarding the incident report received on 02/23/24. Youth displayed aggressive behaviors following inability to use facility phone. LPA met with Facility Manager(FM) Angelique Ambrosi who granted access to the facility. LPA obtained a copy of facility phone policy and client daily communication notes and observed client call log. Further investigation is needed to determine whether a personal rights violation occurred. No deficiencies will be cited. Exit interview was conducted and a copy of this report was emailed to the facility administrator.

met_with: Angelique Ambrosi Facility Manager (FM)


summary: Facility Evaluation

raw_content:
Narrative:
On 03/25/24 at 02: PM Licensing Program Analyst (LPA) Jhane Haynes and Licensing Program Manager (LPM) Kevin Sauk made an unannounced visit to the above facility for the purpose of conducting a follow up case management inspection initiated 03/14/24. Youth displayed aggressive behaviors following inability to use facility phone. LPA met with Facility Administrator(FA) Aysia Riewaldt who granted access to the facility. LPA and LPM attempted interview with C1. There are no deficiencies to be cited today. An exit interview was conducted and a copy of this report will be emailed.


summary: Facility Evaluation

raw_content:
Narrative:
On 04/24/24 at 02: PM Licensing Program Analyst (LPA) Jhane Haynes made an unannounced visit to the above facility for the purpose of conducting a follow up case management inspection initiated 03/14/24. Youth displayed aggressive behaviors following inability to use facility phone. LPA met with Facility Manager (FM) Rosalie Romero who granted access to the facility. LPA attempted interview with C1. There are no deficiencies to be cited today. An exit interview was conducted and a copy of this report was emailed to the facility administrator.

met_with: Facility Manager (FM) Rosalie Romero


summary: Facility Evaluation

raw_content:
Narrative:
On May 22, 2024 at 11: AM Licensing Program Analysts (LPAs) Rosslyn Gray and Deborah Lee made an announced visit at AGAPE HOMES/SHORT TERM RESIDENTIAL THERAPEUTIC PROGRAM (STRTP) to conduct the Psychotropic Case Medication Inspection. LPAs conducted a Health and safety risk assessment upon arriving at the facility. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs Gray and LPA-Lee met with the Administrator Aysia Riewaldt conducted a brief walk through of the entire physical plant inside and out. LPAs reviewed three (3) of child's psychotropic medications records. LPAs reviewed three (3) staff personnel files on site at the facility. LPAs interviewed 2 of the 3 (C1 & C3) available children currently prescribed psychotropic medication on site on site at the facility. LPA'S reviewed the LIC500 to confirm the shift which starts in the evening and ends early morning. The Administrator provided a physical hard copy of the psychotropic medication training topics during the training for LPA's to review. No deficiency were cited per Interim Licensing Standards for Group Home Division Chapter 5 . An exit interview was conducted, and a copy of this report was left with the Administrator Aysia Riewaldt

met_with: Administrator Aysia Riewaldt


summary: Facility Evaluation

raw_content:
Narrative:
On 07/17/24 at 11:32am Licensing Program Analyst (LPA) Christine Wilson made an unannounced visit to the above listed facility to conduct a collateral interview, regarding a complaint at another licensed facility. LPA Wilson was met by staff person (AFM) who provided LPA with access to the facility. LPA obtained a copy of the LIC500, and Client Roster. There were (2) clients in the home with (AFM). LPA Wilson attempted to interview (C7) who was not in the home and attending a therapy session. At 12:36pm, LPA Wilson interviewed (C7). No deficiencies have been cited. An exit interview was conducted and a copy of this report was discussed and will be emailed to licensee. .

met_with: Facility Manager (AFM)


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Raymond Canal conducted a case management inspection on 8/22/24 at 10:45 am based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 5 out of Direct Care Staff and 3 out of 3 youth files were reviewed. 2 out of Direct Care Staff and 3 out of 3 youth were interviewed. (See the Confidential Names List, LIC 811, 8/22/24). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, youth case plans, and Trauma informed safety plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Canal observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Administrator Aysia Riewaldt.

met_with: Aysia Riewaldt, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 08/23/2024 at 12:54PM, Licensing Program Analyst (LPA) Jhane Haynes made an unannounced inspection to the above facility for the purpose of concluding the case management inspection initiated 03/14/24. Youth displayed aggressive behaviors following inability to use facility phone. LPA met with Facility Administrator(FA) Aysia Riewaldt who granted access to the facility. The department has found no violation that occurred. Staff denied access at the time to uphold the safety of both youth and staff as behaviors escalated. This was an example of exercised prudent parenting. Once youth was able to return to baseline, phone use continued as normal the same day. There are no deficiencies to be cited at this time. An exit interview has been conducted and a copy of this report was emailed to the facility administrator.

met_with: Aysia Riewaldt Facility Administartor(FA)


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Raymond Canal conducted a case management inspection on 7/24/25 at 10: Am based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 6 out of Direct Care Staff and 5 out of 5 youth files were reviewed. 2 out of Direct Care Staff and 2 out of 5 youth were interviewed. (See the Confidential Names List, LIC 811, 7/24/25). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, youth case plans, and Trauma informed safety plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Canal observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Administrator Jazmin Cooks.

met_with: Jazmin Cooks, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
A Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Connie Jones-Steward on August 14, 2025 at 9: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA Jones-Steward met with administrator Jazmine Cooks who assisted with the inspection LPA reviewed one (1) client record, including Needs & Services Plan and Psychotropic Medication Records, and three (3) personnel files on site at the facility. LPA interviewed 1 client currently prescribed psychotropic medication and three (3) staff persons. LPA inspected medication bubble packs and reviewed the program statement sections regarding medication. At the conclusion of the inspection, an exit interview was held with the administrator. No citations were issued during the inspection. This concludes the SB Inspection for 2025

met_with: Jazmine Cooks, Administrator


facility_name: ALANA'S HOUSE

summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13On 10/29/21 at 3PM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility to deliver invesitgation findings. LPA met with Facility Manager Patricia McCorkell and informed of purpose of visit. Based on report, the complaint was regarding an incident in which the resident was left unattended at the hospital. Based on confidential interviews with staff, resident, and witnesses, resident R1 (See LIC Confidential Names) was left unattended at the hospital and, during this stay, was administered medication without the hospital obtaining appropriate consent from authorized representatives. Staff statements contradict, but no staff witnessed staff S1, who was delegated to supervise R1, go to the hospital, following R1 in the ambulance. R1's authorized representative notified staff S3 that R1 was unattended at the hospital and that the hospital had no contact for the facility. S3 called the facility and spoke to S1 and informed S1 at that time that S1 needed to be at the hospital with R1. S3 went to hospital, supervised R1, and transported back to facility after discharge. The preponderance of evidence standard has been met, and therefore the above allegation is found to be Substantiated. LPA issued a citation per Short-Term Residential Therapeutic Program Interim Licensing Standards Section 87065. Personnel Duties. An exit interview was conducted, appeal rights provided, and a copy of this report left with Facility Manager Patricia McCorkell. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: ALANA'S HOUSEFACILITY NUMBER: 075650092

met_with: Facility Manager Patricia McCorkell


raw_content:
Narrative:
The preponderance of evidence standard has been met, and therefore the above allegation is found to be Substantiated. LPA issued a citation per Short-Term Residential Therapeutic Program Interim Licensing Standards Section Personal Rights. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Facility Manager Patricia McCorkell.

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:


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
The preponderance of evidence standard has been met, and therefore the above allegation is found to be Substantiated. LPA is issuing a citation of Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Section Personal Rights, which requires the facility to accord residents the personal rights provided in Welfare and Institutions Code Section 16001.9, including 16001.9(a)(1) To be free from unreasonable searches of personal belongings. An exit interview was conducted, appeal rights provided, and a copy of this report left with Facility Manager Patricia McCorkell, whose signature on this form confirms receipt.

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


raw_content:
Investigation Findings:
13On 11/18/22 at 12: PM, Licensing Program Analyst (LPA) Alyssa Ng made an unannounced inspection to the listed facility. The reason for the inspection is to deliver the findings for the allegations listed above. LPA Ng met with Patricia McCorkell, Facility Manager who assisted with the inspection. Based on confidential interviews conducted by LPA Belfield and supportive documentation to include but is not limited to; incident reports and needs and service plans. although the allegation may have happened, there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, this allegation is Unsubstantiated. No violations of California Code of Regulations, Title 22, Division Six or Interim Licensing Standards were cited during this inspection. An exit interview was conducted a copy of this form was given to Patricia McCorkell, Facility Manager. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng 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 3

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

met_with: Patricia McCorkell


summary: Complaint Investigation - Substantiated - 3 allegations

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Shikya Belfield made an unannounced inspection to the above facility 12: PM on 4/10/2023. LPA Belfield met with facility manager Marvette Simmons who assisted with the inspection. The purpose of this inspection is to inform the facility representative of the findings of the above allegation. Based on confidential interviews conducted by LPA Belfield and supportive documentation to include but not limit; needs and serivce plans and incident reports. One at least one occasion staff were inappropriate in their interactions with cleints in care. The proponderance of the evidence has been met and the above allegation is Substantiated. Facility cited for violation of 87072(c) (10) Personal RIghts. An exit interview was conducted a copy of this report, along with appeal rights will be sent to LIcensee Lasondra Jones and Facility Marvette Simmons. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Shikya Belfield LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: ALANA'S HOUSEFACILITY NUMBER: 075650092

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- Estimated Days of Completion: 90

met_with: Marvette Simmons


raw_content:
Investigation Findings:
13At 03:00PM on 10/23/2023, Licensing Program Analyst (LPA) Karmen Balhotra made an unannounced complaint inspection to the facility listed above. The reason for the inspection is to deliver findings for the allegation listed above. LPA met with Marvette Simmons, Manager. Over the course of the investigation, LPA conducted confidential interviews and a file review. Evidence obtained revealed that for the allegations of; Minor is engaging in inappropriate behavior with another minor in care is found to be unsubstantiated. Confidential interviews with clients denied that the incident did not occur. This agency has investigated the complaint alleging the allegations listed above and have found that the complaint is unsubstantiated, meaning that although the allegation may have happened, or is valid, there is not a preponderance of the evidence to prove that the allegations above occurred. Based on today's inspection, no California Code of Regulations were cited. An exit interview was conducted, and a copy of this report was left with Manager. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Karmen Balhotra LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


summary: Complaint Investigation - Substantiated

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


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

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

met_with: Famang Dorley, Assistant Facility Administrator


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Based on facility inspection, observations, and interviews, LPAs found that facility was serving expired food. On March 27, 2025, LPAs issued a type B citation under California Code of Regulations 80076(a) Food Services. LPAs received documentation of correction on April 03, 2025, and cleared citation. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Marvette Simmons, Facility Manager, whose signature on this form confirms receipt.

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

met_with: Marvette Simmons - Facility Manager


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


summary: Facility Evaluation

raw_content:
Narrative:
On Friday 6/25/21 at 10:11AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility to conduct a required annual inspection. A screening call was made prior to the visit. Safety precautions were taken, including face masks, hand sanitizer, disinfectants, and social distancing. Additionally, LPA tested negative for COVID-19 on Monday 6/21/21 and does not have any symptoms of COVID-19. LPA met with Facility Manager Patricia "Pat" McCorkell and informed of the purpose of the visit. At 10:20AM, LPA inspected the facility site and grounds. The facility is organized and free of debris. LPA observed that the facility is clean and commonly used surfaces are clean. However, LPA advised that the facility could wipe down cabinet doors, doorways, and bedroom walls in unused rooms in preparation for new placements. The grounds are free of obstructions and are well-maintained. LPA observed that the recycling was stored in a trash bag in the backyard. LPA suggested that recycling be kept in a bin or a recyclable bag in a bin. Hot water and room temperature measured within permitted ranges at 112. F and F, respectively. The kitchen is stocked with food to meet the needs of the residents in care and meets the mandated 7-day non-perishable and 2-day perishable standard. Food items are in date and are labeled by date of purchase. Cleaners and sharps are kept in locked storage areas downstairs, and the laundry room cleaners are locked. LPA observed a shower cleaner under the sink of the downstairs bathroom that is locked and used for staff. However, currently it is being used for residents while the upstairs bathroom is being updated. Pat immediately removed the cleaner. There is a sign-in and screening table set up by the front entrance. Youth personal rights, emergency plan, and facility sketch visibly posted. LPA advised that the license should be posted in a visible location so it is visible to visitors. It can also be posted in the office. LPA inspected staff and client files and observed the files to be mostly complete, but the following items were missing: 2020- Training record for staff S1, S2, S3; Physician's Report for R2; LIC 601 for R1 (see LIC Confidential Names). Pat was able to complete R1's LIC 601 at visit, and R2's file indicates the physical was done but the form needs to be taken back to the doctor to be filled out and signed. During visit, LPA was informed that the upstairs bathroom shower/tub was being updated. LPA was not informed of this alteration and advised the facility that the Licensing agency should be notified prior to any alteration to the facility site, especially when it restricts residents' access to parts of the facility. LPA requested copies of the most current LIC 610 and LIC 500 no later than Friday 7/2/21. LPA spoke to Administrator LaSondra Jones, who said she has finished her training and needs to send in her request for recertification. Once she has done so, she will let LPA know, and she will send the new certification to LPA. There are no citations. Three advisories are being issued, per California Code of Regulations, Title 22, Sections 80087 and 80086 and Short-Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) Section 87066. An exit interview was conducted, and a copy of this report was left with Facility Manager Patricia "Pat" McCorkell, whose signature on this form confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On Tuesday, May 10, 2022 (05/10/2022) at 11AM, a meeting was held with the provider to discuss the facility's current status on the pending mental health components of the short-term residential therapeutic program (STRTP) and the facility's upcoming expiration of the provisional period on June 15, 2022 (06/15/2022). In attendance from the facility were Director LaSondra Jones and Consultant Candis Bazley; from Community Care Licensing (CCL) were Regional Manger Nelson Martinez, Licensing Program Manager (LPM) Helga Wong, LPM Isabel Mendoza, and Licensing Program Analyst (LPA) Mariah Hawkins; from the Department of Health Care Services (DHCS) was Alexandria Andrews; and no representatives from Alameda County were able to attend. The following was discussed: 1. The facility has a valid contract with Alameda County that expires on 06/30/2022. The renewal paperwork has been submitted and is being processed. 2. The Medi-Cal certification is with Alameda County, who informed the facility that the documents have been submitted. 3. The facility is fully accredited through 2025. 4. The facility received a revisions request for minimal revisions from DHCS. The revised program will be submitted this week. The reviewer is expected to contact the facility next week to schedule an on-site review. DHCS is unable to provide a specific timeline, but it is expected that the facility canreceive a mental health program approval by 06/15/22. In case all components cannot be completed, to provide notice to the counties of the possibility of facility closure, the facility agrees to develop and send out a closure plan by Monday 05/16/22. A copy of this report was sent to Director LaSondra Jones, whose signature on this form confirms receipt.

met_with: Director LaSondra Jones


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 6/20/22 at 10:36AM, Licensing Program Analysts (LPAs) Mariah Hawkins and George Karkazis made a visit to the Short-Term Residential Therapeutic Program (STRTP) to conduct a random annual inspection. LPAs met Facility Manager Marvette Simmons and informed of the purpose of the visit. Safety precautions were taken, including mask-wearing, pre-visit screening call, and entry screening. The CARE Inspection Tool was used to conduct this inspection. The facility was observed to be clean and organized. Kitchen and bathrooms were sanitary. There were utensils, dishware, and food supplies to meet the needs of the residents in care. Residents had individual beds with clean linens, and the facility had stock of spare linens. The below violations were found, and a continuation visit will need to be conducted to complete the inspection. 1) Hot water at upstairs resident bathroom measured 127. F. The water heater was turned down, and hot water measured 124. F. Facility posted a sign at visit cautioning of hot water. LPAs issued a citation of Title 22, Section 80088. 2) Resident R3 (See LIC Confidential Names) is age 18, and there is no approved age exception in the file. LPAs issued a citation of Title 22, Section 80010. 3) No emergency drills were logged for 2022. Facility manager was able to find in the daily shift notes that a drill was conducted in March 2022. However, this drill was not documented in the drill log binder. LPAs issued a citation of Title 22, Section 80023. 4) Medications had been transferred from the originally received container, stored in the upstairs staff office, to a daily dispenser, stored in the downstairs locked closet. LPAs issued a citation of Title 22, Section 80075. 5) The needs and services plans for two residents (See LIC 811) had not been updated every 30 days. One youth's file contained a plan dated 4/29/22, more than 30 days before today's date, and one youth had plans dated 4/28/22 and 2/24/22, more than 30 days between these reports. LPAs issued a citation of STRTP Interim Licensing Standards (ILS) Section 87068.3. Please refer to the attached LIC 809-D pages for the above deficiencies. Please refer to the attached LIC 9102 advisory notes also discussed at today's visit. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Facility Manager Marvette Simmons, whose signature on this form confirms receipt.

Deficiencies:
87068.3(a): (a) The needs and services plan specified in Section 87068.2 shall be updated at least every 30 days to determine the following

met_with: Facility Manager Marvette Simmons


summary: Facility Evaluation

raw_content:
Narrative:
On 7/7/22 at 11:09AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for an annual continuation. LPA met with Direct Care Worker Cynthia Alvarez and Facility Manager Patricia McCorkell and informed of the purpose of the visit. Refer to LIC 809 dated 6/20/22 for the initial portion of the annual inspection. The following additional deficiencies were cited at today's visit. See attached LIC 809-D. 1) Two staff are missing health screening and/or TB documentation. LPA is issuing a citation of California Code of Regulations, Title 22, Section 80065. 2) Four staff have first aid certificates that expired last month. LPA is issuing a citation of California Code of Regulations, Title 22, Section 80075. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Facility Manager Patricia McCorkell, whose signature on this form confirms receipt.

met_with: Direct Care Worker Cynthia Alvarez; Facility Manager Patricia McCorkell