summary: Facility Evaluation

raw_content:
Narrative:
On July 30, 2021 at 1: PM, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced case management at Heritage Youth Services-1, a Short Term Residential Therapeutic Program (STRTP) and met Tami Tutolo, Administrator regarding a Special Incident Report (SIR) that was submitted to Community Care Licensing Department (CCLD) on July 07, 2021. Today, July 30, 2021 at 9: AM, LPA interviewed STRTP Administrator Tami Tutolo via telephone with regards to Non-Minor Dependent's (NMD) filing police report (reference Confidential Names Form LIC 811 dated July 30, 2021) that she was sexually assaulted while on pass. According to the Administrator, NMD was in a home pass due to being on a level for attending her therapy, finishing her chores and DCFS CSW approved the home pass with her boyfriend. When NMD returned to the facility on 7/07/21, she reported to staff that she was sexually assaulted while on pass at Los Angeles. NMD reported she was separated with her boyfriend when the sexual assault incident happened. Per Administrator, staff contacted the Pomona Law Enforcement (LE) to report it the same day. Pomona LE responded and took NMD's statement and informed NMD that an Officer from Los Angeles Police Department LAPD will need to get another statement since the sexual assault took place in Los Angeles. Per Administrator, Dr. Tamayo facility's Mental Health Supervisor accompanied NMD the following day in 7/08/21 to San Gabriel Valley Medical Center for a medical examination or rape test kit exam. According to Administrator, upon arrival at the facility from the Medical Center, NMD took a shower and when she came out, staff noticed several superficial cuts on her left leg. Staff and Dr. Tamayo implemented crisis intervention. Per administrator she provided first aid until paramedics arrived due to NMD's expressing loneliness and not wanting to live. SIR disclosed that Dr. Tamayo updated NMD's safety plan, including social media safety planning and increased therapy sessions with Therapist. NMD will meet individually with her therapist at least 3x weekly. Per Administrator, NMD and all other clients will not be given a razor to shave but will be given a cream instead. Per SIR addendum, NMD was discharged from the hospital on 7/13/21. Dr. Tamayo met NMD and updated her safety plan. NMD was provided a one on one for a period of 24 hours to assist her emotionally. Per Administrator, NMD now has a job and participated in the Child Family Team (CFT) meeting held on 07/20/21, which documented that NMD agrees that she will continue to practice safety when she goes on out-passes as well as during her time on social media. NMD will continue to practice clear communication with the team about her whereabouts. Staff and therapist will continue to work with NMD about safety and encourage her to reach out to investigators and to notify first CSW and case manager in order to make sure she is safe before communicating or going to a specific meeting. LPA was provided with CFT document held on 7/20/21 and NMD's written safety plan dated on 3/31/21, 7/06/21 and 7/13/21. Based on the information obtained through interviews and records reviewed there is no evidence of any violation of Title 22. There were no deficiencies cited at this time, and a copy of LIC 809, LIC 811 was given to the facility representative.

met_with: Tami Tutolo


state: CA

facility_name: HERITAGE YOUTH SERVICES - 2

summary: Facility Evaluation

raw_content:
Narrative:
On June 9, 2021 at 9: AM Licensing Program Analyst (LPA), Timika Martin conducted an unannounced annual/required inspection at the Short Term Residential Therapeutic Program (STRTP) facility and met the Administrator, Farrah Richmond. The facility is licensed to provide services to 6 female clients ages 12-17 and to Non-Minor dependents. There are currently 3 clients in placement. Physical Plant: At 10: AM, LPA conducted a tour of the inside and outside of the facility with Administrator, Farrah Richmond. LPA observed the following required posted items that are accessible to clients: Facility license, facility sketch, grievance procedures, Personal Rights, Ombudsman poster, Emergency Disaster Plan, daily schedule/activities, daily food menu and Covid-19. postings. The kitchen is sanitary and in good repair. LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients as well. Sharp knives and sharp utensils were locked inside of a closet near the kitchen. Dishes, glasses and eating utensils were clean and in good condition. The smoke/carbon monoxide detectors were tested and working. The fire extinguisher is in the kitchen and serviced this year. The first aid kit was checked and complete. All medications and medication logs are centrally stored and in a double locked cabinet located upstairs in the staff office. Disinfectants, cleaning solutions and other hazardous items are kept inaccessible to the clients in a locked closet. The washer and dryer is located near the kitchen area. The facility vehicles' current insurance, registration and vehicle log were checked. The hot water temperature in the bathrooms were checked using a digital thermometer and registered at 108 degrees Fahrenheit. Each client is supplied with personal hygiene products. There were extra towels and linens for clients use in cabinets. There is a total of (4) bedrooms, (3) bathrooms and (1) staff office located on the second floor. There are four (4) bedrooms that have solo occupancy. There is adequate drawer, shelf and closet space for client's belongings. All beds are clean and in good repair. Staff Files: At 10: AM, LPA started to review staff and client files. LPA obtained Personnel Summary report (LIC 500) from the facility. LPA reviewed three (3) staff files. All staff files contained the required documentation per Title Regulations. All three (3) staff who required caregiver background checks have received criminal record and child abuse index check clearances or exemptions and associations. Staff files contained the Mandated Reporter/acknowledgement form. Client Files: LPA reviewed three (3) client files. Documentation for each client is complete, signed and current. All medications are recorded and logged. Psychotropic medications prescribed have current JV220 court order, medical consent authorization is available for review and current in client's file. Facility is providing adequate services with the client's needs & services plan; it is current and updated. At 12: PM LPA Martin conducted interviews. LPA interviewed one (1) staff and three (3) clients. LPA Martin reviewed the current LIC 500, LIC 309 current Board Meeting minutes and an updated copy of the emergency disaster plan. Based on the facility inspection and file reviews on this date, there are no deficiencies found at this time. An exit interview was conducted with the Administrator. LPA provided a copy of the following reports: LIC 809, LIC 809C, LIC 858, LIC 859, were provided to Administrator Farrah Richmond.

report_type: Facility Evaluation

visit_type: Annual

met_with: Farrah Richmond, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Jenny Mundo on 2/25/2022 at 11:10 am. During the inspection, LPA Mundo met with Farrah Richmond, Program Administrator and inspected the facility inside and out. LPA did not review children records, children psychotropic medications or interview children due to the facility having no children in placement currently. LPA reviewed one (1) staff file on site at the facility at 11: AM. LPA interviewed one (1) staff on site at 11: AM. LPA conducted exit interview with Farrah Richmond, Program Administrator at 11: AM. LPA provided the Summary Report to Farrah Richmond, Administrator upon completion. One (1) Technical Assistance (LIC9102TA) was also issued.

visit_type: Case Management

met_with: Farrah Richmond, Program Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On February 25, 2021 at 10: AM Licensing Program Analyst (LPA), Timika Martin conducted an unannounced annual/required inspection at the Short Term Residential Therapeutic Program (STRTP) facility and met the Administrator, Farrah Richmond. The facility is licensed to provide services to 6 female clients ages 12-17 and to Non-Minor dependents. There are currently 0 clients in placement and 1 working staff at the facility. The facility is currently licensed and is planning to relocate. LPA obtained and reviewed the following updated documentation: · LIC Personnel · LIC 610-C Emergency Disaster Plan · Fire Clearance · Accreditation · Board of Directors report and program statement LPA observed the facility to be clean, safe and sanitary. The STRTP consists of a total of (4) bedrooms, (3) bathrooms and (1) staff office located on the second floor. There are four (4) bedrooms that have solo occupancy. The agency has all the required documents posted. The hot water temperature in the bathrooms/kitchen were checked using a digital thermometer and registered at 118 degrees Fahrenheit. LPA reviewed one (1) staff file and conduct an interview with one (1) staff. LPA Martin reviewed the current LIC 500, LIC 309 current Board Meeting minutes and an updated copy of the emergency disaster plan. Based on the facility inspection and file review on this date, there are no deficiencies found at this time. An exit interview was conducted with the Administrator. LPA provided a copy of the following reports: LIC 809, were provided to Administrator Farrah Richmond.

met_with: Farrah Richmond


facility_name: HERITAGE YOUTH SERVICES - 3

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
The investigation revealed an allegation whereby a foster child in placement uploaded nude pictures of another foster child through Instagram from the child's personal cellphone. It also alleged that the foster child got beat up by the foster child in placement. Confidential statements obtained during the investigation were unable to corroborate the allegations as the staff denied the incident took place due to lack and supervision and that staff intervene when the foster child attempted to beat up a foster child. Staff indicated that crisis communication was used during the incident. Interviews revealed that the foster child that was previously placed at the facilty climbed through the window which was opened by a new client who had no clue both foster children had issues with each other. Interviews with staff revealed that foster child voluntary had provided the other foster child with the PIN # to her cell phone which gave her access to everything on her phone. Interviews with County Social Worker indicated that both foster children got along well but had a recent fall out because one foster child began dating the other foster child's boyfriend which created conflict between them. The staff reported that the house rules is something that's discussed constantly with clients to prevent incidents such as the misuse of cellphones. Other statements obtained during the investigation were unable to corroborate the allegation. LPA attempted to interview both foster children but was unsuccessful due to both foster children being AWOL from their placements. CSW indicated that they cannot be located. Based on the information gathered, the allegation is unsubstantiated as the preponderance of evidence to prove the allegation was not met although the allegation may have happened or is valid. A copy of this report and Confidential Names Form were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On April 16, 2024, at 10: AM, Licensing Program Analyst (LPA) Claudia Portillo conducted a follow-up inspection to deliver the findings of a complaint investigation concerning the allegation above. LPA Portillo discussed the findings with the facility representative named above. During the course of the investigation, LPA obtained the statements from the staff and county social worker (CSW) on 2/6/24, one staff and CSW on 2/7/24, and another staff on 2/8/24. LPA made several attempts to interview both foster children, however, both FC have been awol and cannot be located. (See Confidential Names Form dated April 10, 2024). LPA also reviewed documents including the placing agency service reports, foster child's Needs and Services Plan, incident reports, and training history of the resource parent. It was alleged that the staff did not ensure that appropriate protection was provided to minor in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Claudia Portillo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HERITAGE YOUTH SERVICES - 3FACILITY NUMBER: VISIT DATE: 04/16/2024

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

report_type: Complaint Investigation

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On June 8, 2021 at 9: AM Licensing Program Analysts (LPA's) Timika Martin and Jenny Mundo conducted an unannounced annual/required inspection at the Short Term Residential Therapeutic Program (STRTP) facility and met the Administrator, Farrah Richmond. The facility is licensed to provide services to 6 female clients ages 12-17 and to Non-Minor dependents. There are currently 5 clients in placement. Physical Plant: At 9: AM, LPA's conducted a tour of the inside and outside of the facility with Administrator, Farrah Richmond. LPA's observed the following required posted items that are accessible to clients: Facility license, facility sketch, grievance procedures, Personal Rights, Ombudsman poster, Emergency Disaster Plan, daily schedule/activities, daily food menu and Covid-19. postings. The kitchen is sanitary and in good repair. LPA's observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients as well. Sharp knives and sharp utensils were locked inside of the hallway cabinet. Dishes, glasses and eating utensils were clean and in good condition. The smoke/carbon monoxide detectors were tested and working. The fire extinguisher is in the kitchen and serviced this year. The first aid kit was checked and complete. All medications and medication logs are centrally stored and kept in a locked cabinet located in the staff office. Disinfectants, cleaning solutions and other hazardous items are kept inaccessible to the clients in a locked closet. The washer and dryer are located in the garage which is locked and inaccessible to the clients. The facility vehicles' current insurance, registration and vehicle log were checked. The hot water temperature in the bathrooms were checked using a digital thermometer and registered at 113 degrees Fahrenheit. Each client is supplied with personal hygiene products. There were extra towels and linens for clients use in cabinets. There is a total of (4) bedrooms, (3) bathrooms and (1) staff office. There are two (2) bedrooms that have two twin beds and two (2) other bedrooms that have solo occupancy with one (1) twin bed. There is adequate drawer, shelf and closet space for client's belongings. All beds are clean and in good repair. Staff Files: At 10: AM, LPA's started to review staff and client files. LPA's obtained Personnel Summary report (LIC 500) from the facility. LPA Jenny Mundo reviewed five (5) staff file. All staff files contained the required documentation per Title Regulations. All five (5) staff who required caregiver background checks have received criminal record and child abuse index check clearances or exemptions and associations. Staff files contained the Mandated Reporter/acknowledgement form. Client Files: LPA Timika Martin reviewed five (5) client files. Documentation for each client is complete, signed and current. All medications are recorded and logged. Psychotropic medications prescribed have current JV220 court order, medical consent authorization is available for review and current in client's file. Facility is providing adequate services with the client's needs & services plan; it is current and updated. At 12: PM LPA's conducted interviews. LPA Mundo interviewed two (2) staff and LPA Martin interviewed four (4) clients. LPA Martin reviewed the current LIC 500, LIC 309 current Board Meeting minutes and an updated copy of the emergency disaster plan. Based on the facility inspection and file reviews on this date, there are no deficiencies found at this time. An exit interview was conducted with the Administrator. LPA provided a copy of the following reports: LIC 809, LIC 809C, LIC 858, LIC 859, were provided to Administrator Farrah Richmond.


summary: Facility Evaluation

raw_content:
Narrative:
On February 23, 2022 at 9: AM Licensing Program Analysts (LPA's) Timika Martin and Jenny Mundo conducted an unannounced annual/required inspection at the Short Term Residential Therapeutic Program (STRTP) facility and met the Administrator, Farrah Richmond. The facility is licensed to provide services to 6 female clients ages 12-17 and to Non-Minor dependents. There are currently 5 clients in placement. Physical Plant: At 9: AM, LPA's conducted a tour of the inside and outside of the facility with Administrator, Farrah Richmond. LPA's observed the following required posted items that are accessible to clients: Facility license, facility sketch, grievance procedures, Personal Rights, Ombudsman poster, Emergency Disaster Plan, daily schedule/activities, daily food menu and Covid-19. postings. The kitchen is sanitary and in good repair. LPA's observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients as well. Sharp knives and sharp utensils were locked inside of the hallway cabinet. Dishes, glasses and eating utensils were clean and in good condition. The smoke/carbon monoxide detectors were tested and working. The fire extinguisher is in the kitchen and serviced this year. The first aid kit was checked and complete. All medications and medication logs are centrally stored and kept in a locked cabinet located in the staff office. Disinfectants, cleaning solutions and other hazardous items are kept inaccessible to the clients in a locked closet. The washer and dryer are located in the garage which is locked and inaccessible to the clients. The facility vehicles' current insurance, registration and vehicle log were checked. The hot water temperature in the bathrooms were checked using a digital thermometer and registered at 115 degrees Fahrenheit. Each client is supplied with personal hygiene products. There were extra towels and linens for clients use in cabinets. There is a total of (4) bedrooms, (3) bathrooms and (1) staff office. There are two (2) bedrooms that have two twin beds and two (2) other bedrooms that have solo occupancy with one (1) twin bed. There is adequate drawer, shelf and closet space for client's belongings. All beds are clean and in good repair. Staff Files: At 10: AM, LPA's started to review staff and client files. LPA's obtained Personnel Summary report (LIC 500) from the facility. LPA Jenny Mundo reviewed two (2) staff files. All staff files contained the required documentation per Title Regulations.Both staff who required caregiver background checks have received criminal record and child abuse index check clearances or exemptions and associations. Staff files contained the Mandated Reporter/acknowledgement form. Client Files: LPA's reviewed five (5) client files. Documentation for each client is complete, signed and current. All medications are recorded and logged. Psychotropic medications prescribed have current JV220 court order, medical consent authorization is available for review and current in client's file. Facility is providing adequate services with the client's needs & services plan; it is current and updated. At 12: PM LPA's conducted interviews. LPA Martin interviewed two (2) staff and LPA Mundo interviewed one (2) clients. LPA Martin reviewed the current LIC 500, LIC 309 current Board Meeting minutes and an updated copy of the emergency disaster plan. Based on the facility inspection and file reviews on this date, there are no deficiencies found at this time. An exit interview was conducted with the Administrator. LPA provided a copy of the following reports: LIC 809 and LIC 811 were provided to Administrator Farrah Richmond.

met_with: Farrah Richmond, Adiministrator


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Juliet Robles and Pamela Silva on 01/18/23 at 9: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs Robles and Silva met with Farah Richmond, Administrator and inspected the facility inside and out. LPAs reviewed one (1) of child's records and two (2) of staff personnel files on site at the facility. LPAs reviewed one (1) of child's psychotropic medications and medication records. LPAs interviewed two (2) of staff on site to discuss the facility's policies and procedures of operation. LPAs were unable to interview child currently prescribed psychotropic medication due to client was unavailable at the time of inspection. LPAs provided a copy of this licensing report to Farrah Richmond, Administrator. No deficiencies are being cited at this time. LPAs conducted exit interview with Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On June 14, 2023, at 11: AM Licensing Program Analysts (LPA) Gilbert Gutierrez and John Bonilla conducted an unannounced case management inspection to the facility and met with Administrator, Farrah Richmond regarding an incident report that the Department received on May 12, 2023. The incident report indicated that Client #1 (C1) was sexually assaulted by an individual at the local park while on unauthorized absence (UA) from the facility. LPA conducted an interview with Administrator Farrah Richmond and C1 regarding the incident. Based on confidential interviews and records review, it was verified that C1 was on unauthorized absence when the alleged incident happened. Also based on the information gathered, the facility staff followed their protocol when C1 left the facility without authorization, when she came back and after the alleged incident was reported. The facility took the appropriate action regarding this incident. No further follow-up is necessary regarding the incident currently. A copy of LIC 809 and LIC 811 were provided to the facility representative listed above and an exit interview was conducted. There were no deficiency citations issued at this time.


summary: Facility Evaluation

raw_content:
Narrative:
On August 10, 2023, at 10: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an unannounced case management inspection to the facility and met Farrah Richmond, Administrator. The purpose of the inspection is to follow-up on a Special Incident Report (SIR) received by the Department. The SIR indicated that client ref#1 (C1) see LIC 811 (Confidential Names List) complained of throat pain and was taken by the staff to the hospital. She was discharged while waiting for the lab result the same day. That same afternoon, staff received a call from the hospital that C1 has an infection. She was prescribed medication and discharged. The treatment team counseled C1 about safe sex and provided her educational materials and a refresher from the sex education she participated before. Per Administrator Richmond, C1 was placed in another facility on 07/10/23. C1 refused to attend Planned Parenthood classes. A copy of In-House Special Incident Report and Refusal of Treatment Form regarding C1's refusal to attend the class were provided to LPA. An exit interview was conducted and a copy of the LIC 809 and LIC 811 were provided to the administrator. No deficiency citation is issued at the time of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On October 12, 2023 at 12: PM, Licensing Program Analyst (LPA) Gilbert Gutierrez made a case management inspection to the facility and met Farrah Richmond, Administrator. The purpose of the case management was to follow up regarding the information the Department received. On 10/10/23, the Department received information that client (C1) reported to a school staff that she visited a friend who had a gun. C1's friend accidentally pointed the gun at her which she grabbed and pointed at her own head. She stated, she did it jokingly. She denied being suicidal. The school security checked C1's backpack and did not find any weapon on her. LPA gathered information from the administrator, that C1 runaway with another client (C2) on 10/04//23. C2 returned on 10/05/23 while C1 returned on 10/06/23. The facility staff made an incident report when both clients runaway on 10/04/23 and an addendum regarding their return. C1 reported to the facility staff that the police talked to her at school to make sure she was not suicidal. She denied being suicidal. She denied the gun incident is how it really happened without giving more detail and stated that everything was fine. C1 did not disclose who her friend was who allegedly has a gun. C1 saw and was assessed by a therapist at the facility. A copy of the incident report regarding the clients' runaway incident with addendum was provided to LPA by the administrator. C1 was not available for interview at the time of inspection. Based on the information gathered, the incident needs no further follow-up currently. No deficiency citation was issued at the time of the inspection. A copy of LIC 809 and LIC 811 were provided to the administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On March 14, 2024, at 9:00AM Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an unannounced annual/random inspection to the Short Term Residential Therapeutic Program (STRTP) facility and met Administrator, Farrah Richmond. The facility is licensed to provide services to 6 female clients ages 12-17 and non-minor dependents. Currently there are six clients placed at the facility. LPA requested and reviewed the LIC 500, client roster, emergency disaster plan and latest board minutes meeting. Physical Plant: At 9: AM a tour of the facility was conducted by LPA together with the administrator. LPA observed the following: a posted license, Children's Personal Rights, Emergency Disaster Plan, menu, the staff schedule, activity, and activity schedule. The smoke and carbon monoxide detectors were working. There was adequate supply of perishable and non-perishable foods. All bedrooms have adequate drawers and closet spaces for clients use. All the beds were observed with clean mattresses, linens, and pillows. There were extra towels, linens, and hygiene supplies in the cabinets. All sharp objects, medications and cleaning solutions were stored inside a locked cabinet. The hot water was tested using a digital thermometer and the temperature was (113 degrees Fahrenheit). All confidential records were stored in a locked cabinet inside the staff office. The passageways and hallways were unobstructed. There was no body of water on the premises. LPA interviewed two clients and two staff available for interview at the time. Client Records LPA reviewed six client records. The client records contain required information including, but not limited to, consent forms, court orders, needs and services plan, medical assessment, safeguards for cash resources, personal property and valuables, education records, and personal rights forms. Staff Records LPA reviewed five staff records. The staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training in the personnel file. The administrator and staff members whose files were reviewed meets the required qualifications and/or experience. An exit interview was conducted and copy of LIC 809, LIC 809C and LIC 811s were provided to the administrator. No deficiency citation issued at the time of the inspection.


facility_name: HERITAGE YOUTH SERVICES - 5

raw_content:
Narrative:
It was alleged that NMD was jumped by two other clients. NMD suffered a cut lip, bloody nose and was hit with a mirror on her back. NMD stepped on broken glass and suffered a cut on her foot. Staff when interviewed indicated when the incident happened staff attempted to intervene, and staff attempted to redirect clients from fighting. Staff called law enforcement, reported the incident, and called for medical attention for the clients. Staff indicated NMD refused any medical attention. NMD when interviewed indicated the clients are always supervised, however staff did not do a good job at preventing NMD from being attacked. NMD stated NMD stepped on a broken piece of glass and cut her foot. NMD stated staff attempted to stop NMD from fighting the other clients. NMD stated NMD refused medical attention. C2 when interviewed indicted NMD was the aggressor and stated staff attempted to intervene, called law enforcement, and offer the clients medical attention. LPA attempted to interview C3, however C3 was not home at the time. CSW when interviewed indicated having no concerns with the facility. Although the incident happened staff attempted to intervene, called law enforcement, reported the incident, and sought medical attention for the clients. Based on the interviews and records reviewed the allegations is/are found unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove the allegations. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited

Investigation Findings:
13On July 19, 2023, at 9: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegations. LPA Cabral met with the STRTP Program Administrator Tami Tutlol. During the investigation, LPA Cabral interviewed one facility staff (AD) on 4/17/23. LPA interviewed two facility staff (S1 & S2), one client (C2) and attempted to interview one client (C3) on 5/23/23. LPA interviewed one client (NMD) on 4/20/23 (see Confidential Names Form LIC 811 dated July 19, 2023). LPA Cabral attempted interview one county social worker (CSW) on 7/15/23. LPA reviewed incident reports from the facility. On 4/10/23 the Department received a complaint alleging staff did not adequately protect NMD from being assaulted by other clients and NMD sustained injury while in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HERITAGE YOUTH SERVICES - 5FACILITY NUMBER: VISIT DATE: 07/19/2023

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

met_with: Tami Tutolo, Program Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On June 14, 2021 at 9: AM, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced annual/required inspection at the Short Term Residential Therapeutic Program (STRTP) and met Administrator Tami Tutolo. The facility is licensed to provide services to six (6) female clients ages 12-17 years old and to Non-Minor dependents. There are currently four (4) clients in placement. LPA together with the Administrator did a walkthrough of the entire facility at 9: AM. Physical Plant: LPA observed that at the entry way, there is a space where they have the sanitizer, thermometer and visitation log. LPA observed that there is a locked closet that stored the sharp knives, sharp utensils, objects and a bag of emergency kits for the facility. The facility has an office where confidential files of client, personnel, medications/log, program statement, emergency drill and residents meeting binder are kept in a locked cabinet. LPA observed the following required posted items and were accessible to clients: facility license, grievance procedures, Foster Youth Bill of Rights poster with Ombudsman, facility sketch, Emergency Disaster Plan, daily activities, laundry schedule, June chore list, menu/meal plan and a suggestion box. LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. The smoke/carbon monoxide detectors were tested and working. The fire extinguisher is in the dining area and serviced this year. The first aid kit in the kitchen was checked and complete. Each client is supplied with personal hygiene products. There was extra towels and linens for clients use in the cabinets located at the hallway. The hot water temperature in the two (2) bathrooms were checked using a digital thermometer and registered at 112- and 111-degrees Fahrenheit. There are two (2) bedrooms that has two (2) twin beds and two (2) other bedrooms that has solo occupancy with one (1) twin bed each. There is adequate shelf and closet space for client's belongings. The facility's inside and outside grounds was observed to be safe, sanitary and in good repair. Emergency exits were free from obstruction. There are no swimming pool/bodies of water located on the premises Staffing: At 10: AM, LPA started to review staff and client files. LPA obtained Personnel Summary report (LIC 500) from the facility. LPA reviewed five (5) staff's file. All staff's file contained the required documentation per Title Regulations. All five (5) staffs have the required caregiver background checks, received criminal record and child abuse index check clearances or exemptions and associations. Staff's file contains the Mandated Reporter/acknowledgement form, emergency intervention training is current, and evidence of initial and annual training requirements. Facility staff is conducting on going staff performance evaluation and current with CPR/First Aid and Relias training. Client Records: LPA reviewed six (6) client files. Documentation for each client is complete, signed and current. All medications are recorded and logged. Psychotropic medications prescribed have current JV220 court order, medical consent authorization is available for review and current in client's file. Facility is providing adequate services with the client's needs & services plan; it is current and updated. At 11: AM LPA started the interview. LPA interviewed three (3) clients and one (1) staff. LPA was provided with LIC 500, LIC 309 and Board of Director Meeting minutes. Based on the facility inspection and file reviews on this date, there are no deficiencies found at this time. An exit interview was conducted with the Administrator. LPA provided a copy of the following reports: LIC 809, LIC 809C, LIC 858, LIC 859, were provided to Administrator Tami Tutolo.

met_with: Tami Tutolo-Administrator


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Pamela Silva and Gilbert Gutierrez on May 12, 2022 at 9: AM. During the inspection, LPAs met with Stephanie Huff, Administrator. LPAs and the Administrator inspected the facility inside and out. LPAs reviewed three (3) children records on site at the facility at 9: AM. LPAs reviewed three (3) child's psychotropic medications and medication records at 10: AM. LPAs reviewed two (2) staff personnel files on site at the facility at 10: AM. LPAs interviewed two (2) staff at 10: AM. LPAs were unable to interview children due to two (2) children being in school and one (1) child refused to be interviewed. LPAs conducted an exit interview with Stephanie Huff, Administrator at 10: AM. LPAs provided the Summary Report to the Administrator upon completion. No deficiencies are being cited at this time.

met_with: Stephanie Huff


summary: Facility Evaluation

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Narrative:
On June 14, 2023 at 9: AM, Licensing Program Analysts (LPA) Gilbert Gutierrez and John Bonilla conducted an unannounced annual/random inspection to the facility and met Stephanie Huff, Administrator. The licensee's preferred language is English. The Short Term Residential Therapeutic Program (STRTP) has current Mental Health Program Approval (MHPA) and CARF ACCREDITATION. The facility is licensed to provide services to six female clients ages 12-17 and Non -Minor Dependents (NMD). There are five clients in placement currently. Physical Plant: At around 9: AM, LPAs together with the administrator toured the facility. LPAs observed the facility license, Emergency Disaster Plan, Youth's Personal Rights, Activity Schedule, Grievance Procedure and facility menu posted on the board. There were perishable foods in the refrigerator and freezer enough for two days and non- perishable foods in the pantry enough for seven days consumption of the clients in care. All the confidential files and sharp objects were observed locked inside a cabinet in the staff office. The cleaning solutions were locked inside the cabinets in the laundry room. The smoke/carbon monoxide detectors were tested and working. The first aid kit was complete. Each client is supplied with personal hygiene products. There were extra towels and linens for the clients. Each bedroom has single beds equipped with clean linens. The faucets being used by clients for grooming and personal care deliver hot water. All exits and hallways were observed to be free and clear of hazards and obstruction. The home is safe sanitary and in good repair. An exit interview was conducted, and a copy of the report was provided to the administrator. No deficiency citations issued at the time of the inspection.


facility_name: HERITAGE YOUTH SERVICES 4

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Narrative:
On 10/25/23 the Department received a complaint alleging the facility did not prevent client from chronically running away from care. It was alleged that client was physically assaulted and sexually trafficked while on AWOL from the facility. Based on the information gathered during confidential interviews, relevant parties denied the allegation indicating client ran away from the facility six times during client's stay at the facility from 5/24/23 through 6/13/23. Confidential interviews indicated when clients AWOL from the facility staff will be attempted to redirect clients, offer alternatives, and follow clients as the clients are AWOLing. Staff will then report AWOL, and call law enforcement. Once a client returns staff will offer medical attention and a safety check is conducted. Confidential interviews revealed clients have no concerns with the facility and stated staff will attempt to redirect clients and offer alternatives. LPA was not able to obtain a statement from the alleged victim due to the victim being on run away status. CSW indicated having no concerns with the facility and stated the incident happened when client was on AWOL and no longer placed at the facility. CSW indicated the client has been on AWOL status for a year. The other agency's delivered service logs and investigative report did not mention client being AWOL'd from the facility, however, there continues to be safety risks for client. LPA reviewed incident reports which indicated client AWOL'd from the facility six times. Each time client AWOL'd, staff wrote incident reports and intervention was attempted. LPA reviewed the STRTP's run away plan and client's safety plan which indicated the steps the facility took to try and discourage client from AWOLing. Based on the interviews and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On January 9, 2024, at 9: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Cabral met with the STRTP Administrator Lilia Garcia. During the investigation, LPA Cabral interviewed three facility staff (AD, S1, S2), two clients (C2, C3) and attempted to interview an additional client (C4) on 11/1/23. LPA attempted to interview one client (C1) on 11/2/23 (see Confidential Names Form LIC 811 dated January 9, 2024). LPA Cabral interviewed one county social worker (CSW) and attempted to interview an additional county social worker on 10/31/23. LPA attempted to interview three county social workers on 12/19/23. LPA reviewed incident reports, STRTP letter about bed hold, client's transition plan, the STRTP's run away plan and client's safety plan. LPA reviewed the other agency's delivered service logs and investigative report on 12/23/23. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HERITAGE YOUTH SERVICES 4FACILITY NUMBER: VISIT DATE: 01/09/2024

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

met_with: Lilia Garcia, Administrator


summary: Facility Evaluation

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Narrative:
On August 6, 2021 at 10: AM Licensing Program Analyst (LPA) Nicolette David conducted an announced Pre-licensing inspection at the above address. Upon arrival, LPA met with, Program Director (PD) Maria Serratos. LPA and PD toured the external and internal area of the facility. The following was observed at the time of inspection: Physical Plant This facility is a single level home located in a residential neighborhood. The facility consists of 5 bedrooms, 4 and a half bathrooms, living room, therapy room, staff office, kitchen, dining room, 3-car garage, laundry room, patio and backyard and a gated pool. Overall, the facility is clean, sanitary and in excellent condition. Knives and sharps item are kept locked in the kitchen pantry with disinfectants, cleaning solutions and first aid kits which contains all required supplies. Per PD, there are no firearms on the premises. The facility has a centralized heat and air-conditioning unit. Temperatures in all rooms are maintained at 71 degrees (F). The hot water temperature was measured at 115 degrees (F). Carbon monoxide and smoke alarms were tested and observed to be operational. The fire extinguisher located in the laundry room is fully charged. The facility has one(1) emergency panel installed in the entry door hallway next to the closet area. The emergency panels are connected to the smoke detectors to alert residences of a fire. The facility is in the process of installing a working telephone including WIFI. A fire inspection was requested on March 26, 2021 conducted by Los Angeles County Fire Department for ambulatory clients. (cont...) Fixtures, Furniture, Equipment, and Supplies Facility has five( 5)(toilets), five (5) wash basins, and four(4) showers for clients' use. LPA observed adequate hygiene supplies including but not limited to shampoo, soap, toothbrush, toothpaste, and toilet paper. Clients will be utilizing bedroom #1 that has one full size bed, one dresser and a closet. Bedroom #2 that has one full size bed, one dresser and a closet, bedroom# 3 that has one full size bed, dresser and a closet, bedroom#4 also has one full size bed with one dresser and a closet and bedroom #5 that has two full size beds, two dressers, two closets and a bathroom. Each bed has clean pillows, pillow cases, bed sheets and blankets. LPA also observed extra linens stored in the hallway cabinet. Facility sketch, emergency disaster plan, house rules, grievance policy, menu, sexual and reproductive health care related rights, foster youth bill of rights and foster youth mental health bill of rights are posted on the wall in the kitchen area. Heath Related Services and Record Keeping Medications, client and staff records will be centrally stored and locked in the steel drawers located in the Staff Office. An exit interview was conducted and a signed copy of this report was provided to the Program Director

visit_type: Prelicensing

met_with: Program Directior Maria Serratos


summary: Facility Evaluation

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Narrative:
On November 22, 2021 at 11: AM Licensing Program Analyst (LPA) Nicolette David conducted an unannounced visit at the above facility and met with Administrator (AD) Lili Garica upon arrival. The purpose of the inspection was to conduct a Post Licensing inspection of the facility. The Facility currently has a Short Term Residential Therapeutic Program (STRTP) license. The STRTP's Mental Health Program Application and The STRTP CARF accreditation is current. This STRTP is license to serve up to six ( 6) ambulatory children ages 12-17 years of age. There are six (6) clients currently in placement. The following was observed at the time of inspection: Physical Plant This facility is a single level home located in a residential neighborhood. The facility consists of 5 bedrooms, 4 and a half bathrooms, living room, therapy room, staff office, kitchen, dining room, 3-car garage, laundry room, patio and backyard and a gated pool. Overall, the facility is clean, sanitary and in excellent condition. Knives and sharps item are kept locked in the kitchen pantry with disinfectants, cleaning solutions and first aid kits which contains all required supplies. Per PD, there are no firearms on the premises. The facility has a centralized heat and air-conditioning unit. Temperatures in all rooms are maintained at 71 degrees (F). The hot water temperature was measured at 115 degrees (F). Carbon monoxide and smoke alarms were tested and observed to be operational. The fire extinguisher located in the laundry room is fully charged. The facility has one(1) emergency panel installed in the entry door hallway next to the closet area. The emergency panels are connected to the smoke detectors to alert residences of a fire. The facility is in the process of installing a working telephone including WIFI. A fire inspection was requested on March 26, 2021 conducted by Los Angeles County Fire Department for ambulatory clients. (cont...) Fixtures, Furniture, Equipment, and Supplies Facility has five( 5) (toilets), five (5) wash basins, and four(4) showers for clients' use. LPA observed adequate hygiene supplies including but not limited to shampoo, soap, toothbrush, toothpaste, and toilet paper. Clients will be utilizing bedroom #1 that has one full size bed, one dresser and a closet. Bedroom #2 that has one full size bed, one dresser and a closet, bedroom# 3 that has one full size bed, dresser and a closet, bedroom#4 also has one full size bed with one dresser and a closet and bedroom #5 that has two full size beds, two dressers, two closets and a bathroom. Each bed has clean pillows, pillowcases, bed sheets and blankets. LPA also observed extra linens stored in the hallway cabinet. Heath Related Services and Record Keeping Medications, client and staff records are centrally stored and locked in the steel drawers located in the Staff Office. Facility sketch, emergency disaster plan, house rules, grievance policy, menu, sexual and reproductive health care related rights, personal rights, ombudsman poster, visitation policies, foster youth bill of rights and foster youth mental health bill of rights, activities and chores are posted on the wall in the kitchen area. LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients as well. .A sample of Five (6) client files and five (5) staff files were reviewed and had all the required documents in file. All staff that work at the facility have Department of Justice and Child Abuse Clearance Index clearances. All staff has evidence of initial and annual training requirements. LPA requested to provide the current Board of Director Meeting minutes and updated LIC 309 form. A copy of LIC 809, LIC 809C, LIC 811 and appeal rights, were provided to the Facility Director.

met_with: Lilia Garica (Administrator)


summary: Facility Evaluation

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Narrative:
On November 10, 2022 at 8:45am, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an unannounced annual/required inspection at the facility and met Lilia Garcia, Administrator. The Short Term Residential Therapeutic Program (STRTP) has current Mental Health Program Approval (MHPA) and CARF ACCREDITATION. The facility is licensed to provide services to 6 female clients ages 12-17 and Non -Minor Dependents (NMD). There are six clients in placement currently. Physical Plant At 9:00am, LPA and Administrator Garcia toured the facility. LPA observed the facility license, Emergency Disaster Plan, Youth's Personal Rights, Activity Schedule, Grievance Procedure and facility menu posted on the board. There were perishable foods in refrigerator and freezer enough for two days and non- perishable foods in the walk-in pantry enough for seven days consumption of the clients in care. All the confidential files and sharp objects were observed locked inside a cabinet in the staff office. The cleaning solutions were locked inside the cabinets in the laundry room. The smoke/carbon monoxide detectors were tested and working. The first aid kit was complete. Each client is supplied with personal hygiene products. There were extra towels and linens for the clients. Each bedroom has single beds equipped with clean linens. The hot water temperature was 113 degrees Fahrenheit when checked using a digital thermometer All exits and hallways were observed to be free and clear of hazards and obstruction. The home is safe sanitary and in good repair. Client Records At 9:30am, LPA started reviewing six client records. The client records contain required information including, but not limited to, consent forms, court orders, needs and services plan, medical assessment, safeguards for cash resources, personal property and valuables, education records, and personal rights forms. Facility is providing adequate services with the client's needs & services plan; it is current and updated Staff Records At 1:00pm, LPA started reviewing five staff records. The staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training in the personnel file. The administrator meets the required qualifications and/or experience. The facility staff meets the requirements. At 3:00pm LPA started interviewing three staff and two clients that were present at the facility at the time. An exit interview was conducted and copy of LIC 809, LIC 809C and LIC 811s were provided to the administrator. No deficiency citation issued at the time of the inspection. .

met_with: Lilia Garcia


facility_name: HERITAGE YOUTH SERVICES 6

summary: Complaint Investigation - Unsubstantiated

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Narrative:
Continue from page 1 . . . The facility staff denied the allegations and stated that the client was taken to get medical attention when needed. The staff stated that the clients are evaluated when the client tell them that they are in pain or hurting and then are taken to get further medical services if needed. The staff indicated that the client's telephone conversation where not listen to when the client was calling Community Care Licensing, Social Worker or the Attorney, however, the client's telephone calls where monitor when the client was speaking with the client's family. The staff indicated that monitor calls were mandated by the County and Social Worker. The staff stated the client was not spoken in an inappropriate matter and that the staff never made comments about the client's family or told anybody that the client was a liar. The staff indicated that they follow instruction in the client's Need and Case Plan which was authorized by the County. The confidential interviews conducted did not corroborate the allegations. Information indicated that the staff did not make inappropriate comments about the client or the client's family. The confidential interviews revealed that the staff seeks medical attention if a client needs it and the staff did not denied the client any medical attention. Information obtained indicated that the staff can monitor telephone call from the clients if they are mandated by the social worker. No information was obtained to corroborate the allegations. The LPA attempted to interview the client but the client was not available to be interview. The social worker stated she had no concerns with the care and supervision in the facility. Based on the information obtained though interviews and records review the allegations are found unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the allegations occurred, therefore, the above allegations are Unsubstantiated. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited. An exit interview was conducted, and a signed copy of this report was left with above staff.

Investigation Findings:
13On July 14, 2022, Licensing Program Analyst (LPA) Heriberto Perez conducted a follow-up complaint inspection to the above facility and met with Tami Tutolo, Administrator. The purpose of the visit was to deliver the finding for the above complaint allegations. During the course of investigating the allegations, LPA interviewed three clients on March 10, 2022, LPA interviewed one client on March 14, 2022, LPA interviewed one staff via telephone on June 23, 2022, LPA interviewed two staff via telephone on June 24, 2022 and LPA interviewed one staff and County Social Worker via telephone on 06/27/22 (see Confidential Names LIC 811 dated July 14, 2022). LPA analyzed pertinent documents such as Foster Child's Need and Case Plan Summary, Child & Family Team Planning Matrix and Special Incidents Reports. It was alleged Staff did not seek timely medical attention for youth in care and Staff do not allow youth to have confidential telephone calls. It was also alleged that Staff speaks inappropriately to youth in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Heriberto Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HERITAGE YOUTH SERVICES 6FACILITY NUMBER: VISIT DATE: 07/14/2022

met_with: Tami Tutolo, Administrator


raw_content:
Narrative:
Investigation revealed the following: It was alleged staff are not providing minors in care a sufficient amount of food. Staff had similar statements and denied the allegation. Staff stated they go grocery shopping weekly for facility. LPA toured facility alongside Administrator and observed ample food for all children in care. Facility had emergency food supply, perishable and non- perishable items for children in care. Children stated that facility provides ample food and various options. It was also alleged; staff are not providing minors planned activities while in care. Staff had similar statements and stated that children are offered to attend various activities provided by the facility. Staff stated that sometimes children decline to attend those planned activities but that children are given the opportunity to attend and the option to see what activities are planned prior to the actual event taking place. Children had similar statements in that facility does have activities for them to do in the home. Additionally, it was alleged staff are using inappropriate forms of punishment with minors in care. Staff and children both denied the allegation. Staff stated that they do not use inappropriate forms of punishment. Staff stated when children get into trouble, they have privileges removed but that they are afforded opportunities to gain those privileges back. Staff stated children are not restricted from receiving essential items or necessities as forms of punishments. Children stated they have never seen or experienced staff restricting them or doing inappropriate forms of disciplines. Furthermore, it was alleged staff do not accord privacy to minors in care. Staff stated that it is policy to knock on doors prior to entering children's rooms and if children do not answer they will announce entry into the room. Children stated that they are not aware or ever had any staff not afford them privacy in the home. It was alleged facility is in disrepair. Staff and children had similar statements in stating that home is well maintained and that if any issues or maintenance is needed that facility addresses issues immediately. On 10/20/ LPA and Administrator toured the facility both inside and out. LPA observed the facility to be in good repair and areas that needed repair already had a date of maintenance scheduled to complete and repair issues. It was alleged staff do not ensure that minor's in care get to school in a timely manner. Staff stated that children sometimes are delayed in getting up in the morning and refuse to go to school. Administrator stated that it has been an issue with tardiness with children and school administration and school resource officer have been to home numerous times to witness children refusing to go to school. Children denied the allegation and stated that staff do try and get children to school on time but that sometimes children in the home cause a delay in getting to school on time. Lastly, it was alleged staff are interfering with minors' ability to purchase clothing while in care. Staff stated that children are given a monthly clothing allowance and that children usually use most of the allowance. However, if children have left over money, they receive the excess money to save or to use. Staff stated that children sign that they receive their allowances and it is documented in the amount that was used or provided back to child. Children had similar statements that they do receive allowances and that they are afforded opportunities to go to purchase clothing monthly. Documents reviewed identified staff do complete weekly grocery shopping and put in for maintenance repairs for facility. Based on information received and documents reviewed there was no indication that facility was or is in disrepair, children are receiving inappropriate disciplines, staff are not affording privacy to children, or that staff are the reason children are not getting to school in a timely manner. Although the allegations may have happened or may be true there is not a preponderance of evidence to support that the allegations did or did not happen. Therefore, this complaint is being closed Unsubstantiated. Exit interview was completed, no deficiencies cited, and a copy of this report was emailed to Administrator for review and signature.

Investigation Findings:
13On 3/2/ Licensing Program Analyst (LPA) Dawn Mahecha made an unannounced visit to the Heritage Short Term Residential Treatment Program (STRTP) for the purpose of closing the above complaint investigation. LPA met with Administrative assistant and discussed the findings to the above identified allegations. Investigation consisted of the following: On 10/20/ LPA met with and interviewed Administrator (see confidential names LIC811 dated 10/20/2022). LPA obtained copies of activity calendar, activity denial logs and recent grocery shopping list. LPA requested the following documents be emailed to LPA: facility staff/ client rosters (including contact information), clothing allowance logs (including shopped items), requested maintenance logs for roof and mirror in bathroom, staff recent training, any SIRs or documents of children running away in the past two months, children's needs and service plans, most recent CFT meetings and school attendance logs. LPA interviewed 4 staff and 2 children. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Dawn Mahecha LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HERITAGE YOUTH SERVICES 6FACILITY NUMBER: VISIT DATE: 03/02/2023

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


summary: Facility Evaluation

raw_content:
Narrative:
On October 27, Licensing Program Analysts (LPAs) Gilbert Gutierrez conducted an unannounced inspection at the facility at 12: PM. LPA met with Maria Serratos, Program Director, The purpose of the inspection was to conduct a post licensing inspection of the facility. Currently, the facility has a provisional Short Term Residential Therapeutic Program (STRTP) license which will expire on June 1, 2022. The STRTP's Mental Health Program Application is pending approval. The STRTP has obtained national accreditation from Commission on Accreditation of Rehabilitation Facilities (CARF) which will expire on June 30, 2022.. This STRTP is licensed to serve six (6) female ambulatory children ages 12-17 years of age and Non-Minor Dependents (NMD). The facility has no placement currently. Physical Plant This facility is a one story home with five (5) bedrooms and two (2) and a three quarter (3/4) bathrooms, living room, office, kitchen, dining and, laundry area. At the time of the inspection, it was observed that the bathroom inside the master's bedroom is under repair for re-piping which will be finished by October 29, At about 12:10PM, LPA conducted the inspection. LPA observed the license posted on the board located in the hallway together with Emergency Disaster Plan, Foster Youth Bill of Rights, facility Menu ,facility sketch, and Grievance Procedures. The disinfectants, cleaning solutions were locked inside a cabinet in the laundry area and the sharps were stored locked in a metal cabinet in the staff office. The facility maintains non-perishable foods for at least a week and perishable foods for at least two days in the premises. There were working smoke/carbon monoxide detectors in the facility. All containers for storage of solid wastes have tight-fitting covers. The air conditioning/heating was working providing comfortable temperature inside the facility. All beds are in good repair; equipped with good springs and clean mattresses, clean pillows, bedsheets, and blankets. Each room has closet and drawer space for client clothes and belongings. The personal hygiene for the clients were stored inside a cabinet in the hallway together with the extra towels, and bed linens. LPA finished the physical plant inspection at 1:00PM.: Staff Records Currently, the facility has not hired any child care workers for this facility. At 1:15PM, LPA reviewed the administrator's records. The Personnel records contain the required documentation including the 24-hour initial training, and 40-hour annual training in addition to CPR and First Aid. LPA finished the review at about 1:40PM. No deficiency citations issued at the time of the inspection. An exit interview was conducted and a copy of the report was provided to Ms. Serratos.

met_with: Maria Serratos


summary: Facility Evaluation

raw_content:
Narrative:
On May 18, 2022 at 11:55 am, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an unannounced inspection at the facility and met Tami Tutolo, Administrator. The Short Term Residential Therapeutic Program (STRTP) is just waiting for the issuance of their Mental Health Program Approval (MHPA). The facility is licensed to provide services to 6 female clients ages 12-17 and Non -Minor Dependents (NMD). There are five clients in placement currently. Physical Plant At 12:00pm, LPA and Administrator Tutolo started the tour of the facility. LPA observed the facility license, Emergency Disaster Plan, Child's Personal Rights, Activity Schedule and facility Menu posted on the board. There were perishable foods in refrigerator and freezers enough for two days and non- perishable foods in the walk-in pantry enough for seven days consumption of the clients in care. All the confidential files and sharp objects were observed locked inside a cabinet in the staff office. The cleaning solutions were locked inside a cabinet in the staff bathroom; inaccessible to the clients. The smoke/carbon monoxide detectors were tested and working. The first aid kit was complete. Each client is supplied with personal hygiene products. There was extra towels and linens for clients use in cabinets. Each bedroom has single beds equipped with clean linens. The hot water temperature was 118 degrees Fahrenheit when checked using a digital thermometer All exits and hallways were observed to be free and clear of hazards and obstruction. Client Records At 12:30pm, LPA started reviewing three client records. The client records contain required information including, but not limited to, consent forms, court orders, needs and services plan, medical assessment, safeguards for cash resources, personal property and valuables, education records, and personal rights forms. Staff Records At 1:30pm, LPA reviewed three staff records. The staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training in the personnel file. The administrator meets the required qualifications and/or experience. The facility manager meets the requirements. An exit interview was conducted and copy of LIC 809, LIC 809C and LIC 811 were provided to the administrator. No deficiency citation issued at the time of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On June 30, 2022 at 9:15am, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an unannounced annual/required inspection at the facility and met Tami Tutolo, Administrator. The Short Term Residential Therapeutic Program (STRTP) is just waiting for the issuance of their Mental Health Program Approval (MHPA). The facility is licensed to provide services to 6 female clients ages 12-17 and Non -Minor Dependents (NMD). There are six clients in placement currently. Physical Plant At 9:25am, LPA and Administrator Tutolo toured the facility. LPA observed the facility license, Emergency Disaster Plan, Child's Personal Rights, Activity Schedule and facility Menu posted on the board. There were perishable foods in refrigerator and freezers enough for two days and non- perishable foods in the walk-in pantry enough for seven days consumption of the clients in care. All the confidential files and sharp objects were observed locked inside a cabinet in the staff office. The cleaning solutions were locked inside a cabinet in the staff bathroom; inaccessible to the clients. The smoke/carbon monoxide detectors were tested and working. The first aid kit was complete. Each client is supplied with personal hygiene products. There was extra towels and linens for clients use in cabinets. Each bedroom has single beds equipped with clean linens. The hot water temperature was 118 degrees Fahrenheit when checked using a digital thermometer All exits and hallways were observed to be free and clear of hazards and obstruction. Client Records At 10:30am, LPA started reviewing four client records. The client records contain required information including, but not limited to, consent forms, court orders, needs and services plan, medical assessment, safeguards for cash resources, personal property and valuables, education records, and personal rights forms. Staff Records At 12:30pm, LPA reviewed five staff records. The staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training in the personnel file. The administrator meets the required qualifications and/or experience. The facility manager meets the requirements. LPA interviewed two staff and two clients. An exit interview was conducted and copy of LIC 809, LIC 809C and LIC 811s were provided to the administrator. No deficiency citation issued at the time of the inspection.


facility_name: HILLSIDES

summary: Facility Evaluation

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Narrative:
On August 18, 2022 at 9:49am, Licensing Program Analyst (LPA) Daphne Edison arrived at Hillsides-Off Campus Satellite (OCS) for the purpose of conducting a Pre-Licensing Inspection Visit. LPA Edison met with Casey Meinster, Senior Clinical Director and Andrew Hernandez, Director of Cottage Services who granted access into the facility and together a tour was conducted. The facility will provide care and supervision to four (4) children, female only, ages 15-17 years, ambulatory only. The facility will also provide services to non-minor dependents pursuant to W & I code 16501.1 (C) (1). The census on this day is zero (0). OCS is constructed as follows: The facility is located at the back of Hillsides main campus and has a total of three (3) bedrooms and two (2) bathrooms for client use. Bedroom #2 and Bedroom #3 are single occupancy and contain one (1) twin size bed in each of the bedrooms and a full-size desk. Bedroom #1 is double occupancy and contains two (2) twin size beds with two (2) desks to divide the bedroom. Bedroom #3 has a door which leads to the laundry room and is always kept locked. Bedroom #2 has a door which leads into the backyard area. All bedrooms have comfortable mattresses, clean linens, and adequate closet/storage space. All window screens are in good repair. There are two (2) bathrooms equipped with a sink and toilet. Bathroom #1 is also equipped with a stand in shower. Bathroom #2 is equipped with a tub/shower combination. All bathrooms are clean, operable, and sanitary. Hot water was measured within a safe temperature. The living room is equipped with a sofa, love seat, chair, and tables. All living room furniture was observed to be in good repair. The fireplace is not operable and has a screen bolted to keep it closed and secured. There is also a desk for staff use located in the living room. The dining area is located off the kitchen and is equipped with a wooden table with seating for five (5). The kitchen was observed to be clean and is equipped with a burner gas stove/microwave oven combination, dishwasher, refrigerator/freezer, and built-in wall oven. Disinfectants and cleaning solutions will be kept in a locked cabinet in the kitchen accessible by staff only. All knives and sharp objects will be kept locked in a kitchen drawer accessible by staff only. Continued on LIC 809-C Meals are provided by Chartwell. Three meals and snacks will be provided for the clients and will be brought to OCS from the main campus cafeteria. The laundry area is located next to the kitchen and is equipped with a full sized operable washing machine and dryer and locked cabinets for laundry supplies. Laundry area has a separate area for staff office use. There is a hall closet between Bathroom #2 and Bedroom #1 which will store extra linens and hygiene products. There is a hall closet near Bedroom #3 which will store extra linens and blankets. All prescribed and over the counter medications will be kept locked in the central nurse's office located on Hillsides main campus accessible and administered only by nursing staff. The smoke detectors and carbon monoxide alarms were tested and are operable. There are three (3) regulation fire extinguishers, all fully charged. Facility also has a Fire Alarm Pull System. First aid kit located in laundry/staff area. LPA observed the facility to have adequate indoor and outdoor activity space. The front and backyards were inspected and found to be clean and free of debris and observable hazards. Foster youth bill of rights and grievance procedures were posted. Caregiver(s)/adults working/residing in the home must have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Plan was posted. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. The home will operate within the capacity and limitations of the license. LPA Follow Up: · Food Service Waiver due to staff informing CCL that meals (breakfast, lunch and dinner) will be transported from one facility (main campus cafeteria) to another (OCS). Food service Procedure in Plan of Operations must be reviewed by CCL. · Perishable and non-perishable food will be supplied prior to resident move-in Exit Interview was conducted, and a copy of this report will be emailed to the Senior Clinical Director.

met_with: Casey Meinster-Senior Clinical Director


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst Connie Jones-Steward met with Andrew Hernandez to conduct the Post-Licensing Inspection for Hillsides Short Term Therapeutic Residential Program (STRTP). The following was observed. The Short Term Therapeutic Residential Program (STRTP) is an Off Campus Satellite (OCS) located in a 3 bedroom, 2 bathroom cottage l adjacent to the main campus. There are three sofas in the common area and a dining room table with enough seating for the capacity. There is a non-operable, fully secured fireplace in the common area. 2 bedrooms are single occupancy and 1 is double occupancy. There are adequate beds and linens in each bedroom. All bedrooms have operable windows and sprinkler systems. There are no security bars on bedroom windows. The fire alarm system is centrally connected. There is a working carbon monoxide detector in the hallway. There is a fully charged fire extinguisher in the kitchen. The kitchen area has a stove and refrigerator in good working condition. All kitchen knives are stored in the central dining hall of the main campus. Medications are stored in the central nursing station of the main campus. There is a complete first aid kit in the cottage. LPA observed the cottage to have adequate indoor and outdoor activity space. The yard area is free of hazards. The following were posted as required: Facility License, Notice of Personal Rights, Client Grievance Procedure, House Rules and Floor Plan are posted in the cottage. There were no deficiencies cited as a result of this inspection. Licensee was advised to use the LIC 9020 to maintain a register of clients.

met_with: Andrew Hernandez, Senior Director of Program Services


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst Connie Jones-Steward met with Andrew Hernandez to conduct the Annual/Required Inspection for Hillsides Short Term Therapeutic Residential Program (STRTP). The following was observed. The Short Term Therapeutic Residential Program (STRTP) is an Off Campus Satellite (OCS) located in a 3 bedroom, 2 bathroom cottage that is adjacent to the main campus. There are three sofas in the common area and a dining room table with enough seating for the capacity. There is a non-operable, fully secured fireplace in the common area. 2 bedrooms are single occupancy and 1 is double occupancy. There are adequate beds and linens in each bedroom. All bedrooms have operable windows.. There are no security bars on bedroom windows. The fire alarm system is centrally connected. There is a working carbon monoxide detector in each bedroom. LPA observed two fully charged fire extinguishers. The kitchen area has a stove and refrigerator in good working condition. All kitchen knives are stored in the central dining hall of the main campus. Medications are stored in the central nursing station of the main campus. There is a complete first aid kit in the cottage. Food supply meets Title 22 guidelines. LPA observed the cottage to have adequate indoor and outdoor activity space. The yard area is free of hazards. The following were posted as required: Facility License, Notice of Personal Rights, Client Grievance Procedure, House Rules and Floor Plan are posted in the cottage. LPA reviewed client records. LPA will return to review staff records and to conduct the required interviews.

met_with: Andrew Hernandez


summary: Facility Evaluation

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Narrative:
On September 21, 2023, Licensing Program Analyst Connie Jones-Steward completed the Annual Inspection. LPA reviewed five employee files. LPA also interviewed 2 staff and 1 client. LPA reviewed the Facility Personnel Report Summary with the administrator who notated employees who no longer work for the agency. There were no deficiencies cited on this date.


summary: Facility Evaluation

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Narrative:
On November 20, 2023 at 9:00am, Licensing Program Analyst (LPA) Deborah Lee and Licensing Program Manager (LPM) Lakescia Smith made an announced visit to Hillsides for the purpose of conducting a Case Management, Licensee Initiated Inspection. LPA met with Andrew Hernandez, Administrator who granted access to the facility. The purpose of this visit: licensee has requested a capacity change--an increase from four (4) bed to six (6) bed. The facility is currently licensed to care for four (4) children ages 6-17 years Ambulatory only. This facility also provides services to non-minor dependents. Overview of facility: The Short Term Therapeutic Residential Program (STRTP) is a 4 bedroom, 2 bathroom cottage that is adjacent to the main campus. Common area/living room has three (3) sofas, dining room table with enough seating for the capacity. There is a non-operable, fully secured fireplace in the common area. Activity cabinet with various board games. Staff office area located adjacent to the living area. Bedrooms: Bedroom 1 is a double occupancy room; beds are in good repair and have adequate linens. There were adequate drawer and closet space for capacity. Bedroom 1 have an operable smoke detector and carbon monoxide detector. Bedroom 2 is a single occupancy room; beds are in good repair and have adequate linens. There were adequate drawer and closet space for capacity. Bedroom 2 have an operable smoke detector and carbon monoxide detector. LPA observe video surveillance in facility; monitors located in Administrators office. Continued on 809C Bedroom 3 is a single occupancy room beds are in good repair and have adequate linens. There were drawer and closet space for capacity. Bedroom 3 have an operable smoke detector and carbon monoxide detector. LPA observed during inspection that in bedroom #3 window was not operable (window unable to stay open due to it being 'off-track') Per Administrator, window to be repaired as a work order has been placed. Bedroom 4 is a double room; beds are in good repair with adequate linens. There were adequate drawer and closet space. Bedroom have an operable smoke detector and carbon monoxide detector. Bathrooms: bathroom 1 was clean, sanitary and in good repair. Water temperature tested and within required range of 105-120 degree F Bathroom 2 was clean, sanitary and in good repair. Washer and dryer is operable and located in laundry room. Kitchen: The kitchen area has a stove and refrigerator in good working condition. All kitchen knives are stored and secured in the central dining hall of the main campus. Medications are stored in the central nursing station of the main campus. There is a complete first aid kit in the cottage. Food supply meets Title 22 guidelines. The facility has a hard wired fire alarm system on premises. LPA observed three fully charged fire extinguishers. LPA observed the cottage to have adequate indoor and outdoor activity space unobstructed and free of clutter. The yard area is free of hazards LPA obtained Lic 500 and client roster. Fire clearance remains pending. LPA advised Administrator to follow with fire department. Exit is completed and copy of report email to administrator


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst Connie Jones-Steward met with Director Andrew Hernandez to discuss the incident of 03/24/24, SIR 1022855, that ended in the death of a client. LPA Jones-Steward and Director Hernandez reviewed the Special Incident Report, the initial intake reports and discharge plans for the client and the two most recent Needs and Services Plan Reports covering 01/22/24 through 03/22/24. LPA also reviewed a list of the client's medications. Copies of all documents were collected for a more in depth review. Director Hernandez stated that Hillsides has not been contacted by the media nor law enforcement regarding this incident. LPA Jones-Steward will further review the documents prior to making any decisions or recommendations.

met_with: Andrew Hernandez, Director


summary: Facility Evaluation

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Narrative:
On 10/3/24 at 9:30 am Licensing Program Analyst (LPA) Reagan Cohen and Licensing Program Manager (LPM) Lakescia Smith met with Andrew Hernandez to conduct an unannounced Annual/Required Inspection for Hillsides Short Term Therapeutic Residential Program (STRTP). The Short Term Therapeutic Residential Program (STRTP) is an Off Campus Satellite (OCS) facility located in a 4 bedroom, 2 bathroom cottage that is adjacent to the main campus. OCS is constructed as follows: The facility is located at the back of Hillsides main campus and has a total of four (4) bedrooms and two (2) bathrooms for client use. Bedroom #2 and Bedroom #3 are single occupancy and contain one (1) twin size bed in each of the bedrooms and a full-size desk. Bedroom #1 and #4 are double occupancy and contains two (2) twin size beds with two (2) desks to divide the bedroom. All bedrooms have comfortable mattresses, clean linens, and adequate closet/storage space. All window screens are in good repair. There are two (2) bathrooms equipped with a sink and toilet. Bathroom #1 is also equipped with a stand in shower. Bathroom #2 is equipped with a tub/shower combination. All bathrooms are clean, operable, and sanitary. Bathroom #2 hot water was measured within a safe temperature. The living room is equipped with a sofa, love seat, chair, and tables. All living room furniture was observed to be in good repair. The fireplace is not operable and has a screen bolted to keep it closed and secured. There is also a desk for staff use located in the living room. The dining area is located off the kitchen and is equipped with a wooden table with adequate seating. The kitchen was observed to be clean and is equipped with a burner gas stove/microwave oven combination, dishwasher, refrigerator/freezer, and built-in wall oven. Disinfectants and cleaning solutions are kept in a locked cabinet in the kitchen accessible by staff only. Per staff all knives are kept locked outside the facility accessible by staff only. Three meals and snacks will be provided for the clients and will be brought to OCS from the main campus cafeteria. The laundry area is located next to the kitchen and is equipped with a full sized operable washing machine and dryer and locked cabinets for laundry supplies.There is a hall closet between Bathroom #2 and Bedroom #1 which will store extra linens and hygiene products. There is a hall closet near Bedroom #3 which will store extra linens and blankets. The smoke detectors and carbon monoxide alarms were tested and are operable. There are three (3) regulation fire extinguishers, all fully charged. First aid kit located in laundry/staff area. LPA observed the facility to have adequate indoor and outdoor activity space. The front and backyards were inspected and found to be clean and free of debris and observable hazards. Foster youth bill of rights and grievance procedures were posted. The following deficiency is being cited for violating of California Code of Regulations Title 22, Division Regulation 80088(e)(1) fixtures furniture's equipment and supplies and 87087(f)(1) building and grounds (see page D). Exit Interview was conducted, and a copy of this report will be emailed to the Senior Director of Program Services. Note: LPA and LPM observed one staff supervising six clients during the walk through. Please ensure sufficient supervision is provided when all clients are present. LPA and LPM will return to interview staff, review client and staff records, and resume physical plant inspection.


summary: Facility Evaluation

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Narrative:
On 10/14/24 at 9:45 am Licensing Program Analyst (LPA) Reagan Cohen and Licensing Program Manager (LPM) Lakescia Smith met with Andrew Hernandez to conduct an unannounced Case Management Annual Continuation Inspection for Hillsides Short Term Therapeutic Residential Program (STRTP). LPA and LPM resumed the walk through of the facility observing a pool that was made inaccessible with a cover and a gate, the main kitchen & walk in freezer with 2 days perishable and 7 days non-perishable food storage, an outdoor basketball court, a swing set, an indoor art studio, a gaming room, a music room, and the nurses center. LPA and LPM reviewed staff and client records including: client health records, client medication administration records/MAR, client admission forms, client medical consent administration forms, client monthly clothing allowance & weekly allowance, staff first aid certificates, staff education & experience, staff training logs, staff pro act certificate, and facility emergency drills. During walk through inspection and records review no violations were found. Exit Interview was conducted, and a copy of this report was given to the Senior Director of Program Services. LPA and LPM will return to interview staff and complete inspection.


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Investigation Findings:
13Licensing Program Analyst investigated the abouve allegation. Per Christine Gonzalez and Andrew Hernandez, Client #2 is a student of Hillsides school but not a client of ther STRTP. The only way that Client #1 and Client #2 could have come in contact would have been on the school campus, which is outside the supervision of the STRTP. LPA Jones-Steward attempted to reach Client #1 at her current placement to inquire about the location of the alleged incident. LPA left messages asking that the foster mother return the phone call. However there has been no return call. Based on lack of complete information regarding the allegation, it is resolved as unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Alan Henry LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

met_with: Amy Cousineau


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Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegation. LPA interviewed Client #1 and three of the four staff that she named in her complaint. Based on the interviews with client and staff this allegation was resolved as unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Alan Henry LICENSING EVALUATOR NAME: Connie Jones-Steward LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

met_with: Christine Gonzalez


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Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward investigated the above allegation. LPA spoke to Client #1, Staff #1 and Staff #2. LPA also reviewed similar special incident reports. Based on the information gathered during the investigation, it was determined that Child #1 did swallow safety glass. It was also determined that there is a pattern developing of children swallowing glass that gets left behind by clean up crews. However at the time there have been no serious injuries reported. Per Ms. Gonzalez the issue was discussed in the leadership meeting held on 06/30/21 and measures are being put into place to lessen the risk of further such incidents. LPA requested a written copy of the corrective action plan to be delivered to the Department by 07/15/21. 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 CCLD Regional Office, N. Continental Blvd. #290B This is an official report of an unannounced visit/investigation of a complaint received in our office on 06/15/2021 and conducted by Evaluator Connie Jones-Steward COMPLAINT CONTROL NUMBER: 34-CR- FACILITY NAME:HILLSIDESFACILITY NUMBER: ADMINISTRATOR:AMY COUSINEAU, PHDFACILITY TYPE: ADDRESS: AVENUE 64TELEPHONE: (323) 254- CITY:PASADENASTATE: CAZIP CODE: CAPACITY:50CENSUS: 32DATE: 07/01/ UNANNOUNCEDTIME BEGAN: 11: AM MET WITH:Christine GonzalezTIME COMPLETED:11: AM 1) Staff did not seek medical attention for client in a timely manner 2) Staff does not prevent Client #1 from being bullied INVESTIGATION FINDINGS: 13LPA Jones-Steward investigated the above allegations. LPA spoke to Client #1, Staff #1 and Staff #2. LPA was not able to establish that Client #1 did not receive medical attention in a timely manner. Likewise LPA was not able to establish that lack of supervision led Client #1 to being bulled into swallowing glass. Based on lack of supporting evidence, the above allegations were resolved as unsubstantiated, finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: 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 CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: HILLSIDESFACILITY NUMBER: 191200313


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Investigation Findings:
13Licensing Program Analyst Connie Jones-Steward met with Andrew Hernandez to discuss the allegations. Mr. Hernandez stated that Client #1 is offered healthy snacks at snack time. However if she wants candy instead of the snack that his offered she will refuse it. Mr. Hernandez stated that he has not noticed any unusual bullying of Client #1. The only thing he has seen is Client #1 bickering back and forth with other clients as usual. When this happens, staff will re-direct client by offering them a different activity, offering them a walk etc. Client #1 was not inclined to be interviewed today. Therefore these allegations were resolved as unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: 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 2

met_with: Andrew Hernandez, Director of Cottage Services


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Narrative:
Several clients were interviewed and neither disclosed witnessing any physical abuse of C1 by staff members. During the investigation, several staff members implicated as witnessing the physical abuse were interviewed. Staff all denied witnessing the incidents C1 claimed occurred. The staff members C1 claimed abused C1 were interviewed. Each staff denied the allegations. The Department of Children and Family Services social workers also denied witnessing any marks or bruises on C1 during C1's time at Hillsides. Therefore, based on the information obtained, the allegation of physical abuse 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 a violation occurred. There were no deficiencies cited per California Code of Regulations, Title 22. Exit Interview conducted with Mr. DaSilva, and a copy of this report and appeal rights are emailed to Mr. DaSilva and Christine Gonzalez, Facility Administrator.

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: Rob DaSilva, Crisis Prevention Coordinator