raw_content:
Narrative:
...CONTINUED Confidential interviews and records reviewed indicated that C1 had a personal cell phone from their relative while living at the above facility, despite C1's Child and Family Team determining C1 should not have a personal cell phone due to their risky behaviors and C1 not following the facility's cell phone policies. A review of interviews conducted by county investigators indicated that S2 was physically abusive to C1 in an attempt to take their cell phone; however, there was no disclosure of staff reaching in C1's pocket or touching C1's privates. A conflicting confidential interview indicated S2 went to pick up C1's phone charger after they had dropped it, leading to C1 being assaultive to S2 while accusing S2 of being assaultive toward C1. Confidential interviews and records reviewed indicated that law enforcement and paramedics were called to the home and determined no crime had been committed and C1 to have no injuries. Confidential interviews with other clients in the home have yielded conflicting information as to S2's conduct with the clients; however, none of the interviews indicated that S2 touched clients in private areas. Due to conflicting information, it was unable to be determined during the investigation whether staff did not allow C1 to possess their personal belongings. Based on confidential interviews and records reviewed, the allegations that a staff interacted inappropriately with a minor in care and staff did not allow a minor in care to possess their personal belonging are unsubstantiated. The allegations may have happened or are valid, but there is not a preponderance of evidence to prove that the alleged violations occurred. An exit interview was conducted with Kandice Nelson, Licensee and a copy of this report and appeal rights were provided.

Investigation Findings:
13On November 5, 2025, at 2: PM, Licensing Program Analyst (LPA) Jacob Salem met with Kandice Nelson, Licensee of Nelson Place to deliver the findings for the above-stated allegations. LPA Salem initiated a complaint inspection at the facility on 2/14/2025 at 2: PM and no immediate deficiencies were observed. During the investigation, LPA Salem interviewed Clients (C2 and C3), Staff (S1 and S2), and County Social Worker (CSW). C1 declined to be interviewed. Pertinent records were obtained and reviewed. On February 7, 2025, Community Care Licensing (CCL) received the allegations that staff (S1) interacted inappropriately with a minor (C1) in care, and that staff (S1) did not allow a minor (C1) in care to possess their personal belonging. It was reported that S1 stepped on C1's toes and pushed C1 into a wall while trying to take C1's cell phone. It was later reported that while trying to take C1's phone out of their pocket, S1 voluntarily or involuntarily touched C1's privates. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Jacob Salem LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # San Diego, CA Facility Name: Nelson Placefacility Number: Visit Date: 11/05/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32...CONTINUED Confidential interviews and records reviewed indicated that C1 had a personal cell phone from their relative while living at the above facility, despite C1's Child and Family Team determining C1 should not have a personal cell phone due to their risky behaviors and C1 not following the facility's cell phone policies. A review of interviews conducted by county investigators indicated that S2 was physically abusive to C1 in an attempt to take their cell phone; however, there was no disclosure of staff reaching in C1's pocket or touching C1's privates. A conflicting confidential interview indicated S2 went to pick up C1's phone charger after they had dropped it, leading to C1 being assaultive to S2 while accusing S2 of being assaultive toward C1. Confidential interviews and records reviewed indicated that law enforcement and paramedics were called to the home and determined no crime had been committed and C1 to have no injuries. Confidential interviews with other clients in the home have yielded conflicting information as to S2's conduct with the clients; however, none of the interviews indicated that S2 touched clients in private areas. Due to conflicting information, it was unable to be determined during the investigation whether staff did not allow C1 to possess their personal belongings. Based on confidential interviews and records reviewed, the allegations that a staff interacted inappropriately with a minor in care and staff did not allow a minor in care to possess their personal belonging are unsubstantiated. The allegations may have happened or are valid, but there is not a preponderance of evidence to prove that the alleged violations occurred. An exit interview was conducted with Kandice Nelson, Licensee and a copy of this report and appeal rights were provided. SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: Jacob Salem LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of 2

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


state: CA

facility_name: NELSON PLACE

summary: Facility Evaluation

raw_content:
Narrative:
On January 9, 2025, at 12: PM, Licensing Program Analyst (LPA) Jacob Salem met with Danielle Nelson, Designee, for the purpose of conducting a pre-licensing inspection for a Small Family Home. Applicant Kandice Nelson is applying for a license for six ambulatory clients. The home is a two story residence located on a residential street. LPA and Applicant Nelson toured the home inside and out. The home is currently empty and unfurnished due to the the applicant's current facility still utilizing the furniture and other supplies. LPA observed the applicant's current facility to be in compliance and contain all the necessary provisions, such as bedding and storage closet for files and medications, and Applicant Nelson stated that all furniture and equipment currently in use will be brought to the new home upon relocating with the clients in care. The current home contains a kitchen, two living rooms, garage, backyard, and will have a storage closet where client files will be stored. The license, LIC 610C, and Personal rights will be posted in the front hallway upon the applicant and clients relocating to the home. The upstairs bedrooms will be set up as follows: - Bedroom 1: sleeping two clients - Bedroom 2: sleeping one client - Bedroom 3: sleeping one client - Bedroom 4: sleeping one client - Bedroom 5: sleeping one client - Bedroom 6: applicant's master bedroom The client bedrooms have ample lighting and are in good repair with adequate storage space for clothing and personal belongings. The applicant has a working and recently inspected fire extinguisher, and complete first-aid kit and manual. The kitchen contains working and clean appliances for food preparation, storage, and cleaning. Continued... ...CONTINUED There were no safety or health hazards observed during the walk though of the home and property. There is a central heating/air conditioning unit in the home located upstairs and additional A/C units downstairs to keep the home at a comfortable temperature. Client bathrooms are clean and appliances are in working order. Windows and screens were inspected and are in good repair. The following deficiencies were observed: 1. Hot water temperature controls in client bathrooms does not automatically regulate water temperature between 105 degrees and 120 degrees, and there are no warning signs for hot water. The request for a license will be forwarded to Licensing Program Manager Dawn Segura for final approval once the deficiency is cleared. Due to printer malfunction, an exit interview was conducted and a copy of this report was emailed to Danielle Nelson, Designee.

report_type: Facility Evaluation

visit_type: Prelicensing

met_with: Danielle Neslon, Designee


summary: Facility Evaluation

raw_content:
Narrative:
On March 28, 2025, at 10: AM, Licensing Program Analyst (LPA) Jacob Salem conducted an unannounced visit to the above facility for the purpose of conducting an post-licensing inspection and met with Kandice Nelson, Licensee. LPA reviewed three client files (C1-C3), which are kept locked in the licensee's office. The client files reviewed contain required information, such as placement agreements, health and immunization records, and authorized representative information. LPA reviewed staff files (S1-S3), which contain the required background clearance documentation, demographic information, and health screenings. LPA conducted two staff interviews. LPA inspected the facility's physical plant, including personal rights postings, health related services, buildings and grounds, food services, telephones, indoor and outdoor activity space, and furniture, fixtures, equipment and supplies. The home is clean, in good repair, and free from observable risks to clients' health, safety, and personal rights. The home is a two story building with three client bedrooms in use and two client bathrooms which are set up as follows: Bedroom #1 has one twin bed and sleep one client, bedroom #2 has one twin bed and sleeps one client, bedroom #3 has one twin bed and sleeps one client, and master bedroom used by the licensee and spouse. There is a kitchen and living room, multiple family room areas, upstairs office and storage closets, and backyard/patio. Due to time constraints, the annual is being extended to conduct client interviews. An exit interview was conducted and a signed copy of this report was provided to Kandice Nelson, Licensee.

met_with: Kandice Nelson, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On April 4, 2025 at 10: AM, Licensing Program Analyst (LPA) Jacob Salem conducted an unannounced visit to the above facility and met with Kandice Nelson, Licensee. The purpose of this Case Management inspection is to conduct an post-licensing continuation from 3/28/2025. LPA conducted client interviews. Based on observations made during the inspection, there were no deficiencies cited at this time. An exit interview was conducted with Kandice Nelson, Licensee and a signed copy of this report.

visit_type: Case Management


summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Narrative:
Continued... Confidential interviews and records reviewed indicated that staff (S4) would watch over minors and make them cry by yelling at them. Confidential interviews indicated that staff (S1) was also making minors cry by yelling at them. Confidential interviews reported that staff (S1) and (S4) (See LIC 811 dated 12/04/2025) go into minor's bedroom, make them shower with curtain open, and do not allow them to use the phone to contact their family or worker. A review of confidential interviews conducted by LPA's reported staff (S4) does not watch over minors in the home or discipline minors in care, reported no staff in home yell at minors in care, and reported minor's biological family members interfere with the care being provided by the licensee and staff. Confidential interviews denied that staff violated any personal rights of the clients. Confidential interviews revealed some minors in care are non-verbal and unable to conduct interviews. LPAs found inconsistencies with the information obtained. Based on confidential interviews and records reviewed, the allegations that adult in foster home handle foster children in a rough manner, and resource parent interferes with foster children's unsupervised visitation, are unsubstantiated. The allegations may have happened or are valid, but there is not a preponderance of evidence to prove that the alleged violations occurred. An exit interview was conducted with Kandice Nelson, Licensee and a copy of this report and appeal rights were provided.

Investigation Findings:
13On December 4, 2025, at 12: PM, Licensing Program Analyst (LPA) Reyna Martinez met with Kandice Nelson, Licensee of Nelson Place to deliver the findings for the above-stated allegations. LPA Jacob Salem initiated a complaint inspection at the facility on 07/21/2025 at 10: AM, conducted a health and safety inspection of the home, and no immediate deficiencies were observed. During the investigation, LPA Salem interviewed Clients (C1 and C2), and Staff (S1 and S5). LPA Martinez interviewed Complainant (CC), Staff (S2 and S4) and Court Child Advocate (AC). Pertinent records were obtained and reviewed. On July 15, 2025, Community Care Licensing (CCL) received an email from the reporting party who received a complaint from CC with allegations that staff (S4) have been physically aggressive with minors (C1) and (C2). It was reported that staff (S4) grab their wrists tightly and yank their arms forcefully. It was reported that staff (S1) interferes with minors (C1) and (C2) sibling contact. It was reported that staff (S1) blocked and deleted minor (C2) Roblox account that was being used to communicate with older sibling. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Reyna Martinez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # San Diego, CA Facility Name: Nelson Placefacility Number: Visit Date: 12/04/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32continued... Confidential interviews and records reviewed indicated that staff (S4) would watch over minors and make them cry by yelling at them. Confidential interviews indicated that staff (S1) was also making minors cry by yelling at them. Confidential interviews reported that staff (S1) and (S4) (See LIC 811 dated 12/04/2025) go into minor's bedroom, make them shower with curtain open, and do not allow them to use the phone to contact their family or worker. A review of confidential interviews conducted by LPA's reported staff (S4) does not watch over minors in the home or discipline minors in care, reported no staff in home yell at minors in care, and reported minor's biological family members interfere with the care being provided by the licensee and staff. Confidential interviews denied that staff violated any personal rights of the clients. Confidential interviews revealed some minors in care are non-verbal and unable to conduct interviews. LPAs found inconsistencies with the information obtained. Based on confidential interviews and records reviewed, the allegations that adult in foster home handle foster children in a rough manner, and resource parent interferes with foster children's unsupervised visitation, are unsubstantiated. The allegations may have happened or are valid, but there is not a preponderance of evidence to prove that the alleged violations occurred. An exit interview was conducted with Kandice Nelson, Licensee and a copy of this report and appeal rights were provided. SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Reyna Martinez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of 2

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

report_type: Complaint Investigation

met_with: Kandice Nelson

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
reported that S2 "smelled like weed" and that their eyes appeared low and red. Confidential interviews reported that S2 is a good driver and did not appear tired or impaired while driving. Additional confidential interviews indicated that S2 stayed up late the night before the park trip assisting C1 with behavioral issues; however, this did not appear to affect S2's ability to safely transport clients. Confidential interviews also reported that the allegation against S2 was made in retaliation for C1 being transferred to another facility. Other confidential interviews stated that during the CSW's visit to the facility, no staff members were observed to be under the influence. LPA was unable to receive additional information. Based on confidential interviews, the allegation that staff transported minors while under the influence of marijuana may have occurred; however, there was not a preponderance of evidence to support the alleged violation. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report and appeal rights were explained and provided to Licensee Kandice Nelson.

Investigation Findings:
13On 01/23/2026, at 8:51 a.m., Licensing Program Analyst (LPA) Joon Choi conducted an unannounced visit to Nelson Place Small Family Home (SFH). LPA Choi met with Licensee Kandice Nelson, to deliver the investigative findings regarding the allegation listed above. On 04/30/2025, Community Care Licensing received an allegation that staff transported minors while under the influence of marijuana. On 05/08/2025, LPA Jacob Salem arrived at the facility, conducted a health and safety inspection, and obtained pertinent documents. No immediate health and safety hazards were observed. During the visit, LPA Salem interviewed Client 3 (C3); Staff 1, 2, and 3 (S1-S3); and the County Social Worker (CSW). Client 2 (C2) declined LPA Salem's request for an interview. Client 1 (C1) was unavailable for an interview, as they had not returned LPA Choi's contact request. Regarding the allegation that Staff 2 (S2) transported minors (C1-C3) while under the influence of marijuana, it was reported that S2 appeared impaired while driving the minors to the park. It was further CONTINUED ON THE NEXT PAGE UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Joon R Choi LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: NELSON PLACEFACILITY NUMBER: VISIT DATE: 01/23/2026

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


raw_content:
Narrative:
Confidential interviews reported that upon initial placement at the facility, C1 engaged in disruptive and unsafe behaviors. Confidential interviews further indicated that C1's behaviors negatively impacted C2 and C3. Interviews consistently reported that facility staff redirected C1 using trauma-informed techniques. Confidential interviews stated that C1 did not respond well to redirection and would escalate behaviors. C1 was unable to be interviewed, as they did not respond to requests for an interview. Regarding the allegation that adult in the home (S3) threatened foster child (C1), it was specifically alleged that staff 3 (S3) threatened C1 by pointing a cane at them and threatening to hit C1. Confidential interviews confirmed that S3 uses a walking cane for mobility assistance. Interviews reported that during the incident described in the complaint, S3 was redirecting C1 and reminding them that cell phone use was required to occur in a designated area of the facility. Some confidential interviews stated that S3 appeared to point the cane at C1 in an aggressive manner. Other confidential interviews reported that S3 was not using the cane in a threatening manner but was instead pointing toward the area where phone use was permitted. Confidential interviews further reported that review of video surveillance footage showed S3 was not using the cane in a hostile or threatening manner. Additionally, confidential interviews indicated that during the CSW's visits to the facility, staff were not observed engaging in threatening behavior toward minors. Based on confidential interviews and review of available evidence, the allegations that C1 was not accorded dignity and respect and that an adult in the home threatened C1 may have occurred; however, there was not a preponderance of evidence to support the alleged violations. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted. A copy of this report and appeal rights were explained and provided to Kandice Nelson, Licensee.

Investigation Findings:
13On 01/23/2026, at 09: AM, Licensing Program Analyst (LPA) Joon Choi conducted an unannounced inspection at Nelson Place Small Family Home (SFH). LPA Choi met with Licensee Kandice Nelson to deliver the investigative findings for the allegations listed above. On 05/01/2025, Community Care Licensing received allegations that a foster child was not accorded dignity and respect and that an adult in the home threatened a foster child. On 05/08/2025, LPA Jacob Salem arrived at the facility, conducted a health and safety inspection, and obtained pertinent documents. No immediate health and safety hazards were observed. LPA Salem interviewed Clients 2 and 3 (C2, C3), Staff 1, 2, and 3 (S1-S3), and the County Social Worker (CSW). Client 1 (C1) was unable to be interviewed, as they did not respond to LPA Choi's requests for contact. In regard to the allegation that foster child (C1) not accorded dignity and respect, it was reported that C1 ran away from the facility due to the way staff spoke to them; however, no specific details were provided. CONTINUED ON THE NEXT PAGE UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Joon R Choi LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: NELSON PLACEFACILITY NUMBER: VISIT DATE: 01/23/2026

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


facility_name: NEW BEGINNINGS SFH

summary: Facility Evaluation

raw_content:
Narrative:
On June 17, 2025, at 08:25AM, Licensing Program Analysts (LPAs) Rachel Vanegas and Carissa Aviles met with New Beginnings Small Family Home Applicants, Shanika Ezeribe (Applicant 1) and Johnteaera Green (Applicant 2), at the Riverside Children's Residential Program Regional Office for the purpose of conducting a Component II meeting. LPAs discussed corrections and revisions needed for the Program Statement. The following is a summary of the corrections and revisions discussed and requested. These revisions are due by close of business on July 02, 2025. A2. Applicant Information (LIC 215) - Please request and provide reference letters from current employment identified for Applicant 1 and Applicant A9. Budget Information (LIC 420) - Please review and revise Source of Income A12. Health Screening Report (LIC 503) - Please review and provide an updated document for Applicant 1 to include physician's stamp A13. Criminal Record Statement - Please complete LIC O-O-S in Guardian for Applicant 1, background clearance is still pending. A15. Facility Sketch (LIC 999) - Please review and revise the facility sketch to include identification of all "Doors" ** ** Program Statement Corrections Needed B7. Facility Program Description Please add page numbers to the entire document and include a Table of Contents Please clarify client population intended for your program Identify client age ranges and ambulatory status. Identify client placement source Please revise section or include "planned activity program" because your program description states "see sample" but is not included Duties and Responsibilities of New Beginnings Small Family Home Please review and identify timelines for Needs and Services Plans (A7) Please review and include notification to Community Care Licensing when the Licensee will be out of the home for longer than 48hrs (B2) Please review and revise reference to regulations stated to ensure accuracy and correctness Please explain what a "Substitute Parent" means Discipline Policy - Please provide more information regarding Documentation; how will disciplinary actions be documented, where will they be documented, how will you report "serious disciplinary actions". - Please include statement for types of discipline not permitted Personal Rights - Please include all foster youth bill of rights, they currently aren't all listed. - Please review, revise, or include your reference to B9. It is not attached or present in the section you mention it in. B9. Admission Policies - Please review and revise this section to clearly indicate it's location and purpose in the program description (Table of Contents) - Please clarify optional services to ensure that access to basic services are still provided to client's if optional services are not purchased (for example: basic grooming, clothes, necessities, etc.) ** ** - Please clarify "government funded programs" identified in this section (pg. 2) - Please review and revise or remove reference for Inland Regional Center if it is no longer applicable as a placement source - Please clarify responsible party for payment of services, authorized representative or placement agency Admission Assessment - Please identify "CSW" and other abbreviations used with full spelling and abbreviation prior to use - Please remove "IRC" if it is no longer applicable as a placement source - Please include timeline of within 30 days of placement for the Needs and Services plan to be completed for clients in care - Please review and revise inclusion of client's signature also being obtained for the Needs and Services Plan - Please include regulated health screening for clients within 30 days of placement and inclusion of tuberculosis screening documentation - Please review and include reporting requirements for incidents involving medical treatment for a client in care - Please review and include reference and use of the Medication Administration Record (MAR) and Psychotropic Medication Administration Record (PMAR) for documentation of medication for clients in care - Please include that there can be temporary administration of psychotropic medication authorized on the JV220(A) Physician's Statement while the JV223 is pending - Please remove repeated information regarding "Welfare and Institutions Code section 739.5 provides:" - Please review and revise additional personal rights listed and clarify that access to a phone for emergency calls or calls related to complaint reporting, etc. cannot be restricted - Please remove non-applicable rights (only list personal rights relative to Title 22 regulations, foster care bill of rights, etc.) New Beginnings Small Family Home House Rules - Please review and clarify Rule #2 regarding children not being allowed to touch knives. It is regulated that knives are to be locked and inaccessible to clients in care - Please review and revise or remove the repeated Refund Policy in this section. ** ** Sample Menu - Please remove "Bio" from the Sample Menu cover section - Please include the regulation of 2 days' worth of perishable foods and 7 days' worth of non-perishable foods - Please review and revise the sample menu provided for correct meal item/times Medical and Other Emergency Plans and Procedures - Please review and remove the mention of Inland Regional Center notifications if no longer applicable - Please include initial reporting requirement of 24hr notice and then a full written report within 7 days - Please include method of documenting disaster drills and record keeping - Please include the COVID- Guide that is referenced or remove the reference to it in this section. It is not currently present - Please review and revise formatting on sections for emergency planning - Please review and revise relocation sites listed in this section to match submitted LIC 610C relocation sites OR update LIC 610C to reflect these relocation sites - Please identify the time frame for reporting a client in care is a missing person Emergency Procedures - Please include job title or person responsible for "Things To Do" section Medication Procedure - Please review and clarify or remove the reference to "ELH" - Please review and revise medication storage guidelines to ensure that all medications are securely stored and inaccessible to clients in care at all times - Please review and clarify the definition of Manager VGII - Please review and identify the use of "ML" in relation to the Medication Administration Record (MAR) usage - Please review and include the use of documentation for medication refusal by a client for prescribed medications ** ** - Please include the identification of the responsibility party for ensuring the ongoing monitoring for accuracy and completeness of the MAR/PMAR - Please review and identify what a TAR is and spell out/define the abbreviation before using it - Please review and provide further clarity for liability of medication refills, person responsible. - Please review and clarify the use of the word "mitten" as used in this section - Please review and identify where a client's medication refusal will be documented - Please review and reference where the documentation of a discarded medication will be logged. - Please review and include the use of and logging for Psychotropic Medication Administration Record (PMAR) - Please review and identify PRN medications Transportation - Please revise the transportation section to include correct guidelines for the California Child Car Seat Law For example: Rear-facing seat guidelines Incident Reporting - Please review and revise reference to Title Regulations - Please include incident reporting guidelines and timelines for reporting requirements Consumer Internal Grievance Procedures - Please review and identify the meaning of "CSC" - Please review and revise the grievance procedure time frame, as there is conflicting information stating two weeks, but also a statement for 10 days. Cause for removal from placement - Please review and provide clarity for "30-day written will be sent..." - Please review and provide clarity for process of removal without reference to eviction. Clients cannot be evicted from placement. ** ** Sign-In Sign-Out Procedure - Please review and provide clarity for authorized use of "self-passes" or only authorized outings to include authorized representative signature, etc. - Please revise the statement of an included copy of the sign in/sign out sheet because it is not currently included OR include the sheet - Please review and revise COVID- Protocol and Health Screening - Please review, revise, remove, or consolidate this section as there are currently two of the same page present. B16. First Aid Card - Please provide an updated CPR/First Aid Card for Applicant Please review and include information regarding Camera Uses and Locations in accordance with Children's Residential Program Provider Information Notice 24- LPAs Vanegas and Aviles conducted an exit interview and a copy of this report along with the signed LIC 281C, Care Tools Pre-licensing form, and Children's Residential Program Provider Information Notice 24-09, and appeal rightswere reviewed and provided to the applicants, Shanika Ezeribe and Johnteaera Green.

met_with: Applicant - Shanika Ezeribe Applicant - Johnteaera Green


summary: Facility Evaluation

raw_content:
Narrative:
On August 1, 2025 at 09:45AM, Licensing Program Analyst (LPA) Rachel Vanegas arrived at New Beginnings Small Family Home (SFH) to conduct a pre-licensing inspection. LPA met with Applicants Shankia Ezeribe and Johnteaera Green who led a tour of the home. The home was toured both inside and out with the applicants. Currently there are no clients in placement. The home is a two story building with four bedrooms and three bathrooms which are set up as follows: Bedroom #1 (Master) has two beds and sleeps the Applicants. It has one crib to sleep an infant client Bedroom #2 (Clients) will have two single beds and sleep two clients Bedroom #3 (Clients) has two single beds and will sleep two clients Bedroom #4 (Clients) has one single bed and will sleep one client The home also consists of a great room/living room, kitchen, dining area, three full bathrooms, a laundry room, a two car garage, and the backyard. There is a properly fenced and secure fire place in the living room. The home has a functioning land line phone in the living room, accessible to clients in care. The Client's bedrooms were arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. There was adequate closet and drawer space for the client's belongings. There were smoke and carbon monoxide detectors in every bedroom and hallway. The combo smoke and carbon monoxide detectors were checked and in properly functioning order. The home's central air conditioning module was located in the back yard. The home's water heater was located in the garage. *Continued on the next page* The home appliances were in working order at the time of this inspection. The client and staff files will be in a locked storage closet in the living room. There was adequate food storage space. LPA observed a two day supply of perishable and a seven day supply of non-perishable food. A trash can for storage of solid waste had a tight-fitting lid and was present in the kitchen. The sharp knives and cleaning chemicals/laundry detergent are in a locked storage cabinet in the garage, inaccessible to clients. The medications will be located in a locked box in the master bedroom. Additional cleaning chemicals are located in a locked kitchen cabinet under the kitchen sink. The hot water was measured in the kitchen and registered at 102.9 degrees Fahrenheit. The home has two First Aid kits that were accessible and contained all required items/supplies. One is located on the first floor in the living room and one is located in the hallway restroom on the second floor. There were two fire extinguishers present in the home one located in the kitchen near the sink and one located on the second floor in the hallway. Fire extinguishers were observed to be properly charged and inspected by the fire department. There are no firearms or weapons in the home as stated by the applicants. There is no pool or body of water at the home at the time of this inspection. The backyard where clients will have access to play is fenced. At the time of this inspection, the backyard has a metal ladder and lawn mower inappropriately stored causing a hazard in the outdoor activity space for clients. The home has one security camera located on the front entrance doorbell. The following corrections need to be made: Final revisions to program statement including sample admission agreement revisions discussed today, camera policy revisions in accordance with Children's Residential Program Provider Information Notice 24-09. Updated LIC 999 to align with Bedroom #1 and #2 changes. Add single bed in Bedroom # Removal or proper storage of hazards identified in the outdoor activity space, backyard. Addition of a dining table to accommodate appropriate seating space for clients in care. Confirmation of water temperature within regulated range (105 - 120 degrees Fahrenheit) Component III was completed during this visit. An exit interview was conducted a copy of this report and appeal rights were reviewed and provided to the applicants, Shankia Ezeribe and Johnteaera Green. Application will be forwarded to the Licensing Program Manager for Licensing upon receipt and confirmation of corrections made to the Program Statement and Physical Plant.


facility_name: NEW JOURNEY

summary: Facility Evaluation

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Narrative:
On June 3, 2025 at 9:30AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with Applicant Shemeen Lewis for a Component II of the application process. Lpa a. Caballero went over revisions needed for the application prior to license and are due no later than July, 3, 2025. Lpa a. Caballero provided applicant with a copy of the LIC 184, Notice of Incomplete Application and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant via email. The original signed copy of this report will be placed in the facility file.

met_with: Applicant-Shemeen Lewis


summary: Facility Evaluation

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Narrative:
On June 16, 2025, at 9:40AM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a pre-licensing inspection of New Journey Small Family Home (SFH). LPA met with Applicant Shemeen Lewis who led a tour of the home. The facility was toured both inside and out with the applicant. There are no clients in placement. The home is a two-story building with five bedrooms and three full bathrooms which are set up as follows: Bedroom #1- It consisted of one queen bed. The bed had linen, comforters, and pillows. It will sleep applicant. Bedroom #2- It consisted of one single bed. The bed had linen, comforters, and pillows. It will sleep one client. Bedroom #3- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. Bedroom #4- Not furnished. It will be utilized for guests. Bedroom #5(first floor)- It will be utilized as an office. A living room, kitchen, dining area, loft, laundry room, two car garage, and a backyard. The garage will be utilized for storage. The clients' bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the clients' belongings. There was a smoke detector in every bedroom. The eight smoke detectors were checked and working properly. The Carbon Monoxide detector was located in the loft area. The home's central air conditioning module was in the backyard. The water heater was in the garage. The appliances were in working order. The clients' and staff files were locked inside a filing cabinet in the office. Medications will be locked in a lock box in a kitchen cabinet. There was adequate food storage space and a supply of perishable food and non-perishable food. The home had a trash can for storage of solid waste inside a sliding cabinet. The hot water was at a temperature of 115.3 degrees Fahrenheit. There was one fire extinguisher present in the home located in the foyer. It was observed to be properly charged and inspected by the fire department. The First Aid Kit was located in the office accessible to clients in care. There are no firearms in the home. There is no pool in the home. The backyard is fully fenced and free of debris. The home has two cameras on the outside premise of the home. Emergency Disaster Plan (LIC 610), Personal Rights, Grievance procedures, and Visitation Policies were posted in the garage accessible to the public. Corrections: Camera Usage added to Program Statement per (PIN 24-09-CRP) All chemicals, sharps, and cleaning solutions must be locked and inaccessible to clients in care. Component III was conducted. An exit interview was conducted, and a copy of this report was provided to applicant Sheemen Lewis via email. The application will be forwarded to Licensing Program Manager Abdoulaye Traore once corrections are submitted to LPA.


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Other confidential interviews stated that C1 was grabbed by the forearm, resulting in redness to C1's forearm. LPA received conflicting statements regarding this allegation. Regarding the allegation that the licensee did not prevent a minor from being verbally abused while in care, it was specifically reported that staff made inappropriate statements to C1. Confidential interviews and record reviews indicated that C1 has a history of being verbally aggressive and easily triggered. Other confidential interviews stated that S1 and S2 used inappropriate language when communicating with C1. LPA received inconsistent information during the investigation. Based on confidential interviews and record reviews, the allegations that the licensee did not prevent C1 from being physically abused while in care and did not prevent C1 from being verbally abused while in care may have occurred; however, there was not a preponderance of evidence to support the alleged violations. Therefore, the allegations are determined to be unsubstantiated at this time. An exit interview was conducted, and a copy of this report along with appeal rights was provided to Licensee Shemeen Lewis.

Investigation Findings:
On 01/14/2026 at 10:11AM, Licensing Program Analyst (LPA) Claudia Aguilera arrived at New Journey Small Family Home and met with Licensee Shemeen Lewis to deliver the findings regarding the above-stated allegations. On 10/28/2025, Community Care Licensing received a complaint alleging that the licensee did not prevent a minor from being physically abused while in care and did not prevent a minor from being verbally abused while in care. On 11/05/2025, LPA C. Aguilera initiated the investigation and conducted a health and safety inspection. No immediate deficiencies were observed. In addition, LPA C. Aguilera interviewed the licensee (S1), one staff member (S2), and one client (C1), and collected pertinent documents. Regarding the allegation that the licensee did not prevent a minor from being physically abused while in care, it was specifically reported that a staff member caused injury to C1, leaving a mark. During the investigation, confidential interviews indicated that C1 was escorted by the arm out of a prohibited area of the home. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Claudia Aguilera 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 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: NEW JOURNEYFACILITY NUMBER: VISIT DATE: 01/14/2026

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

met_with: Licensee, Shemeen Lewis


facility_name: NIA SANCTUARY

summary: Facility Evaluation

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Narrative:
On 8/21/24, Licensing Program Analyst (LPA) Kristin Pierotti and LPA Mariah Hawkins conducted a post-licensing inspection. LPAs met with Licensee Betheny Jordan and informed of the purpose of the visit. LPAs used the CARE Inspection Tool to complete this inspection. LPAs toured the facility site and inspected facility records. One resident interview was conducted. LPAs observed the facility to be maintained in safe condition, kitchen and bathrooms were in sanitary condition, resident bedrooms were furnished and offered clean linens and plenty of storage space, and potentially dangerous items, including chemicals, knives, and medications, were stored where inaccessible to the resident in care. LPAs observed some food cabinets in the kitchen are locked for client's safety as recommended by the client's physician. LPAs advised that an exception request must be made for having locks. LPA came to know through talking with Licensee that they assist the client with their injection medication. LPA advised that Licensee speak with pharmacist to ensure proper administration of the medication and requested the training details of the Medication Education training that both Licensee and licensee's husband have obtained. LPAs observed staff and client files to be complete. LPAs observed that there is no record of psychotropic medication administration. LPA is issuing a Type B citation of Title 22, Division 6, Chapter 4, Article 6, Section 83070(b), which specifies the requirement to log administration of psychotropic medication. See LIC 809-D attached. An exit interview was conducted, appeal rights were provided, and a copy of this report was left with Licensee.

met_with: Betheny Jordan, Licensee


summary: Facility Evaluation

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Narrative:
On May 15, 2024 at 10: AM, Licensing Program Analyst (LPA) Shikya Belfield and LPA Celeste Aparicio conducted an announced pre-licensing inspection of the home. LPA 's met and toured the home with Licensee, Betheny Jordan. This Small Family Home (SFH) is a two story home located in a residential area. The home consists of 3 client bedrooms and 1.5 client bathrooms, living and dining areas, and kitchen. The home is clean, safe, sanitary, and in good repair. All passageways are unobstructed and all doors open freely. There is no pool on the premises. Fire arms, are not allowed on the home premises. At the time of visit, the following was observed and the care tool was used: Fire extinguishers is located in the kitchen. Smoke detectors/carbon monoxide detectors are throughout the house and operational. Each bedroom has a bed, clean linens, and adequate drawer/cabinet space. First aid kit was not observed during this inspection. Hot water temperature was within the required range per regulations. Staff and client records will be stored and locked on site. Medications will be centrally stored and locked on site. Disinfectants and other toxic materials will be locked in cabinet in the kitchen, Extra bedding and towels are kept in the hallway cabinet. Knives and sharps will be kept locked in a cabinet in the kitchen. By the end of business today 5/15/2024 at 5PM, licensee agrees to submit proof of purchased first aid kit. There were no citations issued during this inspection. An exit interview was conducted and a copy of this report was left with licensee Betheny Jordan.

met_with: Betheny Jordan


summary: Facility Evaluation

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Narrative:
On 05/05/2025 at 11:15am, Licensing Program Analyst (LPA) Kristin Pierotti made an unannounced visit to the facility to conduct the Annual Inspection. LPA met with Betheny Jordan, Licensee and explained the purpose of the visit. LPA was unable to conduct the inspection at this time due technical issues. LPA will return to complete the inspection at a later date. There are no deficiencies at this time. A copy of this report was left with Betheny Jordan, Licensee, whose signature confirms.


summary: Facility Evaluation

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Narrative:
On 08/21/2024, Licensing Program Analyst (LPA) Kristin Pierotti completed the Post-Licensing Inspection for the facility listed. All documents were given to Betheny Jordan, Licensee, on 08/21/24. See LIC809 - Post Licensing dated 08/21/2024. Due to a system error, the CARE Tool used during the inspection did not final print. On 05/19/2025, LPA Pierotti printed the CARE Tool to complete the inspection. A copy of this report was left with Betheny Jordan, whose signature confirms receipt.


summary: Facility Evaluation

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On 05/19/2025 at 10:45am, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced inspection at the facility. The purpose of the visit was to print the facility's updated license. LPA met with Betheny Jordan and explained the purpose of the visit. During the inspection, there were 2 staff present and 1 client. Client was participating in online school while LPA was present. LPA observed the facility to be in good condition, clean and well organized. Kitchen and bathrooms are sanitary. The facility currently has 1 residents and each resident has their own bedroom with individual beds and plenty of storage for personal items. The rooms and common spaces are nicely decorated and furnished. Medications, sharps, and chemicals are stored where inaccessible to the residents. No deficiencies were found at this time. An exit interview was conducted and a copy of this report and the updated Facility License was left with Betheny Jordan, Licensee whose signature confirms receipt.

met_with: Betheney Jordan, Licensee


summary: Facility Evaluation

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Narrative:
On 07/01/25 at 9:45am, Licensing Program Analyst (LPA) Kristin Pierotti conducted a random annual inspection. LPA met with Betheny Jordan, Licensee and informed of the purpose of the visit. LPA used the CARE Inspection Tool and conducted a tour of the facility site, review of 5 personnel records and 1 resident record, and confidential interviews with 1 staff member and no residents. The resident was not present at the time of inspection. LPA observed the facility to be in good condition, clean and well organized. Kitchen and bathrooms are sanitary. The facility currently has 1 resident and who has their own bedroom with an individual bed and plenty of storage for personal items. The rooms and common spaces are nicely decorated and furnished. Medications, sharps, and chemicals are stored where inaccessible to the residents. LPA observed personnel and resident records to be complete and had all necessary documents. Staff have full background clearances and first aid training certifications. Residents' records contain current emergency contact information. The resident in care is an emergency placement and has not been in the facility long enough to have a completed medical assessment or Needs and Services Plan. Based on interviews, LPA observed staff to be knowledgeable of facility policies, mandated reporting, and client needs. No deficiencies were observed at this time. An exit interview was conducted and a copy of this report was left with Licensee whose signature confirms receipt.

visit_type: Annual


summary: Facility Evaluation

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CN - 2243-FN On 10/10/25 at 11:30am, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced Case Management Inspection at the above listed facility. The purpose of the inspection was to conduct a follow-up on an Incident Report (IR) that was submitted. LPA met with Dominique Jordan, staff and explained the purpose of the inspection. Betheny Jordan, Licensee joined via telephone. Based on the submitted incident report, a restraint was conducted. LPA reviewed the facility's Plan of Operation (POO) and Program Statement (PS). The facility does not have an approved Emergency Intervention Plan (EIP) that includes the use of restraints. LPA conducted interviews with staff to obtain additional information regarding the incident. Interviews confirmed that staff placed client's arms to their side during the incident in order to prevent the client from harming themselves or others. Staff that conducted the restraint is Pro-ACT certified. Based on LPA's record review and interviews, the facility used a restraint on a client during an incident. This is a violation of the California Code of Regulations, Title 22, Division 6, Chapter 4, Section 83072(d)(1) Personal Rights. The facility is being issued a citation on the attached LIC809-D page. An exit interview was conducted, appeal rights discussed, a plan of correction was made and a copy of this report was left with Dominique Jordan, staff whose signature confirms receipt.

met_with: Dominique Jordan, Staff


summary: Facility Evaluation

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CN - 2843-FN On April 7, 2026 at 2:05pm, Licensing Program Analysts (LPA) Kaitlyn Wong and Hanako Primer conducted an unannounced Case Management Inspection at the above listed facility. The purpose of the inspection was to conduct a follow-up on an Incident Report (IR) that was submitted. LPAs met with Betheny Jordan, Licensee, and explained the purpose of the inspection. At the time of the inspection, 1 staff and 0 clients were present at the facility. LPA Wong received incident reports that were not submitted to the licensing agency within the required time frame. LPAs toured the facility, both inside and outside. LPAs observed the laundry cleaning supplies were located in an unlocked cabinet in the hallway above the washer. LPA is issuing one Technical Assistance pursuant to the CCR Section 80087(c) Buildings and Grounds. LPA discussed the reporting requirements with Licensee. As a result of this visit, LPA Wong issued one Technical Violation pursuant to CCR Section 80061(b), Reporting Requirements. (Refer to LIC9102-TV and LIC9102-TA) An exit interview was conducted, and a copy of the report was provided to Betheny Jordan, Licensee, whose signature confirms receipt.


facility_name: NIKKI'S ANGELS SMALL FAMILY HOME

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****Continued from LIC 9099**** . During investigation, a confidential interview denied the FP threatened to spank the children in care. Another confidential interview stated that the LIC would threaten to spank FC3 and FC4 when they did not do their chores. A confidential interview stated the LIC would call FC1 and FC2 "stupid and a whore". However, another confidential interview stated the words "stupid or whore" were never used at the SFH. LPA received a conflicting information. Based on confidential interviews, the allegations the FP threatened to spank FC3 and FC4 and FPinappropriately to FC1 and FC2 may have happened or be valid, but there is not a preponderance of evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted. A copy of this report and appeal rights were explained and given to the Licensee, Nicole Wilson.

Investigation Findings:
13On January 7, 2025 at 1: PM, Licensing Program Analyst(LPA) Karen Beal met with Licensee Nichole Wilson to deliver the investigative finding for the above-stated allegations. On October 31, 2024, at 12: PM, LPA initiated the investigation at Nikki's Angels Small Family Home (SFH) and obtained pertinent documents from the facility files. LPA interviewed the foster parent (FP) and foster child 1 (FC1), foster child 2 (FC2), foster child 3 (FC3), attempted to interview foster child 4 (FC4) but was unable to due to FC4 limited ability to communicate. In addition, LPA interviewed the County Social Workers (CSW). On October 28, 2024, Community Care Licensing (CCL) received a complaint that foster parent threaten minor with physical harm and foster parent spoke inappropriately to minor in care. Specifically, it was alleged the Licensee (LIC) threatened to spank foster children and the LIC used inappropriate language towards FC1 and FC2. R- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: NIKKI'S ANGELS SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 01/07/2025

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

met_with: Nichole Wilson, Licensee


summary: Facility Evaluation

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Narrative:
On October 31, 2024, at 1: PM Licensing Program Analyst (LPA) Karen Beal began a post licensing inspection for Nikki's Angels Small Family Home . LPA met with applicant Nichole Wilson who led a tour of the home. The facility was toured both inside and out with the applicants. Applicants are applying for a capacity of 4 ambulatory children and the house is a 5 bedroom two-story house: Downstairs: It consists of a kitchen; a closet, a bathroom, a pantry, dining room, living room; family room and the garage. Bedroom #1- it is vacant and it is located downstairs Upstairs: Bedroom #2- licensee's Bedroom Bedroom #3- foster children's room FC1 and FC2- two twin beds Bedroom #4 foster children's room FC3 and FC4- two twin beds Bedroom # Bio daughter room Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. Outside the bedrooms, there is a laundry room. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items will be stored upstairs in the laundry room and have been properly made inaccessible, children will not have access. Medication lockbox were locked and stored in downstair closet. Sharp knives were inaccessible and stored downstairs in a locked box in the pantry. First Aid kit expires on 02/2026 on was accessible with all required items and is located in the washroom. A Fire extinguisher was observed and properly charged. They are located in the kitchen and in the upstairs hallway. There were no guns or weapons as stated by licensee. The hot water temperature was tested and noted to be 118 degrees. Trash cans for storage of solid waste have tight fitting lids. ***Continued to LIC 809-C*** ***Continued from LIC 809*** The Emergency Disaster Plan with exit map, Personal Rights, client list, License, and visitation policies were posted at this time. The home have a telephone service at this time. The backyard where children will have access to play is completely fenced and free of hazards. There is no pool or other body of water. Exit interview conducted and a copy of this report was discussed and provided to Nichole Wilson, licensee.


summary: Facility Evaluation

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Narrative:
On October 6, 2025, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at Nikki's Angels Small Family Home (SFH) pre-licensing inspection for change in capacity. Currently, there are four clients in placement. The home was licensed for a capacity of four ambulatory clients. The licensee is applying to be licensed for a capacity increase from four to six ambulatory clients. The Facility was toured both inside and out with the licensee. The home is a two-story building with five bedrooms and four full bathrooms. During the inspection, LPA observed that the downstairs consisted of the kitchen, a living room, a family room, a dining area and one bedroom. Bedroom #1 was vacant, and it consisted of two twin-sized beds, it would sleep two clients, it was vacant. Medications were stored in a locked box in the storage. Sharp knives were inaccessible and stored in a locked in the pantry. The garage was inspected and used as storage. The water temperature was tested and measured at 112 degrees F. LPA observed a minimum of seven-day non-perishable and a three-day perishable supply of food. There was a variety of snacks available for clients. In addition to the downstairs space, there was also one full bathroom fully functioning and large space under the stairs used as a storage. A trash can was observed to have tight fitting cover. The following required posted items were observed accessible to clients: personal rights, visitation policy, and current menu. The clients' medication log records were kept updated with no discrepancy. Two fire extinguishers were observed and operable. Upstairs was bedroom #2, it was fully furnished with one king-size bed, a full bath; it sleeps licensee. Bedroom #3, it was fully furnished with one twin and one full size beds; it sleeps two clients. Bedroom #4 was fully furnished with two twin-sized beds, a closet and plenty of storage space. It sleeps two clients. Bedroom #5 sleeps a biological daughter seventeen-year-old and was fully furnished, a closet, storage space. The First Aid Kit was in a cabinet and contained all required items. The licensee's bedroom is not accessible to the clients. All bedrooms were arranged for one child per bed. No room was commonly used for other purposes other than a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for each child's belongings. The smoke and carbon monoxide detectors were checked and working. Cleansers/chemicals were locked and stored in the laundry room. The upstairs space includes an additional bathroom used by the clients. All hazardous items have been properly made inaccessible to areas where clients have access. All windows and screens were in good repair. Licensee states that there are no guns/weapons in the home. There was a total of five cameras, one located outdoors, and four indoors, which met the title 22 camera policy. The facility outside grounds were also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. Based on today's inspection and observations, there are no deficiencies being cited at this time. The request to increase capacity to six ambulatory clients will be discussed with the Licensing Program Manager for final approval.

met_with: Licensee


summary: Facility Evaluation

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Narrative:
On January 29, 2026,at 9: AM, Licensing Program Analyst (LPA) Karen Beal arrived at Nikki's Angels Small Family Home to conduct a Random annual inspection. LPA met with Licensee, Nichole Wilson who led a tour of the home. The facility was toured both inside and out with the Licensee. The house is a 5-bedroom two-story house: Downstairs: It consists of a kitchen; a closet, a bathroom, a pantry, dining room, living room, family room, and the garage. Bedroom #1- it is vacant and it is located downstairs Upstairs: Bedroom #2- licensee's Bedroom Bedroom #3- foster children's room FC1 and FC2- One full size bed and a twin bed Bedroom #4 foster children's room FC3 and FC4- two twin beds Bedroom # Bio-daughter room Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No bedroom serves as a passageway to another room. There are adequate drawers and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items will be stored upstairs in the laundry room and have been properly made inaccessible; children will not have access. ***Continued to LIC 809-C*** ***Continued from LIC 809*** Medication lockboxes were locked and stored in downstair closet. Sharp knives were inaccessible and stored downstairs in a locked box in the pantry. First Aid kit expires on 02/2028 and a locked cabinet in the in the laundry room. A Fire extinguisher was observed and properly charged. They are in the kitchen and in the upstairs hallway. There were no guns or weapons as stated by licensee. The hot water temperature was tested and noted to be 119 degrees. Trash cans for storage of solid waste have tight fitting lids. The Emergency Disaster Plan with exit map, Personal Rights, client list, License, and visitation policies were posted at this time. The home has a landline telephone service. The backyard where children will have access to play is completely fenced and free of hazards. There is no pool or other body of water on the premises. Exit interview conducted and a copy of this report was discussed and provided to Nichole Wilson, licensee.


summary: Facility Evaluation

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Narrative:
On April 10, 2026, at 10: AM, Licensing Program Analyst (LPA) Karen Beal arrived at Nikki's Angels Small Family Home to conduct a two year annual inspection. LPA met with Licensee, Nichole Wilson who led a tour of the home. The facility was toured both inside and out with the Licensee. The house is a five bedroom two-story house: Downstairs: It consists of a kitchen; a closet, a bathroom, a pantry, dining room, living room, family room, and the garage. Bedroom #1- Foster Child bedroom has a queen size bed and a twin bed and sleeps a Non-minor dependant Upstairs: Bedroom #2- Master Bedroom, has a California King bed and sleeps the Licensee Bedroom #3- foster children's bedroom, has two twin beds and sleeps foster children FC1 and FC Bedroom #4 foster children's bedroom , has two twin beds and sleeps foster children FC2 and FC Bedroom # Adult relative room, has a queen size bed Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No bedroom serves as a passageway to another room. There are adequate drawers and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items will be stored upstairs in the locked laundry room and have been properly made inaccessible. ***Continued to LIC 809-C*** ***Continued from LIC 809*** Medication lockboxes were locked and stored in downstair closet. Sharp knives were inaccessible and stored downstairs in a locked box in the pantry. First Aid kit expires on 02/2028 and a locked cabinet in the in the laundry room. A Fire extinguisher was observed and properly charged. They are in the kitchen and in the upstairs hallway. There were no guns or weapons as stated by licensee. The hot water temperature was tested and noted to be 117.3 degrees. Trash cans for storage of solid waste have tight fitting lids. The Emergency Disaster Plan with exit map, Personal Rights, client list, License, and visitation policies were posted at this time. The home has a landline telephone service. The backyard where children will have access to play is completely fenced and free of hazards. There is no pool or other body of water on the premises. LPA reviewed staff and foster children's files Exit interview conducted and a copy of this report was discussed and provided to Nichole Wilson, licensee.


facility_name: NIRVANA FAMILY HOME

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Narrative:
Confidential witnesses informed LPA that S1 yelled at C1 when S1 became upset with C1. Furthermore, an additional confidential witness stated that S1 yelled at C1 when C1 yelled at S1. S1 admitted to yelling at C1 when C1 was being verbally aggressive toward S1 and other clients. Regarding the allegation that S1 slammed a video game console on the ground confidential witnesses informed LPA that S1 slammed a video game console on the ground. S1 admitted to slamming a video game console on the ground when C1 did not want to share the video game console with another resident of the SFH. LPA received conflicting information regarding S1 refusing to speak to C1 and slamming a door in C1's face. Based on confidential interviews and record review the preponderance of evidence standard has been met and the allegations that resource parent yelled at minor and resource parent does not treat minor with dignity or respect are substantiated. The facility is being cited for violation of Title Regulations 80072(a)(3) Personal Rights and 80072(a)(1) Personal Rights. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Kezia Houzell. Confidential witnesses informed LPA that clients were fed daily and provided at least three meals a day. County social worker (CSW) informed LPA that CSW was never informed of a shortage of food in the SFH or that clients were limited on their food intake. SFH staff denied the allegation. Another confidential witness informed LPA that on one occasion C1 was not fed dinner. Regarding the allegation that S1 was going through C1's belongings confidential witnesses informed LPA that C1 sometimes sneaks food to C1's bedroom and candy wrappers had been found in C1's bedroom. CSW stated that C1 would sneak food to C1's bedroom so S1 would check to ensure that C1 didn't hide food. CSW stated that she didn't have concerns with SFH staff, not according C1 privacy. Another confidential witness stated that S1 went through C1's belongings often. LPA received conflicting information regarding both allegations. Based on confidential interviews the allegations resource parent resource parent is not providing adequate meals to minor and resource parent is not according privacy, may have occurred, however, they are not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Kezia Houzell.

Investigation Findings:
13On August 13, 2025, at 10: AM Licensing Program Analyst (LPA) Michael Almaraz met with Nirvana Small Family Home (SFH) Licensee, Kezia Houzell, to issue the finding for the above allegations involving clients (C1, C2, C3) listed on the confidential names list (LIC 811) dated August 13, 2025. The complaint was jointly conducted by LPA Almaraz and LPA Rachel Vanegas On April 21, 2025, at 10: AM LPA Vanegas conducted a health and safety inspection of the SFH, and no immediate health and safety hazards were observed. During the investigation LPA Almaraz reviewed three clients (C1, C2, C3) records. Additionally, LPA conducted interviews with two SFH staff, two county social workers, and three of three clients On April 16, 2025, the Department received a complaint alleging resource parent yelled at minor, and resource parent does not treat minor with dignity or respect. It was specifically alleged that staff 1 (S1) threw a video game console onto the ground and yelled at C1. Also, the following day S1 refused to speak to C1 and slammed a door in C1's face. (continued on page 2...) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Michael Almaraz 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 61-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: NIRVANA FAMILY HOMEFACILITY NUMBER: VISIT DATE: 08/13/2025

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: Kezia Houzell


raw_content:
Narrative:
County social worker (CSW) stated that they were never informed that minors were locked out of the SFH. County social worker 2 (CSW2) informed LPA that they did not have suspicions of abuse or personal rights violations occurring in the SFH. Other confidential witnesses informed LPA that C1 and C3 were in the backyard and when they went to enter the SFH they could not enter due to the backdoor being stuck which caused them to be locked outside for 10 minutes. Furthermore, it was disclosed to LPA that S1 was present but did not immediately respond to C1 and C3's calls for assistance. LPA received conflicting information regarding the allegation. Based on confidential interviews the allegation staff locked minors outside of the facility, may have occurred, however, it is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Kezia Houzell.

Investigation Findings:
13On August 22, 2025, at 9: AM Licensing Program Analyst (LPA) Michael Almaraz met with Nirvana Small Family Home (SFH) Licensee, Kezia Houzell, to issue the finding for the above allegation involving clients (C1, C2, C3) listed on the confidential names list (LIC 811) dated August 22, 2025. The complaint was jointly conducted by LPA Almaraz, LPA Linda Haynes, and LPA Rachel Vanegas. On March 14, 2025, at 2: PM LPA Haynes conducted a health and safety inspection of the SFH, and no deficiencies were observed. During the investigation LPA Almaraz reviewed three clients (C1, C2, C3) records. Additionally, LPA conducted interviews with two SFH staff, two county social workers, and three of three clients. On March 6, 2025, the Department received a complaint alleging staff locked minors outside of the facility. It was specifically alleged that C1 and another minor were locked outside the SFH. Confidential witnesses informed LPA that S1 was present and inside the SFH while C1 and C3 were in the backyard but when C1 and C3 went to enter the SFH the screen door was stuck preventing the minors from entering. (continued on page 2...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Michael Almaraz 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 61-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: NIRVANA FAMILY HOMEFACILITY NUMBER: VISIT DATE: 08/22/2025

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


summary: Facility Evaluation

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Narrative:
On Monday February 26, Licensing Program Analyst (LPA) Linda Haynes met with Applicant Kezia Houzell via Microsoft Teams to complete a component II interview. LPA discussed applicants fingerprints. A signed copy of this form will be placed in applicants file.


summary: Facility Evaluation

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Narrative:
On April 12, 2024 at 12: PM, Licensing Program Analyst (LPA) Linda Haynes completed a pre-licensing inspection of Nirvana Small Family Home. LPA met with Applicant Kezia Houzell who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients in placement. The home is a two story building with four bedrooms and three bathrooms which are set up as follows: · Bedroom #1 (Applicants) has one bed will sleep the applicant. · Bedroom #2 (Client's) has two bed, it will sleep two client's. · Bedroom #3 (Client's) has two bed, it will sleep two client's. · Bedroom #4 (Client's) has two bed's, it will sleep two client's. · A great room/living room, kitchen, dining area, three bathrooms, laundry room, a loft/office, three car garage and the backyard. The Client's bedrooms were arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector/carbon monoxide detector in every bedroom. The seven smoke detectors/carbon monoxide detectors were checked, and they were working properly. The home is equipped with a fire sprinkler system. The home's central air conditioning module was located in the back yard. The home's tank less hot water heater was located the garage. The appliances were in working order. The client's files will be locked inside a filing cabinet in the office. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A trash can for storage of solid waste had a tight-fitting lid and was present. The sharp knives will be in a locked drawer in the kitchen. The medications will be located in a locked cabinet the applicants bathroom. The hot water in bathroom one measured to be 109.7 degrees Fahrenheit, bathroom two was 117.5 degrees Fahrenheit, and in bathroom three 115.4 degrees Fahrenheit. The home's First Aid kit was accessible and is located in the kitchen and contained all required supplies. There are two fire extinguisher present in the home one is located in the kitchen by the kitchen cabinets and the second is located in the upstairs laundry room. They were observed to be properly charged and inspected by the fire department. Licensee stated there were no weapons/firearms in the home. There is no pool or other body of water at the home. The backyard where clients will have access to play is fenced. There are no corrections that need to be made at this time A Component III was completed. An exit interview was conducted. Application will be forwarded to the Licensing Program Manager for Licensing.


summary: Facility Evaluation

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Narrative:
On April 21, 2025 at 10: AM, Licensing Program Analyst (LPA) Rachel Vanegas, arrived unannounced at Nirvana Family Home, Small Family Home (SFH) for the purpose of conducting a post licensing annual inspection. LPA met with the licensee Kezia Houzell who led a tour of the facility both inside and outside. The facility is a two story home with the following layout: First story contains: a living room also used as a recreational space and contains board games, card games, etc. that were observed to be safe, clean, and age appropriate for the children in care, one restroom, bedroom #1, the kitchen, a pantry, a locked drawer that stores sharps/knives, a locked storage cabinet that stores cleaning chemicals and laundry detergent, a locked access door to the attached garage that children in care do not have access to. Bedroom #1 - Has two single beds that sleeps one client and has one vacant bed. There is adequate storage space for personal belongings in drawers and a closet. The second story contains: Bedroom #2, Bedroom #3, Bedroom #4, two additional restrooms, one play area/loft with a desk space that the Licensee utilizes for work. Bedroom #2 - has one bed and sleeps the Licensee. Client medications and staff/client files are double locked and located in the Licensee's bedroom where clients in care do not have access. Bedroom #3 - Has two single beds that sleeps two clients. There is adequate storage space for personal belongings in drawers and a closet. Bedroom #4 - Has two single beds that will sleep two clients and is currently vacant. All bedrooms are arranged so that no more than two clients are in a room and there is one client per bed. **.** LPA observed an adequate supply of perishable and non-perishable foods and posted meal menus in the kitchen. There was a trash can for storage of solid waste with a tight-fitting lid located in the kitchen. The first aid kit is located in a kitchen cabinet and contained all of the required materials. LPA also observed other required postings in the kitchen including the facility license, foster youth personal rights, Complaint Hotline, etc. There are combination smoke detector/carbon monoxide detectors in every bedroom and hallway. The smoke detector/carbon monoxide detectors were tested and are in properly functioning order. There are two fire extinguishers in the home that are observed to be properly charged. One is located in the kitchen on the first floor and one is located in the laundry room on the second floor. The home has a tankless water heater located inside the garage and the temperature is set to 120 degrees Fahrenheit. The hot water temperature was checked in the kitchen and registered at 114.9 degrees Fahrenheit. Telephone services and appliances were in working order at the time of this inspection. The facility outside grounds were also inspected and were observed to be clean and well maintained. Emergency exits were free from obstruction. There is no pool or other body of water. LPA conducted three client file reviews for Client 1 (C1), Client 2 (C2), Client 3 (C3) and observed the needed documents in the files including, consent to medical treatment authorization forms, placement agreements, signed personal rights form, etc. Three out of three files (C1, C2, C3) did not contain documented results of tuberculosis (TB) screening or Needs and Services Plan's signed by authorized representatives. LPA conducted two staff file reviews for Staff 1 (S1) and Staff 2 (S2). LPA observed that two out of two staff files contained needed documents including CPR/First Aid certificates, Drivers License, Job Duties, Health Screening, etc. LPA provided technical assistance and discussed with the Licensee the importance of ensuring easy access for documentation required on Medication Administration Records and Psychotropic Medication Administration Records for proper compliance with Client Records. **** Based on observation and record review, the facility is being cited one Type B violation in accordance with California Code of Regulations (CCR) (Title 22) 80069(c)(1) for not having documentation of a medical/TB examination on file for C1, C2, and C3 within 30 days of admission. The facility is issued one technical violation in accordance with CCR Section 83068.2(b)(12) for C1, C2, and C Needs and Services plan not having authorized representative signatures. An exit interview was conducted and a copy of this report, LIC 811, and appeal rights were reviewed and provided to the Licensee - Kezia Houzell.

met_with: Licensee - Kezia Houzell


summary: Facility Evaluation

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Narrative:
On June 13, 2025 at 1:25pm, Licensing Program Analysts (LPAs) Rachel Vanegas and Carissa Aviles arrived unannounced at Nirvana Family Home, Small Family Home (SFH) for the purpose of conducting client interviews for the annual inspection conducted on 04/21/2025. LPAs conducted three client interviews. An exit interview was conducted and a copy of this report, Confidential Names List (LIC 811), and appeal rights were reviewed and provided to the Licensee - Kezia Houzell.

met_with: Kezia Houzell - Licensee


facility_name: NOBLE SMALL FAMILY HOME

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Regarding the allegation that LS refused to pick up FC1, it was specifically reported that FC1 was found at the Metrolink Train Station attempting to go to Los Angeles. Law Enforcement contacted the licensee who was at work and hesitant about leaving work to pick up the foster child, and she stated that she gets off work at 5: PM. During investigation, confidential interview stated FC1 left the home unauthorized. The confidential interview continued stating that FC1 refused to be picked up and decided not to return home due to LS not allowing FC1 to smoke. A confidential witness observed FC1's effort to smoke in the home. The confidential witness believed FC1 did not want to return home due to structural reasons. Based on confidential interviews, the allegation that LS refused to pick up FC1 may have occurred, however, there was not a preponderance of evidence to prove that the violation occurred. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted and a copy of this report LIC 9099 was discussed and provided to LS.

Investigation Findings:
13On August 15, 2025, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at Noble Small Family Home (SFH) and met with SFH Licensee (LS) Mercedes Noble to deliver the investigative finding for the above stated allegation involving the Small Family Home and foster child listed on the confidential list (LIC811) dated August 15, 2025. On Apil 25, 2025, a complaint report was referred to Community Care Licensing (CCL) alleging Licensee is refusing to pick up minor. On May 5, 2025, LPA Babatunde Aborchie arrived at the SFH to initiate investigation, conducted a safety inspection and interviewed LS. In addition, LPA interviewed a county social worker (CSW). LPA was unable to interview foster child 1 (FC1) due to FC1 being out of state. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Babatunde Aborchie 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 19-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, MAIN ST., SUITE FACILITY NAME: NOBLE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 08/15/2025


summary: Facility Evaluation

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Narrative:
On August 10, Licensing Program Analyst (LPA) Babatunde Aborchie, met with applicant Mercedes Noble this date for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the LIC 184, Notice of Incomplete Application, and additional correspondence to assist with the revisions needed for the application. Copy of this report was provided to applicant.

met_with: Mercedes Noble


summary: Facility Evaluation

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Narrative:
On November 29, 2023 at 10: AM Licensing Program Analyst (LPA) Babatunde Aborchie began a Pre-Licensing inspection for a Small Family Home license. LPA met with applicant Mercedes Noble who led a tour of the home. The facility was toured both inside and out with the applicant. Applicant is applying for a capacity of 3 ambulatory clients. The home is a single story, it consists of: Bedroom #1, It was furnished with a twin size bunked bed. It sleeps two legal guardianship children of ages 11 and 15 years. Bedroom #2, The room consisted of two twin beds. It will sleep two residents - vacant. Bedroom #3, The room was furnished with a twin bed and a crib. It sleeps applicant. There were also a family room, a living room, dining area and two bathrooms. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in a locked box in the hallway closet. Cleansers/chemicals were locked and stored in the kitchen cabinet under the kitchen sink. Sharp knives were inaccessible and stored in a locked box in the kitchen closet above the refrigerator. There were no guns or weapons as stated by applicant at this time. The hot water temperature was tested and noted to be 118 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items, and it was in the hallway cabinet. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed for small family home will be forwarded to Licensing Program Manager for final approval. A component III orientation was conducted with applicant. An exit interview was conducted. A copy of this report was provided to Applicant/Licensee

met_with: Merceddes Noble


summary: Facility Evaluation

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Narrative:
On May 30, 2024, at 11: AM, Licensing Program Analyst (LPA) Joon Choi arrived at Noble Small Family Home to conduct an inspection in regards to a request for a non-ambulatory status. LPA met with applicant Mercedes Noble who led a tour of the home. The facility was toured both inside and out with the applicant. Applicant is converting one room to a non-ambulatory room approved by the Fire Department. The home is a single story facility, and it consists of: Bedroom #1, It was furnished with a twin size bunked bed. It sleeps two legal guardianship children of ages 11 and 16 years. Bedroom #2, The room consisted of two twin beds. It will sleep two residents - vacant. Bedroom #3, The room was furnished with a twin bed and a crib. It sleeps applicant. (crib is vacant) Bedroom #4, (Please note, applicant has received fire clearance to modify / re-classify the pre-existing family room into Bedroom #4). After applicant receives approval for their updated license to place non-ambulatory client(s), this room will house one non-ambulatory client who is awaiting placement. The facility also had a living room, kitchen, dining area, two bathrooms, two car garage and backyard. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in a locked box in the hallway closet. Cleansers/chemicals were locked and stored in the kitchen cabinet under the kitchen sink. Sharp knives were inaccessible and stored in a locked box in the kitchen closet above the refrigerator. There were no guns or weapons as stated by applicant at this time. The hot water temperature was tested and noted to be 118 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items, and it was in the hallway cabinet. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced and free of hazards. There were no deficiencies to be cited at this time. The request to change one room to a non-ambulatory room will be discussed with the Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Applicant/Licensee.

met_with: Mercedes J. Noble, Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On May 29, 2025, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at Noble Small Family Home (SFH) pre-licensing inspection for a relocation. Currently, there are two clients who are under legal guardianship with the licensee, and the home is licensed for a capacity of four clients (one non-ambulatory and three ambulatory clients). The Facility was toured both inside and out with the licensee. The home is a two-story building with five bedrooms and three bathrooms. During the inspection, LPA observed that the downstairs consisted of the kitchen, a den, a living room, a dining area with a large table and one bedroom. Bedroom #1 was vacant, and it consisted of a full-size bed, it will sleep one non-ambulatory client, it has an exit door to the outside. The medications will be stored and locked in a metal storage safe located in the bedroom #1. Sharp knives were inaccessible and stored in a locked cabinet in under the kitchen sink. The First Aid Kit was in the downstairs closet and contained all required items. The garage was inspected and used for cars. The water temperature was tested and measured at 110 degrees F. LPA observed a minimum of seven-day non-perishable and a three-day perishable supply of food. There was a variety of snacks available for clients. In addition to the downstairs space, there was also one full bathroom fully functioning and hallway closets used for storage. A trash can was observed to have tight fitting cover. The following required posted items were observed accessible to clients: personal rights, visitation policy, and current menu. The clients' medication log records were kept updated with no discrepancy. Eight fire extinguishers were observed and operable. The downstairs consisted of a laundry room that always remained locked. The upstairs was a master bedroom #2 for licensee and spouse and it consisted of a king size bed and a bathroom; The licensee's bedroom is not accessible for the clients; bedroom #3 was fully furnished with a queen size bed, a closet and plenty of storage space. It will sleep one client, it was vacant. Bedroom #4 sleeps a seventeen-year-old male client and a twelve-year-old both under legal guardianship and was fully furnished with two twin beds, a closet, storage space. All bedrooms were arranged for one child per bed. No room was commonly used for other purposes other than a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawer and closet space for each child's belongings. The smoke and carbon monoxide detectors were checked and working. Cleansers/chemicals were locked and stored in the laundry room. The upstairs space includes an additional bathroom used for the clients. All hazardous items have been properly made inaccessible to areas where clients have access. All windows and screens were in good repair. There were no guns or weapons in the home as stated by Licensee. There was a total of five cameras, all located outdoor which meet the title 22 camera policy. The facility outside grounds were also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. Clients' files and staff files were reviewed and found to comply. Based on today's inspection and observations, there are no deficiencies being cited at this time. An exit interview was conducted, and a copy of this report was discussed and provided to Licensee.


facility_name: NOJA'S SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On February 4, 2022 at 8: AM Licensing Program Analyst (LPA) Babatunde Aborchie, met with licensee Ms. Noja Anjannette Nash, who led a tour of the home. The purpose of the visit was to conduct an annual inspection of the Noja's Small Family Home. The facility was toured inside and out with the licensee. Currently, there are no clients in the home. The home is set up as follows: · Bedroom #1- Adult son's bedroom with queen bed. Located downstairs - Vacant. · Bedroom #2- Master suite w/full bath. Licensee's bedroom. Located upstairs. · Bedroom #3- Client(s) bedroom has bunk beds and crib. All vacant. Located upstairs. · Bedroom #4- Client(s) bedroom had two cribs and queen bed. All vacant. Located upstairs. · Bedroom #5- Daughter's bedroom with queen bed. Located upstairs - Vacant. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawer and closet space for children's belongings. The fireplace was properly screened. All hazardous items have been properly made inaccessible to areas where children will have access. Cleansers/chemicals were locked and stored in the locked laundry room. Sharp knives are inaccessible and stored in locked closet near laundry room. The first aid kit is located in the locked kitchen closet. There were no guns or weapons as stated by licensee at this time. The hot water temperature was tested and noted to be within regulatory requirements. Proper storage of all food was noted. Trash cans for storage of solid waste had tight fitting lids. The smoke detectors located in the hallways were tested and were in good working order. The carbon monoxide detector located downstairs was also operable. The Emergency Disaster Plan with exit map, Title Personal Rights, and visitation policies were posted at this time. The backyard where children will have access to play is completely fenced and free of hazards. There were no bodies of water on the premises. In accordance with Title 22, Division 6, Chapters 1 & 4 there were no deficiencies being cited at this time. Exit interview conducted and a copy of this report along with a Confidential Names List (LIC 811) was provided to facility licensee.