summary: Complaint Investigation - Unsubstantiated - 1 deficiency - 1 allegation

raw_content:
Investigation Findings:
13On 6/6/24 at 11: AM, Licensing Program Analyst (LPA) Jonathan Medina conducted a complaint investigation visit to deliver findings. LPA met with the Director of Residential Services, Terrance Harris, and informed him of the purpose of the visit. Based on a review of Client C2's Needs and Services Plan, Individual Behavior Support Plan, and incident reports, LPA observed a discrepancy in the required staffing ratios. The Needs and Services Plan was not signed by authorized representative and several sections were missing. Interviews with staff confirmed there was confusion about which ratio was to be followed. Therefore, the allegation is SUBSTANTIATED.This is a violation of Title 22, Section 80065(a) and Section 80068.3(b). Please refer to LIC809-D. An exit interview was conducted, appeals rights discussed and a copy of this report was provided to Terrance Harris, Director of Residential Services, whose signature below confirms receipt. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Jonathan Medina LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE This is an official report of an unannounced visit/investigation of a complaint received in our office on 04/15/2025 and conducted by Evaluator Jonathan Medina COMPLAINT CONTROL NUMBER: 14-CR- FACILITY NAME:YAI BYRON COMMUNITY CRISIS HOMEFACILITY NUMBER: ADMINISTRATOR:IMARA NAKOOKAFACILITY TYPE: ADDRESS: CAMINO DIABLOTELEPHONE: (646) 946- CITY:BYRONSTATE: CAZIP CODE: CAPACITY:4CENSUS: 3DATE: 06/06/ UNANNOUNCEDTIME BEGAN: 12: PM MET WITH:Terrance Harris - Director of Residential ServicesTIME COMPLETED:02: PM 9Staff are not providing a safe environment for minor(s). INVESTIGATION FINDINGS: 13On 6/6/24 at 1: PM, Licensing Program Analyst (LPA) Jonathan Medina conducted a complaint investigation visit to deliver findings. LPA met with the Director of Residential Services, Terrance Harris, and informed him of the purpose of the visit. Based on confidential interviews, although the above allegation may have occurred or is valid, there is not a preponderance of evidence to prove that the allegation did or did not happen. Therefore, the allegation is determined to be UNSUBSTANTIATED.Through staff interviews and review of training records, it was determined that the facility is a Community Crisis Home serving youth with high behavioral needs. As such, there are inherent safety risks; however, all staff are trained in CPI and UKERU de-escalation techniques.Additionally, during each visit conducted throughout the investigation, LPA observed the facility to be clean, well-maintained, and in good repair. An exit interview was conducted, and a copy of this report was provided to Terrance Harris, Director of Residential Services, whose signature below confirms receipt. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Jonathan Medina LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: YAI BYRON COMMUNITY CRISIS HOMEFACILITY NUMBER: 075650162

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:

Deficiencies:
80065: Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs.

title: Personnel Requirements (a)


state: CA

facility_name: YAI BYRON COMMUNITY CRISIS HOME

raw_content:
Narrative:
Regarding the allegation that "Staff are mismanaging clients' medication," the allegation is also SUBSTANTIATED. However, no deficiency is being cited at this time due to Plan of Corrections (POCs) that were previously issued for the same concern during the timeframe of this ongoing investigation. The facility required time to implement those corrective measures and has since increased staff training related to medication management. An exit interview was conducted, appeal rights were discussed, and a copy of this report was provided to Terrance Harris, Director of Residential Services, whose signature below confirms receipt.

Investigation Findings:
13On 7/17/2025 at 10: AM, Licensing Program Analyst (LPA) Jonathan Medina and LPA Will Ea conducted a complaint investigation visit to deliver findings. LPA met with the Director of Residential Services, Terrance Harris, and informed him of the purpose of the visit. LPA Jonathan Medina previously made a visit on 7/11/2025, but nobody was at the home for the inspection. The following attachements including the LIC9909-D, LIC9909-A, and LIC9909-C have the date 7/11/25 but was done on today's visit on 7/17/25. Director of Residential Services, Terrance Harris akowledges this discrepency and correct sign-off dates were fixed on this document. Based on a review of confidential interviews, case management notes, incident reports, MARs, and maintenance logs, the allegations staff did not ensure th a/c was not in disrepair and staff are not providing a comfortable environment for clients are SUBSTANTIATED. This is a violation of Title 22, Section 80087(a) - Buildings and Grounds, and Section 84072(d)(1) - Personal Rights. Please refer to LIC 809-D for additional details. Regarding the allegation that "Staff are mismanaging clients' medication," the allegation is also SUBSTANTIATED. Continues on LIC9909-C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Jonathan Medina LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE This is an official report of an unannounced visit/investigation of a complaint received in our office on 05/09/2025 and conducted by Evaluator Jonathan Medina COMPLAINT CONTROL NUMBER: 14-CR- FACILITY NAME:YAI BYRON COMMUNITY CRISIS HOMEFACILITY NUMBER: ADMINISTRATOR:IMARA NAKOOKAFACILITY TYPE: ADDRESS: CAMINO DIABLOTELEPHONE: (646) 946- CITY:BYRONSTATE: CAZIP CODE: CAPACITY:4CENSUS: 3DATE: 07/11/ UNANNOUNCEDTIME BEGAN: 10: AM MET WITH:TIME COMPLETED:11: PM 9Staff made inappropriate comments towards client Staff are not properly changing the menus weekly Staff are not properly sanitizing the bathroom Staff are engaing verbal altercations in front of the clients INVESTIGATION FINDINGS: 13On 7/17/2025 at 10: AM, Licensing Program Analyst (LPA) Jonathan Medina conducted a complaint investigation visit to deliver findings. LPA met with the Director of Residential Services, Terrance Harris, and informed him of the purpose of the visit. Based on confidential interviews, observations, and record reviews, although the above allegations may have occurred or are valid, there is not a preponderance of evidence to prove that the allegations did or did not happen. Therefore, the above allegations are determined to be UNSUBSTANTIATED. LPA observed weekly menus, clean bathrooms during each visit, and through confidential interviews insufficient evidence was provided to support claims of inappropriate staff altercations in the presence of clients. An exit interview was conducted, and a copy of this report was provided to Terrance Harris, Director of Residential Services, whose signature below confirms receipt. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Jonathan Medina LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: YAI BYRON COMMUNITY CRISIS HOMEFACILITY NUMBER: 075650162

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:

Deficiencies:
80087(a): (a)

report_type: Complaint Investigation

complaint_status: unsubstantiated

title: Buildings and Grounds

description: (a)


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
(continued from previous page) A citation is being issued for a repeat violation, with no civil penalty assessed due to an active POC in progress for a recent citation for the same allegation. An exit interview was conducted, appeal rights were provided and discussed, and a copy of this report was given to Terrance Harris, whose signature confirms receipt.

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

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

met_with: Terrance Harris, Director of Client Services


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13On 8/27/2025 at 10: AM, Licensing Program Analyst (LPA) Will Ea conducted an unannounced inspection of the facility for the purpose of opening a new complaint. LPA met with the Karla Advincula, assistant administrator, and informed them of the purpose of the visit. During the investigation of the above allegation, LPA conducted confidential interviews with staff, gathered photographic evidence of the facility perimeter, and reviewed photographic evidence sent directly to CCLD. Based on a comparison of photos of the facility grounds against the provided photos of staff smoking, it was determined that facility staff on at least one occasion were discovered smoking on facility grounds. Based on the preponderance of evidence obtained, the allegation of facility staff are smoking on premise is SUBSTANTIATED. This is a violation of Title 22, Division 6, Chapter 5, Article 7, Physical Environment Section 84087(c) - Buildings and Grounds. Appeal Rights were provided and discussed with the assistant administrator. An exit interview was conducted and a copy of the report was left with the assistant administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Willy Ea LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: YAI BYRON COMMUNITY CRISIS HOMEFACILITY NUMBER: 075650162

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

met_with: Karla Advincula, Assistant Admin

complaint_status: SUBSTANTIATED


facility_name: YAI DAVIS RD. COMMUNITY CRISIS HOME (CCH)

raw_content:
Narrative:
The dentist requested that the staff help prevent the patient from interfering with receiving an injection for the safety of the patient and the dentist. The allegation is determined to be UNSUBSTANTIATED. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegation are UNSUBSTANTIATED. An exit interview was conducted. A copy of the report was provided and the appeals process.

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

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

met_with: Administrator


raw_content:
Narrative:
Additionally, there was only a general timeline provided as to when the allegations occurred and the information provided has changed since the initial allegations. During the time of the alleged incident the client stated the only people present was the client and the staff member accused of the incident. The allegations are determined to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegation are UNSUBSTANTIATED. An exit interview was conducted. A copy of the report was provided and the appeals process.

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

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


raw_content:
Narrative:
Based on interviews conducted during the investigation process the allegations above cannot be substantiated because 11 out of 15 interviews conducted from 8/01/23-9/04/23 corroborated that staff do not punch youth in care for discipline. In addition, there were no witnesses of staff punching clients in care. Although 5 confidential interviews disclosed witnessing staff making inappropriate comments towards youth in care, 9 confidential interviews corroborated that staff do not make inappropriate comments towards youth in care. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted. A copy of this report and the Appeal Rights were provided to the Administrator.

Investigation Findings:
13On 9/15/23 at approximatley 12:28 p.m Licensing Program Analysts (LPAs) Jacqueline Carmona made an unannounced visit to the above Community Crisis Home (CCH) to deliver findings for the allegations noted above. LPA Carmona met with Steven Toal, Program Administrator. During the investigation, LPA Carmona reviewed the agency's file at the licensing office, including the complaint history and criminal background check for staff. LPA Carmona also reviewed the Clients Needs and Services Plans (IPPs), Personnel Progressive Discipline Reports, Personal Rights Staff Training Log, Behavior Agent (BA) notes, LIC500 for the months of April 2023, May 2023, Investigation report dated 7/07/23, SIRs dated 7/07/23 and 7/10/23.LPA Carmona conducted 15 confidential interviews between 7/12/23- 9/04/23 and 1 contact on 8/24/23. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Jacqueline Carmona 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: YAI DAVIS RD. COMMUNITY CRISIS HOME (CCH)FACILITY NUMBER: VISIT DATE: 09/15/2023

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

met_with: Steven Toal, Program Administrator


raw_content:
Narrative:
Based on evidence obtained in witness interviews and in documentation reviewed, the allegations surround events that happened when 2 staff took 1 client on an outing to see the "Barbie" movie. (of note: the 2 clients who reside in this CCH require 2 staff to 1 client ratio). After the movie, the client wanted to call their friend. Staff requested the client place their call after they get home, take their medications and a shower. Client became escalated, screamed obscenities, ran down the street, one staff followed on foot, the other staff drove behind in the agency van, staff lost sight of the client, lead staff and law enforcement arrived, the child was located, law enforcement personnel encouraged the client to return home with staff, client attempted to run away from officers, the client was detained and taken to Lodi Memorial Hospital by law enforcement. In witness interviews, staff deny they have made inappropriate comments to a client and/or inappropriately disciplined the client, that staff were physically aggressive with client and that a client sustained an injury; the CCH facility documentation indicates the same. There is different information obtained in the evidence that a mandated reporter relayed: staff have made unkind/inappropriate comments when disciplining the client by kicking them, stomped on their feet, threw water at them, spit on them, made fun of the client's relationship with their friend, staff were physically aggressive with a client, and that a client sustained an injury. Although the allegation that staff made inappropriate comments towards the client, staff inappropriately disciplined a client, staff were physically aggressive with a client, and that the client sustained an injury may be valid, there is not a preponderance of the evidence to prove the alleged violations did, nor did not occur, therefore, the allegations are UNSUBSTANTIATED. LPA conducted exit interview, provided appeal rights and delivered this report 11/21/2023.

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

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

met_with: Steven Toal, Administrator


raw_content:
Narrative:
Based on LPAs observations and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation(s) are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 & Chapter 1, are being cited on the attached LIC 9099D. Exit interview was conducted and a copy of this report along with appeal rights were provided to the RBT Lead.

Investigation Findings:
13On January 17, 2024 at approximately 10: AM Licensing Program Analyst (LPA) Farhaan Sarangi arrived unannounced at YAI Davis Rd. Community Crisis Home (CCH) and met with RBT Lead, Christian Thurman for the purpose of opening a complaint and delivering findings. During the course of the investigation, LPA Sarangi reviewed incident reports and other supportive documents. In addition, LPA conducted client interviews and conducted a facility tour during the investigation. Based on interviews that were conducted, an observation of the incident report and a facility tour, LPA learned that the facility heater is inoperable. LPA received a phone call from the Licensee on January 10, 2024, and was made aware that the facility heater has not been working at the facility. A review of the incident report filed by the facility corroborated the above allegation. According to the incident report, the facility has space heaters and a work order pending with maintenance has been completed. Furthermore, during a tour of the facility both the LPA and the RBT Lead observed space heaters around the facility (See LIC 812-Photos). (Report continued on LIC 9099C) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Farhaan Sarangi 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: YAI DAVIS RD. COMMUNITY CRISIS HOME (CCH)FACILITY NUMBER: VISIT DATE: 01/17/2024

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

met_with: RBT Lead, Christian Thurman


raw_content:
Investigation Findings:
13On January 17, 2024 at approximately 10: AM Licensing Program Analyst (LPA) Farhaan Sarangi arrived unannounced at YAI Davis Rd. Community Crisis Home (CCH) and met with RBT Lead, Christian Thurman for the purpose of delivering findings. During the course of the investigation, LPA Sarangi reviewed the facility file, client records which includes the Individual Program Plan (IPP) and Needs and Services Plan. LPA Sarangi conducted staff interviews, client interviews and an outside agency interview. Based on interviews conducted during the investigation process the allegations above cannot be substantiated because there were inconsistent statements made throughout the course of the investigation process. In addition, there were no witnesses that staff mishandled a minor while in care. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted. A copy of this report was provided to the RBT Lead UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Farhaan Sarangi LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


raw_content:
Narrative:
LPA made observations of all clients at their respective educational institution, all clients were observed to be free from bruises and marks. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted. A copy of this report was provided to Administrator, Steven Toal.

Investigation Findings:
13On June 14, 2024, at approximately 10: AM Licensing Program Analyst (LPA) Farhaan Sarangi arrived unannounced at YAI Davis Rd. Community Crisis Home (CCH) and met with Administrator, Steven Toal for the purpose of opening a complaint and delivering findings. During the investigation, LPA Sarangi reviewed the facility file at the licensing office, including the complaint history, criminal background check and facility personnel report summary. LPA conducted 8 confidential interviews with all appropriate parties between May 13 and May 22, 2024. Based on interviews conducted, the allegation above cannot be substantiated because there were inconsistent statements made throughout the course of the investigation process. Five out eight interviews denied the allegation and stated they didn't witness nor hear or were present during the incident. In addition, two out of three clients had no concerns about the staff in question, and only two out of eight interviews confirmed alleged allegation. (Report continued on LIC 9099C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Farhaan Sarangi 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: YAI DAVIS RD. COMMUNITY CRISIS HOME (CCH)FACILITY NUMBER: VISIT DATE: 06/14/2024

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

met_with: Administrator, Steven Toal


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Based on evidence gathered and confidential interviews conducted during the investigation, the allegations above cannot be substantiated. Statements obtained during confidential interviews were inconsistent and could not establish whether the facility staff did not meet youth's medical needs. 9 out of 12 confidential interviews stated that the facility does meet the youth's medical needs. It was confirmed that on January 16, 2025 the staff in question was heard to make statements to other staff regarding a youth in cares condition, but LPA was unable to determine that the staff instructed other to not provide medical care. Also, the facility staff contacted a nurse who advised them how to proceed with medical care and that staff followed this advice. Lastly, all clients reported to have their medical needs met. Although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, copy of this report and the Appeal Rights were discussed and provided to the Zach O'Dell, Lead RBT.

Investigation Findings:
13On April 18, 2025, at 2: PM Licensing Program Analyst (LPA) Sarina Buchannan made an unannounced visit to deliver findings to the above Community Crisis Home (CCH) and met with Zach O'Dell, Lead RBT. LPA conducted a walkthrough of the interior and exterior of the facility. Prior to the meeting LPA Sarina Buchannan conducted the 10-day inspection of the CCH on 1/29/2025 and a subsequent inspection on 2/19/2025. LPA Buchannan requested the following documents: Staff Roster (LIC 500), Staff Contact information, Client Roster, Needs and Services Plan, Incident Report, disciplinary record for staff in question, Internal Investigation Report, and Medication Records for Month of December 2024, and January 2025 for all clients. (report continued on LIC 9099C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Sarina Buchannan 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: YAI DAVIS RD. COMMUNITY CRISIS HOME (CCH)FACILITY NUMBER: VISIT DATE: 04/18/2025

met_with: Zach O'Dell, Lead RBT


facility_name: YAI ELECTRIC ST - CCH

raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegations. LPA interviewed the administrator, staff persons who were involved, the regional director and C1. LPA also reviewed the incident report generated by the allegations and the Needs & Services Plan most recent to the allegations. LPA was unable to obtain a written police report. The two staff who were present during the incident denied that either of them hit the client, spoke to her harshly or injured her in anyway, The client herself declined to be interviewed, The incident report did not describe any injuries to C1. The administrato at the timer was not present during the incident and could only report what he had been told. Based on the available information and evidence, the above allegations are resolved as unsubstantiated. Unsubstantiated means that though an allegation may be true, there is not a preponderance of evidence to prove that it did or did not happen. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Jennifer Prodiggalidad, Lead RBT on duty


raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward met with the administrator, Staff #1 and Staff #2 to discuss the allegations. LPA attempted to interview C1. However he was non-responsive. LPA was unable to interview the complainant due to anonymity. LPA also reviewed the two most recent weekly Individual Behavioral Support Plans for C1. Based on the obtainable information, it was not proven conclusively that staff #1 forced the client out of bed or forced him to shower against his will. All staff denied the allegations, but the client was not able to speak on them. Therefore the allegations were resolved as unsubstantiated. An unsubstantiated finding means that although an allegation may have occurred, there is not a preponderence of evidence that it did occur. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Adedapo Ajibade, Administrator


raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegations. LPA spoke to Staff #1, Staff #2 and Client #2. Client #1 was not available due to being detained by the Gardena Police Department and returned to his home county. LPA also reviewed Client #1's Individualized Behavioral Support Plan (IBSP) and a related incident report made to Client #1's Regional Center. There were no related reports found in the Department's data base related to this incident. Both staff members denied that staff speaks inappropriately to Client #1. They also deny that staff spreads false information about Client #1 to outside agencies. Client #2 did not remember anything about Client #1 other than his name. As stated previously, Client #1 could not be reached. LPA found no inappropriate information in the ISBP or the Special Incident Report that was submitted to the Regional Center. Based on the available information, the above findings are both resolved as unsubstantiated. Unsubstantiated means that although an allegation may have happened or is valid, there is not a preponderance of evidence that it did occur. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegations by speaking to staff who were in witness to the incidents and reviewing relevant documentation such as C1's Individualized Behavior Support Plan (IBSP), the internal investigation report conducted by the licensee. LPA Jones-Steward also reviewed the Special Incident Report submitted to the Department on April 30, 2024. C1 is non-verbal and cannot be interviewed. During the internal investigation, the management of Young Adult Institute found that the allegations of personal rights violations were substantiated and Staff #1 was terminated. Witnesses confirmed that there was only one staff person assigned to supervise C1 during the time of the incident. Based on the information that this LPA was able to gather the allegations that client was confined to his room, that staff handled client in a rough manner and that C1 was inappropriately supervised are substantated. A substantiated finding means that there is a preponderance of evidence that an allegation did occur. The licensee was cited under Title Sections 84078(b) & 84072(d)(23) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: YAI ELECTRIC ST - CCHFACILITY NUMBER: 198209741

met_with: Jimmie Silvestri, QMBPS


raw_content:
Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegation. LPA interviewed management staff, reviewed photographic evidence and reviewed the facility's HIPPA policies and the facilitiy's HIPPA training. The complainant stated that there was no other evidence to support her allegations. Staff #1 could be reached for comment. C1 declined to be interviewed. Based on a review of photographic evidence, staff interviews and facility policies, it was determined that staff did take photos of client which violated his HIPPA rights and the allegation was substantiated. The facility was cited under Title 22 84072(d)(1) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B This is an official report of an unannounced visit/investigation of a complaint received in our office on 02/22/2023 and conducted by Evaluator Connie Jones-Steward COMPLAINT CONTROL NUMBER: 34-CR- FACILITY NAME:YAI ELECTRIC ST - CCHFACILITY NUMBER: ADMINISTRATOR:MEAGAN CAMPANAFACILITY TYPE: ADDRESS: ELECTRIC STREETTELEPHONE: (510) 304- CITY:GARDENASTATE: CAZIP CODE: CAPACITY:4CENSUS: 3DATE: 09/13/ UNANNOUNCEDTIME BEGAN: 11: AM MET WITH:JImmy Sivestri, BCBATIME COMPLETED:12: PM Medications are being improperly handled The facility is chronically short staffed INVESTIGATION FINDINGS: 13Licensing Program Analyst Connie Jones-Steward investigated the above allegations. LPA interviewed management and Staff #2. LPA reviewed photographic evidence and medication records for C1, and employee schedules. Staff #2 denies that the allegations occured. Photographic evidence does not support the allegation that medication was handled or disposed of inappropriately. The medical Medical Authorization Records does not show that C1 missed his medication on the dates of the alleged mishandeling. Review of schedules show that the facility was properly staffed for the months in question. Based on lack of supporting evidence, the above allegations are resolved as unsubstantiated. Unsubstantiated means that even though an allegation may have happened, there is not a preponderance of evidence that it did happen. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: YAI ELECTRIC ST - CCHFACILITY NUMBER: 198209741

met_with: Jimmy Silvestrie, BCBA


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with John Smith and staff of YAI Electric to conduct the pre-licensing evaluation. The following was observed. This is a 4 bedroom, 2 bathroom home located in a residential area of the City of Gardena, CA. One of the bathrooms is ADA compliant. There are no bodies of water, no fireplaces and no firearms on the premises. There are no security bars on windows. There is a fire extinguisher near the front door. Smoke detectors and carbon monoxide detectors are working as required. There is a backup generator There is secure, locked space for medications, knives and household chemicals. There are complete first kits in the home and in the facility van. The facility van passed a visual check of headlights, brake lights, signal lights, windshield wipers, horn, seat belts and tires. The yard space is free of hazards There is space available for private visitations and client interviews. There is a back house that provides secured space for client and staff records,. Kitchen and bathroom fixtures are working as required. The stove and refrigerator are in good condition. The hot water temperature is within a safe range. The home is at a comfortable temperature. There are four bedrooms. Each bedroom has a twin bed with complete set of required linens and pillows. There is adequate closet space in each bedroom. All bedroom and household furniture is weighted for client safety. The following items are needed prior to license approval: Permanent or portable chests of drawers for each bedroom and window coverings for the bedroom windows.

report_type: Facility Evaluation

visit_type: Prelicensing

met_with: John Smith, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with Behavioral Specialist Jimmy Silvestre to conduct the post-licensing evaluation. The following was observed. This is a four bedroom, two bathroom home located in the City of Gardena, CA. There is currently one client in placement. Client and employee files were locked by the administrator and there was no key available. In the kitchen, there is an electric range and refrigerator in good working condition. All knives, medications and household cleaners are securely stored. There is a complete first aid kit. There are no firearms in the home. There are no fireplaces or bodies of water. There are no security bars on windows. Smoke and carbon monoxide detectors are working, The floor plan is posted as required. Other current postings included the menu, employee schedule, activity schedule and notice of personal rights. The yard area was free of visible hazards. All bedrooms have one bed, along with the required linens and drawer space. Food supply was adequate except for lack of milk or non-dairy substitute. Bedrooms number one and three did not have window coverings however curtains were placed during the inspection. Bathroom equipment was in working order with covered waste cans. All waste and trash cans were covered. Staff was advised that client and employee records are to be available upon request. However due to lack of access to records by on-site staff, a follow-up visit will be made to review records. Citations were issued for Buildings and Grounds and Food Service. See case management visit dated 10/13/22

met_with: Jimmie Silvestre, BCBA


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with Administrator Adedapo Ajibade to conduct the Annual Required Inspection. The following was observed. This is a four bedroom, two bathroom home located in the City of Gardena, CA. There is currently one client in placement. In the kitchen, there is an electric range and refrigerator in good working condition. All knives, medications and household cleaners are securely stored. There are no fireplaces or bodies of water. There is a complete first aid kit on the premises Smoke and carbon monoxide detectors are working, The floor plan and Emergency Disaster Plan are posted as required. Other current postings included the menu, activity schedule and notice of personal rights. The employee work schedule was last updated 02/03/2023. The yard area was free of visible hazards. Bathroom equipment was in good working order with covered waste cans. All waste and trash cans were covered. All bedrooms have single beds and appropriate linens in good condition. All windows are operable with good screens and no security bars. All staff and client records were currently being reviewed by Regional Center personnel. LPA will return at a later date to review these items. There were no deficiencies cited as a result of this inspection.

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
On May 14, 2026, at 1: PM, Licensing Program Analyst (LPA), Aimee Moratalla conducted a case management - other (follow-up) on an incident investigation at YAI Electric and met with the Program Administrator, Dana Boulden. The initial visit was conducted on 03/25/2026. The incident report concerning lack of supervision was received by the department on 03/18/2026. At the time of the car accident incident which occurred on 03/17/2026, there were two staff accompanying the minor for a community drive. One staff member was the designated driver, and the other staff was assigned to provide supervision to the minor. Based on interviews and information gathered, this case management, the Department determined no further investigation is needed. There are no deficiencies cited per California Code of Regulations, at this time. Exit Interview conducted, and a copy of this report will be emailed to Licensee.

visit_type: Case Management

met_with: Program Administrator, Dana Boulden


summary: Facility Evaluation

raw_content:
Narrative:
On May 14, 2026, at 2: PM, Licensing Program Analyst (LPA) Aimee Moratalla made an unannounced visit to YAI Electric, for the purpose of conducting a Case Management for Special Incident Report the department received on 05/06/2026. The incident occurred on 04/05/2026. The report stated that two staff members were caught sleeping at approximately AM, during their shift, and both staff were assigned to supervise the minor in care. The facility has conducted its own internal investigation which was concluded on 05/05/2026, that resulted in the termination of one staff member, and the other staff received corrective action. LPA met with Program Administrator (PA), Dana Boulden and discussed the incident. LPA requested a copy of the LIC500 and LIC9020. During this visit, LPA interview PA, but not the staff as the individuals were not available in the facility. LPA received a copy of the facility's internal investigation, photograph, letter of termination and corrective action issued to the staff members Based on the information provided, and interview conducted, it was confirmed that neglect/lack of supervision has occurred on April 5, 2006, when two staff members were sleeping while on duty. LPA informed Program Administrator, Dana Boulden, that the facility would be cited. The following deficiency is being cited for violating California Code of Regulations Title 22, Division Regulation 80078(a) and 80061(a). An exit interview was completed, appeal rights issued, and a copy of this report will be emailed to the Program Administrator.


facility_name: YAI EMPIRE AVENUE CCH

raw_content:
Investigation Findings:
13At 3:30pm on 08/15/2023, Licensing Program Analyst (LPA) Karmen Balhotra made an unannounced complaint inspection to the facility at N Davis Road, Lodi, California. The reason for the inspection is to deliver findings for the allegation listed above. LPA met with Christian Thurman, Lead Registered Behavior Technician, who helped with the inspection. Based on confidential interviews, it was confirmed that adequate supervision was not provided to C1 (LIC 811 dated 08/15/2023) while staff were cooking food for C1 using an oven in the kitchen and client independently grabbed the food from the oven and briefly burned themselves that resulted in no injuries to the client. Therefore, the allegation is substantiated. At this time, the facility is being cited under section 80078(a) of the California Code of Regulations, Title 22, Division 6. An exit interview was conducted and a copy of this report was left. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Karmen Balhotra LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: YAI EMPIRE AVENUE CCHFACILITY NUMBER: 075650161

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

met_with: Christian Thurman


facility_name: STAR VIEW COMMUNITY TREATMENT FACILITY

raw_content:
Investigation Findings:
13On June 11, 2021, at 2: PM Regina Martin, Licensing Program Analyst (LPA) met with Kelly McMahon for the purpose of delivering complaint findings. The above-mentioned allegation was investigated by Community Care Licensing Division (CCLD) Investigations Bureau, Investigator Douglas Real. On January 19, 2021, CCLD received a complaint alleging minor was sexually assaulted while in care and staff did not prevent minor from self-harming. Information obtained during the investigation including interviews and related reports did not provide enough evidence to support allegations. Child #1 indicated that she was touched inappropriately underneath her clothes by Child #2 (see LIC811, dated 06/11/2021). Child #1 indicated that this incident was not reported to facility staff. Child #2 denied that she touched Child #1 inappropriately. Child #2 also denied that she and Child #1 had a physical or sexual relationship. There were no witnesses or documentary evidence to support that the allegations occurred. It has been determined that the allegations are Unsubstantiated at this time meaning, although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred. There were no deficiencies cited during the investigation. A copy of this report is provided to Ms. McMahon by email. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Alan Henry LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Kelly McMahon


raw_content:
Investigation Findings:
13On June 11, 2021, at 2: PM Regina Martin, Licensing Program Analyst (LPA) met with Kelly McMahon for the purpose of delivering complaint findings. The above-mentioned allegation was referred to Community Care Licensing Division (CCLD) Investigations Bureau. On December 14, 2020, CCLD received an allegation alleging unidentified staff member(s) had an inappropriate relationship with Client #1 (C1) [see LIC811, dated 06/11/2021]. Based on interviews there is not enough evidence to support alleged claim as C1 denies the allegation indicating that the allegation never happened and that the claim was a rumor. Further facility administration deny past issues or concerns of staff being inappropriate with C1. A review of records indicates C1 has remained consistent of her position during the investigation that the allegation is false. Due to limited information the allegation finding is Unsubstantiated at this time. There were no deficiencies cited during this investigation. A copy of this report is provided to Ms. McMahon by email. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Alan Henry LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Facility Representative


raw_content:
Investigation Findings:
13On June 11, 2021, at 2: PM Regina Martin, Licensing Program Analyst (LPA) met with Kelly McMahon for the purpose of delivering complaint findings. The above-mentioned allegation was investigated by Community Care Licensing Division (CCLD) Investigations Bureau, Investigator Peter Zertuche. On November 9, 2020, CCLD received a complaint of sexual abuse as report alleges Client #1 facility staff "sexually abused him" (see LIC811, dated 06/11/2021). Based on interviews and review of facility video surveillance footage, there is no corroborating evidence to support alleged abuse. Client #1 made inconsistent statements reporting the allegation occurred on different dates and sexual intercourse took place when it did not. Information reported did not coincide with what was observed on video. At no time does the video show Staff #1 in C1's room for an extended amount of time. Due to a lack of evidence at this time, the allegation is deemed Unsubstantiated. There were no deficiencies cited during this investigation. A copy of this report is provided to Ms. McMahon by email. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Alan Henry LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


raw_content:
Narrative:
Due to the lack of evidence and inconsistent information obtained during the investigation, LPA determines that the allegation is Unsubstantiated at this meaning, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred. There were no deficiencies cited at this time. Exit interview was conducted and appeal Rights and a copy of this report will be emailed to Kelly McMahon, Facility Director.

Investigation Findings:
13On October 15, 2021 at 10:45am Licensing Program Analyst (LPA) Donald Martin conducted a follow-up complaint inspection and spoke with Kelly McMahon, Facility Director and delivered findings for the above complaint allegation. During the course of investigating the allegation for minor sustained unexplained injuries while in care, LPA conducted interviews and reviewed the video footage from the incident. Interviews and video did not produce evidence to support the allegation. Video evidence showed Child #1 rubbing his own face on the carpet while being restrained. Video footage also shows staff assisting client to a seated position as a result. Child #1 refused to speak with LPA during the visit. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: STAR VIEW COMMUNITY TREATMENT FACILITYFACILITY NUMBER: VISIT DATE: 10/15/2021

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

met_with: Kelly McMahon-Facility Director


raw_content:
Narrative:
Due to lack of evidence and inconsistent information obtained during the investigation LPA determines that the allegation is Unsubstantiated at this time meaning, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred. There were no deficiencies cited at this time. Exit interview was conducted and appeal Rights and a copy of this report will be emailed to Kelly McMahon, Facility Director.

Investigation Findings:
13On October 25, 2021 at 2:15pm Licensing Program Analyst (LPA) Donald Martin conducted a follow-up complaint inspection and spoke with Kelly McMahon, Facility Director and delivered findings for the above complaint allegation. During the course of investigating the allegation for staff did not prevent inappropriate sexual behavior between minors, LPA conducted interviews and collected the unit roster from December 2020 and July 2021. Interviews and documentary evidence did not produce corroborating evidence to support allegation. Unit roster shows the two clients in question residing in different rooms. C2 also denies allegation. Child #1 was unavailable for comment due to being in the PHF unit. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: STAR VIEW COMMUNITY TREATMENT FACILITYFACILITY NUMBER: VISIT DATE: 10/25/2021

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


raw_content:
Narrative:
Staff interviews were consistent with the distribution of snacks. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred; therefore, the above allegations are Unsubstantiated. There are no deficiencies being cited at this time. Exit interview was conducted, Appeal Rights and a copy of this report will be emailed to the facility.

Investigation Findings:
13On December 28, 2021 at 2pm Licensing Program Analyst (LPA) Donald Martin conducted a follow-up complaint inspection and spoke with Kelly McMahon, Facility Director. The purpose of the inspection was to provide findings for the above complaint allegations. During the course of investigating the allegations for Facility restricting youth access to personal belongings and facility not allowing youth access to snacks, LPA conducted interviews. The interviews did not produce corroborating evidence to support said allegations. Interviews revealed inconsistent statements and no witnesses to suggest allegations occurred. There was no evidence that staff didn't allow youth snacks or access to personal belongings. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: STAR VIEW COMMUNITY TREATMENT FACILITYFACILITY NUMBER: VISIT DATE: 01/03/2022


raw_content:
Narrative:
Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred; therefore, the above allegations are Unsubstantiated. There were no deficiencies cited at the time of the visit. Exit interview was conducted, Appeal Rights and a copy of this report will be mailed to the facility.

Investigation Findings:
13On March 1, 2022 at 2pm Licensing Program Analyst (LPA) Donald Martin conducted a follow-up complaint inspection and spoke with Kelly McMahon, Facility Director. The purpose of the inspection was to deliver findings for the above complaint allegations. During the course of investigating the allegations of Staff threatened youth, Staff made inappropriate comments to youth and Facility does not provide a safe environment for youth, interviews were conducted. The interviews did not produce corroborating evidence to support said allegations. Interviews revealed inconsistent statements and no witnesses to suggest allegations occurred. There was no evidence that Staff threatened youth or made inappropriate comments to youth. Client stated not remembering the incident at all. Client also mentioned feeling safe in the facility during the interview. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: STAR VIEW COMMUNITY TREATMENT FACILITYFACILITY NUMBER: VISIT DATE: 03/01/2022


raw_content:
Narrative:
Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred; therefore, the above allegations are Unsubstantiated. There were no deficiencies cited at the time of the visit. Exit interview was conducted, Appeal Rights and a copy of this report will be mailed to the facility.

Investigation Findings:
13On March 11, 2022 at 12pm Licensing Program Analyst (LPA) Donald Martin conducted a follow-up inspection for the above facility. The purpose of this inspection is to provide findings for the above complaint investigation. LPA delivered the findings to Facility Director, Kelly McMahon. During the course of investigating the allegations of Facility staff inappropriately restrained youth and facility staff did not dispense medication as prescribed, interviews were conducted and documents provided. The interviews did not produce corroborating evidence to support said allegations. Interviews revealed inconsistent statements and no witnesses to suggest allegations occurred. There was no evidence that facility staff inappropriately restrained youth. All staff denied the allegation and the client refused to speak with LPA. For facility staff not dispensing medication as prescribed, the nurse provided documentation that stated how the medication is to be dispensed to the client. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: STAR VIEW COMMUNITY TREATMENT FACILITYFACILITY NUMBER: VISIT DATE: 03/11/2022

met_with: Kelly McMahon-Faciity Director


facility_name: VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CARE

raw_content:
Narrative:
Witnesses had no independent knowledge of the incident and have not witnessed Staff Member #1 behave inappropriately with clients. Staff Member #1 denied the allegation. Due to a lack of evidence, it has been determined that the allegation is Unsubstantiated at this time meaning, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred. There were no deficiencies cited per California Code of Regulations, Title 22. Exit Interview conducted with Facility Representative and a copy of this report and appeal rights are emailed to Unit Supervisor Renee Capeloto.

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

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

met_with: Facility Representative, Kathy Williams Youth Development Counselor Lead


raw_content:
Narrative:
It was revealed that on 06/13/2021, C1 stroked and orally copulated the penis of Client #2 (C2) in a room at the facility. Interviews and review of video footage confirm C1 and C2 along with two other clients were unsupervised by staff at the time the incident occurred, as the sole staff member who was in the room, momentarily left the room. The investigation further revealed that it was the suggestion of one of the other clients in the room that C1 orally copulate C2 to which C1 ultimately agreed after persistent request from that client. Although the act was not the request of C2, C2 did not refuse the act and pulled C2's pants down to assist C1. It was revealed C1 felt pressured to perform the act on C2 and as a result, C1 later informed a staff member what happened. Local law enforcement was contacted by the facility. C1 acknowledged C1 willfully performed the act on C2 but indicated C2 held C1's wrist while C1 performed the act. Per the video surveillance footage, the staff member on duty at the time left the room. C1 orally copulated C2 for approximately 3 seconds before the staff member returned to the room. Video footage indicates the staff member had left the room for approximately 30 seconds. Based on all information obtained during the investigation, the preponderance of the evidence standard has been met. The Department has determined a lack of supervision contributed to sexual misconduct between C1 and C2 while in care. The allegation is deemed substantiated at this time and thus poses an immediate health, safety and personal rights risk of harm to children placed in care. The facility is issued a citation in accordance with the California Code of Regulations, Title Regulations, Division 6, Chapter 5; Section 84172 (b) Personal Rights and Chapter 6; Section Responsibility for Providing Care and Supervision. An exit interview was conducted, and appeal rights were discussed. A copy of this report, the Confidential Names List and appeal rights were provided to Facility Representative. (Continued on page LIC9099-D)

Investigation Findings:
13On December 16, 2021 at 1: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection to deliver findings concerning the above-mentioned allegation. LPA Martin met with Mark Walker, Youth Development Counselor Supervisor and Jermaine Trottie, Unit Supervisor to discuss the investigative outcome. The investigation was conducted by Licensing Special Investigator Dennis Douglas of the Community Care Licensing (CCL) Investigations Bureau. On June 14, 2021, CCL received an allegation that Client #1 (C1) (see LIC811, dated 12/16/2021) was sexually assaulted by Client #2 while in care. Investigator Dennis completed the investigation which included confidential interviews with three Clients, staff members and review of related client files, Los Angeles Police Department Incident Report and review of corresponding facility surveillance video footage. (Continued on page LIC9099-C) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CAREFACILITY NUMBER: VISIT DATE: 12/16/2021

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

met_with: Facility Representatives, Mark Walker and Jermaine Trottie


raw_content:
Narrative:
Child 1 stated that staff did not touch Child 1 and that someone touched Child 1 while in El Salvador. Child 1 stated not interacting with any male staff at facility. Based on the interviews conducted and documentary evidence obtained the information did not produce corroborating evidence to support the above said allegation. Due to inconsistent statements LPA Phillips was not able to determine if the above said allegation occurred, therefore the allegation is found to be Unsubstantiated meaning that although the allegations may have happened or is valid there is not a preponderance of evidence to prove that the alleged incidents occurred. No deficiencies cited at the time of this investigation.

Investigation Findings:
13On 12/30/2021, 2021 at 1: PM Licensing Program Analyst (LPA), Zena Phillips conducted a follow-up complaint investigation visit to VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CARE and met with Renee Capeloto, Unit Director. The purpose of the visit was to deliver findings for the above complaint allegation. During the course of investigating the allegation, pertinent parties were interviewed, reviewed facility records and Incident Reports. Based on the interviews conducted and statements obtained during the investigation the above allegation cannot be substantiated because LPA Phillips obtained inconsistent statements from staff and resident in care. Staff 1 denied the above allegation happened as there about six (6) overnight staff walking the floors. Staff 1 stated that Child 1 has not been left alone with any males in this unit. Staff 2 stated that Child 1 said having flash back about abuse from an uncle. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CAREFACILITY NUMBER: VISIT DATE: 12/30/2021

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

met_with: Renee Capeloto/Unit Director


raw_content:
Narrative:
restraints are conducted when clients in care pose imminent danger to self and others, staff have to be Pro-Act trained and two or more staff must conduct the restraint. There were no video footage to corroborate the incident due to complaint reported two or more months after incident. Staff #2, Staff #4 and Staff #5 all stated that Child #1 did not disclose reason for needing to make call @2 : AM and call was denied to due to phone policy. No calls are allowed after 10:00PM unless emergency. Child #1 did not state reason for call during interview. Staff #1, Staff #2, Staff #4 & Staff #5 all stated will intervene when an altercation occurs between resident for safety of residents. Staff #2 denied having inappropriate interactions with Child #1 and would not enter room without knocking. Staff #2 stated three staff were present during incident with Child #1. Staff #4 & Staff #5 confirm Staff #2 did not handle Child #1 in a rough manner or touch inappropriately. Based on the interviews conducted and documentary evidence obtained the information did not produce corroborating evidence to support the above said allegations. Due to inconsistent statements LPA Phillips was not able to determine if the above said allegations occurred, therefore the allegations are found to be Unsubstantiated meaning that although the allegations may have happened or is valid there is not a preponderance of evidence to prove that the alleged incidents occurred. Therefore, the allegations are unsubstantiated. There are no deficiencies cited at this time. Exit interview was conducted, and copy of the report will be emailed to facility Jermaine Trottie/ Unit Supervisor.

Investigation Findings:
13On June 3, 2022 at 8: AM Licensing Program Analyst (LPA), Zena Phillips conducted a follow-up complaint investigation visit to VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CARE and met with Rebecca Hatcherson/Adminstrative Assistant. The purpose of the visit was to deliver findings for the above complaint allegations. LPA conducted confidential interviews and reviewed Child and Family Team Meeting Minutes, Needs and Service Plan, Incident Reports and facilities emergency intervention policies and procedures. Confidential interviews indicated that client in care was restrained by staff for attempting to assault staff, however did not sustain any injuries as a result of the restraint. Child #1 also stated was not injured during restraint. Confidential interviews indicated that UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CAREFACILITY NUMBER: VISIT DATE: 06/03/2022

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


raw_content:
Narrative:
Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Unit Director.

Investigation Findings:
13On July 21, 2022 at 8: AM Licensing Program Analyst (LPA), Zena Phillips conducted a follow-up complaint investigation visit to VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CARE and met with Richard Harbor/ Overnight Supervisor. The purpose of the visit was to deliver findings for the above complaint allegation. During the investigation, a total of one (1) client, four (4) staff and one (1) CSW were interviewed. Confidential interviews, documentary evidence of Special Incident Report (SIR) 788640. Based on the interviews conducted and documentary evidence, the information gathered did not produce corroborating evidence to support the above said allegation. LPA Phillips was not able to determine if the above said allegations occurred, therefore the allegation is determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CAREFACILITY NUMBER: VISIT DATE: 07/21/2022

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

met_with: Richard Harbor/ Overnight Supervisor


raw_content:
Narrative:
Staff report that personal items are not stored in the client's rooms due to safety. Clients are given personal items with supervision and then items returned to locker. Client interviews reveal that one client is taking items that are not their personal items. The items are then returned to rightful client. All staff and two (2) client confirm this is what has happened. The facility provided documentation showing inventory log of items resident had upon placement at facility. After reviewing inventory log LPA Phillips did not observe any missing items mentioned in the complaint allegations. Based on the interviews conducted and documentary evidence, the information gathered did not produce corroborating evidence to support the above said allegations. LPA Phillips was not able to determine if the above said allegations occurred, therefore the allegations are determined to be unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. Based on the observations made during today's inspection, no deficiencies were cited Exit interview was conducted, and a copy of this report will be emailed to the Unit Director.

Investigation Findings:
13On August 18, 2022 at 9: AM Licensing Program Analyst (LPA), Zena Phillips conducted a follow-up complaint investigation visit to VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CARE and met with Mark Walker/Youth Development Counselor Supervisor . The purpose of the visit was to deliver findings for the above complaint allegations. During the investigation of the allegations. LPA Phillips conducted confidential interviews with five (5) Staff and three (3) clients. After conducting the confidential interviews and review of the following documentation: Child and Family Team Meeting Minutes, Needs and Service Plan, client file, allowance log and SIR reports. There was not enough evidence to support the allegations occurred. Staff deny that residents personal items are not safe guarded. Staff report personal items are stored in a locker and client allowed access with supervision. Staff deny that client does not have access to personal items. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CAREFACILITY NUMBER: VISIT DATE: 08/18/2022

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


raw_content:
Narrative:
Confidential interviews revealed the facility has six (6) air conditioning units on the Earth wing with regular maintenance scheduled. LPA Phillips observed laser thermometer reading of vents for five (5) rooms and one (1) common room. LPA Phillips was not able to determine if the above allegation occurred, therefore the allegation is determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred Based on the observations made during today's inspection, no deficiencies were cited. Exit interview was conducted, and a copy of this report will be emailed to Mark Walker /YDC Supervisor. .

Investigation Findings:
13On October 10, 2022 @ 10: AM Licensing Program Analyst (LPA) Zena Phillips made follow up vsiit to VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CARE for the purpose of delivering findings on the allegation listed above. LPA Phillips was greeted by Mark Walker/ YDC Supervisor who granted access to the facility. During the course of the investigation LPA Phillips conducted seven (7) confidential interviews, reviewed facility work orders request for HVAC,and LPA observed laser thermometer reading in Earth wing air condition vents. Confidential interviews revealed that facility was at uncomfortable temperature , however documentary evidence and LPA observation showed facility temperature was in compliance. Based on the interviews conducted and documentary evidence, the information gathered did not produce corroborating evidence to support the above said allegation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CAREFACILITY NUMBER: VISIT DATE: 10/10/2022

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

met_with: Mark Walker/ Youth Development Counselor Supervisor


raw_content:
Narrative:
LPA Phillips was not able to determine if the above said allegation occurred, therefore the allegation is determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. Based on the observations made during today's inspection, no deficiencies were cited. Exit interview was conducted, and a copy of this report will be emailed to Renee Capeloto/ Unit Director.

Investigation Findings:
13On 10/28/2022 @ 9:10AM Licensing Program Analyst (LPA) Zena Phillips made an unannounced follow up visit to VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CARE for the purpose of delivering findings. LPA was met by Kathy Williams/Lead YDC who provided current census. During the investigation LPA Phillips conducted six (6) confidential interviews and reviewed the following documentation:: SIR's, NSP along with CFTM notes. Staff #1 through Staff #5 denied the allegation occurred and reported to LPA Phillips that only staff notes were taken from Child #1 . Confidential interviews and documentary evidence reveal that Child #1 was not handled in a rough manner and no physical contact occurred with staff during incident. Due to inconsistents statements from confidential interviews LPA was not able to substantiate that minor was handled in a rough manner while in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: VISTA DEL MAR CHILD & FAMILY SERVICES-SPECIAL CAREFACILITY NUMBER: VISIT DATE: 10/28/2022

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

met_with: Kathy Williams/Lead Youth Development Counselor


facility_name: BAY AREA CRISIS NURSERY

summary: Facility Evaluation

raw_content:
Narrative:
On 7/28/22 at 1:13PM, Licensing Program Analyst (LPA) Mariah Hawkins conducted a random annual inspection at the facility. LPA met with Director/Administrator Tara Bartholomew and informed of the purpose of the visit. Safety precautions were taken, including mask wearing and hand hygiene. LPA toured the facility and grounds with Director/Administrator. The facility is clean and organized, bathrooms and kitchen are sanitary, play spaces and toys were observed to be clean, in safe condition, and developmentally-appropriate, and the outdoor play area was free of obstructions. There are no bodies of water on the grounds. No dangerous items were observed, and per Director/Administrator, there are no firearms or weapons on the premises. The facility has four youth bedrooms, and all were clean and tidy. The facility has a waiver to have more than two beds in a room. The large bedrooms with five beds each currently have three beds in use in order to provide six feet separation between used beds. The toddler room also currently has three beds instead of five. Chemicals and medications are stored where inaccessible to youth. Room and hot water temperatures measured within permitted ranges, at F and 113. F, respectively. Youth records were observed to be complete. Staff files reviewed reflected that staff had background clearances and were associated to the facility, had medical clearances to work in the facility, had valid first aid/CPR certificates, and had signed acknowledgements of mandated reporter status. Youth were observed to be engaged with staff in activities, and staff were attentive to youth needs. During incidents that occurred during visit, staff were responsive to each youth's needs and communicated well with other staff. There are no citations. An exit interview was conducted, and a copy of this report was left with Director/Administrator Tara Bartholomew, whose signature on this form confirms receipt.

met_with: Director Tara Bartholomew


summary: Facility Evaluation

raw_content:
Narrative:
On 09/23/2024 at 11:55 a.m., Licensing Program Analyst (LPA) Brenda Rodriguez and Licensing Program Analyst (LPA) Jonathan Medina conducted a random annual inspection at the facility. LPA's met with Program Manager, Gina McGlasson and informed her the purpose of the visit. LPA's toured the facility and grounds with Program Manager. The facility is clean and organized, bathrooms and kitchen are sanitary, play spaces and toys were observed to be clean, in safe condition, and developmentally appropriate, and the outdoor play area was free of obstructions. There are no bodies of water on the grounds. The facility has four client bedrooms, and all were clean and tidy. Chemicals and medications are stored where it is inaccessible to the clients. LPA Rodriguez and LPA Medina reviewed four (4) client records. Client records were observed to be complete. LPA Rodriguez and LPA Medina reviewed three (3) staff files. Staff files reviewed reflected that staff had background clearances and were associated to the facility, had medical clearances to work in the facility, had a valid first aid/CPR certificates, and had signed acknowledgements of mandated reporter status. Clients were observed to be engaged with staff in activities, and staff were attentive to client needs. During incidents that occurred during visit, staff were responsive to each youth's needs and communicated well with other staff. The required Annual Inspection is complete. No deficiencies were cited. An exit interview was conducted at 2:10 p.m., and a copy of this report was emailed to Director/Administrator Tara Bartholomew, whose signature on this form confirms receipt.

met_with: Gina McGlasson, Program Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 01.29. Licensing Program Analysts (LPAs) Misty Valencia and Tina Thorn arrived unannounced at the facility and met with Lynn Woerner, Director .The purpose of the visit was to conduct a Required, Two year Annual Inspection of the facility. The last Annual inspection for the facility was on 09.12.19. LPA utilized the CARE Tool to complete the Annual inspection. LPA conducted an inspection of the physical plant, and checked for all necessary requirements. The facility was clean and organized,and maintained an acceptable room temperature. The facility is a home like setting, with 3 client bedrooms, a large open plan kitchen/dining area, and one locked staff office. Each client had a closet and dresser in good repair. Mattresses and bedding were observed to be clean. The backyard was free from hazards, safely fenced, with a variety of play equipment accessible to clients. LPA observed the proper postings including: facility license, complaint hotline, client personal rights, and emergency disaster plan. The facility has 1 client bathroom and two staff bathrooms. All were observed to be clean and fully functioning. Smoke alarms were fully functioning and current and first-aid kits were available in a locked cabinet. The facility has no outstanding fees. The facility currently has no clients, with a licensed maximum capacity of 6. Staff to client ratio is 1: LPA reviewed one staff file. Staff file had completed criminal record clearances and all required initial and annual training. All First Aid and CPR certifications were up to date for staff. No Crisis care clients have been enrolled in six years. LPA interviewed one staff on site. No citations were given on this date. A Lic 9099 was provided to the Director An exit interview was conducted.

met_with: Lynn Woerner, Executive Director


summary: Facility Evaluation

raw_content:
Narrative:
*Correction: This was not an office visit. This was a visit to the facility. On 01.23. Licensing Program Analyst (LPA) Tina Thorn attempted a visit for the purpose of an Annual Inspection. There was nobody at the facility when LPA Arrived. LPA spoke with Lynn Woerner, Administrator on the phone. LPA was advised that the facility closed and would reopen the next week.

met_with: spoke on the phone with Lynn Woerner, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 01/10/ Licensing Program Analysts (LPAs) Misty Valencia and Lyta Vue arrived unannounced at the facility and no one was present .The purpose of the visit was to conduct a Required, Two year Annual Inspection of the facility. The last Annual inspection for the facility was on 01/29/2024. LPAs arrived and knocked on the front door, with no response. There was a sign on the door says that the facility is open Monday-Wednesday 11-5. LPA Valencia called and left a message requesting a call back at 9am, with no response. LPAs attempted again at 11am, but no one was present. LPA Valencia called and left another message. LPAs stayed until 1130. No one returned LPA's phone call or was present at the facility. LPAs observed no vehicles and the facility and the lights were off inside the facility. LPA Valencia mailed out a certified letter to the facility regarding no contact and late fees to the Facility and PO Box address. LPA gave them 30 days to respond back.


facility_name: SACRAMENTO CRISIS NURSERY

raw_content:
Narrative:
police report, nursery log dated 10/6/22, staff training log dated 9/28/22, staff meeting agenda dated 9/28/22, and new employment training logs. LPA Carmona conducted 17 confidential interviews between 12/7/22- 1/10/23 and 2 attempted interviews. Based on interviews conducted during the investigation process the allegations cannot be substantiated because statements given from 11 confidential interviews conducted from 12/7/22-1/3/23 corroborated that staff did not cause injury to C1 or hit C1. The facility had proper documentation of the injury in question on an injury report dated 10/06/22 which was signed at discharge. In addition, the facility also documented the injury on the nursery log dated 10/06/22. Lastly, there were inconsistent statements from interviews conducted on 12/5/22, 12/15/22 and 1/3/23. On 11/8/22 the facility staff met mandated reporting requirements and addressed concerns of reported previous incidents on 10/19/22. LPA Carmona was also not able to qualify C1 during the investigation process. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted. A copy of this report and the Appeal Rights were provided to the Program Manger.

Investigation Findings:
13On 01/13/ Licensing Program Analyst (LPA) Jacqueline Carmona conducted a complaint inspection to the above Crisis Nursery (CN) and met with Annette Jumper, Program Director for the purpose of delivering findings. During the investigation, LPA Carmona reviewed the agency's file at the licensing office, including the complaint history, criminal background check, incident reports and facility personnel report summary. LPA also reviewed an email dated 10/19/22, pictures dated 11/08/22, intake documents dated 10/6/22, 10/27/22, 11/1/22, 11/3/22,11/8/22, injury reports dated 10/06/22 and 10/27/22,microsoft teams log dated 11/8/22, phone call log dated 11/8/22,LIC 500, facility work schedule dated week of 11/5/22-11/11/22, case notes dated 10/5/22, 10/6/22, 10/19/22,10/28/22,11/1/22,11/3/22,11/4/22 and 11/8/22, protective custody report dated 11/08/22, UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Jacqueline Carmona 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 23-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, NATOMAS PARK DR., STE FACILITY NAME: SACRAMENTO CRISIS NURSERYFACILITY NUMBER: VISIT DATE: 01/13/2023

met_with: Annette Jumper, Program Director


raw_content:
Narrative:
Although the allegation may have happened or is valid there is not a preponderance of evidence to prove the alleged violation did occur therefore the allegation is UNSUBSTANTIATED. Exit interview was conducted, and Appeal Rights were discussed with Cherelle Blufoarcraving, Supervisor. A copy of this report and Appeal Rights were left at the facility.

Investigation Findings:
13On September 17, Licensing Program Analyst (LPA) Sara Luman-Gonzalez conducted an unannounced visit to the above agency to deliver the findings of a complaint investigation. LPA met with Cherelle Blufoarcraving, Supervisor and was granted entry. During the investigation, LPA conducted the 10-day inspection of the facility on May 24, LPA obtained C1's file, Staff Schedule for the week of May 8, 2024, Staff Roster and Phone List. 6 confidential interviews were conducted between May 2024 and September 2024 by LPA Luman-Gonzalez. Based on LPA's Interviews and records review, C1 was unable to be qualified during the interview process as well as they kept changing the physical details of the alleged perpetrator. Also, records show who was all scheduled during that time and none of them matched the first description provided by C1. Lastly, there no confirmed witnesses to the incident in question nor was there camera footage showing the alleged incident. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Sara Luman-Gonzalez 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: SACRAMENTO CRISIS NURSERYFACILITY NUMBER: VISIT DATE: 09/17/2024

met_with: Cherelle Blufoarcraving, Supervisor