state: CA

facility_name: CENTRAL VALLEY STAR #1

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On August 31, 2023, Licensing Program Analyst (LPA) Vanessa Galvan conducted an unannounced follow up complaint inspection at Central Valley Star located in Springville, CA and met with Angie Smith, Program Director. The purpose of the inspection was to deliver the findings for the above complaint allegation. The Department has investigated the complaint alleging Staff inappropriately restrained minor in care. During the investigation, Community Care Licensing (CCL) conducted confidential interviews and review of documentations. Based on the interviews and documents reviewed, it was determined that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated. An exit interview was conducted discussing this report and appeal rights. A copy of this report and appeal rights were provide to Lori Miller at the conclusion of the inspection. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Vanessa Galvan LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

report_type: Complaint Investigation

met_with: Angie Smith & Lori Miller

complaint_status: unsubstantiated


raw_content:
Investigation Findings:
13On Novemeber 13, 2024, Licensing Program Analyst (LPA) Vanessa Galvan conducted an unannounced follow up complaint inspection at Central Valley Star located in Springville, CA and met with Administrator Norma Garcia and Assistant Program Director Andrena Wiggins. The purpose of the inspection was to deliver the findings for the above complaint allegation. The Department has investigated the complaint alleging facility staff improperly restrained youth, Community Care Licensing (CCL) conducted confidential interviews and reviewed documents. Based on the interviews and documents reviewed, it was determined that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated. An exit interview was conducted discussing this report and appeal rights. A copy of this report and appeal rights were provide to Norma Garcia at the conclusion of the inspection. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Vanessa Galvan LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Norma Garcia and Andrena Wiggins


raw_content:
Investigation Findings:
13On December 20, 2024, Licensing Program Analyst (LPA) Vanessa Galvan conducted an unannounced follow up complaint inspection at Central Valley Star located in Springville, CA and met with Assistant Program Director Andrena Wiggins. The purpose of the inspection was to deliver the findings for the above complaint allegation. The Department has investigated the above complaint allegation, Community Care Licensing (CCL) conducted confidential interviews and reviewed documents. Based on the interviews and documents reviewed, it was determined that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated. An exit interview was conducted discussing this report and appeal rights. A copy of this report and appeal rights were provide to Andrena Wiggins at the conclusion of the inspection. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Vanessa Galvan LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Andrena Wiggins


summary: Facility Evaluation

raw_content:
Narrative:
On 07/07/2022, a virtual video Component II Orientation was conducted by Licensing Program Analysts (LPAs) Vanessa Galvan and Lisa Slusher with Angie Smith, Program Director and Norma Garcia, Administrator. The following was addressed and discussed; the program expectation/review, overview of the first review letter submission, discussed the pending application and the additional items and updates needed,corrections needed for the Plan of Operation (POO) section, and Central Valley Star #1 transferring and associating employees in Guardian. The location of the Pre-licensing inspection will be conducted at Meadow Drive Springville, CA 93265, and Component III is scheduled for 08/16/2022 at 11: AM.

report_type: Facility Evaluation

met_with: Angie Smith and Norma Garcia


summary: Facility Evaluation

raw_content:
Narrative:
On 08/16/2022, Licensing Program Analyst (LPAs) Lisa Slusher and Vanessa Galvan travelled to the facility listed above. The purpose of the visit is to conduct a pre-licensing Facility Inspection. LPAs were met at the facility by Angie Smith- Program Director/Administrator, Norma Garcia- Facility Manager, Andrena Wiggins- Program Assistant/LCSW. LPAs toured the facility and observed the following listed below. 1. The facility has a staff room and is inaccessible to clients. Staff room has extra supplies of linens, personal hygiene products, and emergency food supply. 2. A medication room that stores the facility's first aid kit. First Aid kit is complete with appropriate manual. The medication room stores all medications. LPAs observed a key locked cabinet with a locked medication box. 3. In the kitchen LPAs observed a fire extinguisher, a key locked drawer for sharps to be stored, kitchen chemicals/disinfectants in key locked cabinet, trash can with a lid, weekly menu, refrigerator temperature 36 degrees and freezer temperature 0 degrees. 4. The house has 5 bedrooms- 2 ambulatory and 3 non-ambulatory, single occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings and storage space. All rooms are equipped with fire alarms and trash can. 5. LPAs observed a sensory media room equipped with activities for sensory. 6. Chemicals were in a key locked cabinet. 7. Adequate storage space observed. Continued on Page 2... Continued from Page 1... 8. Dining room had a table with chairs to accommodate the number of clients. 9. Outdoor space observed. The outdoor space has plenty of outdoor space and equipped with a basketball court, garden, and outdoor furniture. 10. The outdoor of the home was free from hazard and obstructions. 11. Adequate food storage space observed. Perishable and non-perishable foods will be available before client are placed in the facility. 12. Facility has two full restrooms and 1 half restroom, all are operable. Facility is to ensure water temperature is maintained between 105 and 120 degrees. All restrooms are stored with hand soap, toilet paper, and paper towels. 13. Appropriate forms posted in the facility. 14. The temperature of the facility was a comfortable temperature of 76 degrees. 15. Licensee has a vehicle for use at the facility. When LPA returns, the vehicle including insurance and registration will be available for inspection. 16. Facility has a separate "annex" building that will be utilized for educational purposes and activities. 17. Facility is a delayed egress facility. The delayed egress is a 15 second delay. An alarm sounds as soon as the bar is pushed, and the gate opens at 15 seconds. The system requires a key turn by staff to deactivate the alarm. Fire clearance has been received from the Tulare County Fire Department. Overconcentration clearance has passed the time frame for county response. Agency will either associate staff through Guardian if able, otherwise a transfer request and copy of identification will be submitted for association.

visit_type: Prelicensing

met_with: Angie Smith


summary: Facility Evaluation

raw_content:
Narrative:
On 12/15/2022, Licensing Program Analyst (LPA) Vanessa Galvan traveled to Central Valley Star #1 in Springville, CA to conduct a post-licensing inspection. The facility was licensed on September 22, 2022. LPA were met at the facility by Administrator Norma Garcia and Program Assistant Andrena Wiggins. A physical plant inspection was completed and included the following observations and checks: Facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. All required forms are posted. The temperature of the facility was a comfortable temperature of 73 degrees. All facility smoke detectors are in appropriate working order and all fire extinguishers are properly charged and serviced. The kitchen has a full-size refrigerator and is operating at safe temperature. Facility maintains an adequate supply of perishable and non-perishable foods and food menu is posted. Knives and sharps are key locked and inaccessible to clients. Chemical, disinfectants, and cleaning solutions are key locked and inaccessible to clients. The dining room is equipped with large table and chairs accommodating of all clients. There are five bedrooms- two ambulatory and three non-ambulatory, single occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings and storage space. All rooms are equipped with a fire alarm and trash can. Individual beds were observed and appropriate clean linens and are in good repair. Facility has two full restrooms and a half restroom, all are operable. All restrooms are stored with hand soap, toilet paper, and paper towels. The facility has a sensory media room equipped with activity station and items. Facility has a medication room where medications are dispensed to clients. Medications are locked and inaccessible to clients. LPA observed medications are centrally stored. First Aid kit is stored in the medication room and is complete with all first aid items. The facility has a staff office and is inaccessible to clients. Staff office stores extra supplies of linens, personal hygiene products, and emergency food supply. Facility has a separate "annex" building that will be utilized for educational purposes and activities. Continued on Page 2... Continued from Page 1... Facility is a delayed egress facility. The delayed egress is a 15 second delay. An alarm sounds as soon as the bar is pushed, and the gate opens at 15 seconds. The system requires a key turn by staff to deactivate the alarm. A facility has two vehicles and two vans and are in safe operable conditions and provide adequate seating for all clients. There are no firearms or weapons are allowed in the facility. There are no bodies of water. LPA reviewed three client and two staff files. A review of staff files indicated that all facility staff have received child abuse index clearances and fingerprint clearances. Agency staff meet requirements of respective job descriptions. Agency Employs one Administrator, one Program Assistant, one Social Worker Supervisor, and thirty-four Psych Tech Assistants. Management staff will review the Disaster and Causality Plan and PMAR to maintain compliance with regulatory standards. There were no deficiencies issued today. A copy of this report was left with Norma Garcia at the conclusion of the inspection.

met_with: Norma Garcia & Andrena Wiggins


summary: Facility Evaluation

raw_content:
Narrative:
On September 7, 2023, Licensing Program Analyst (LPA) Vanessa Galvan traveled Central Valley Star #1 located in Springville, CA, to conduct an Annual Required Inspection and met with Norma Garcia, Administrator/Unit Supervisor. The facility currently has 3 clients and capacity for 5 clients. A tour of the facility was conducted, a physical plant inspection was completed and included the following observation: Facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. All required forms are posted. The temperature of the facility was a comfortable temperature of 73 degrees. All facility smoke detectors are in appropriate working order and all fire extinguishers are properly charged and serviced. The kitchen has a full-size refrigerator and is operating at safe temperature. Facility maintains an adequate supply of perishable and non-perishable foods and food menu is posted. Knives and sharps are key locked and inaccessible to clients. Chemical, disinfectants, and cleaning solutions are key locked and inaccessible to clients. The dining room is equipped with large table and chairs accommodating of all clients. There are five bedrooms- two ambulatory and three non-ambulatory, single occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings and storage space. All rooms are equipped with a fire alarm and trash can. Individual beds were observed and appropriate clean linens and are in good repair. Facility has two full restrooms and a half restroom, all are operable. All restrooms are stored with hand soap, toilet paper, and paper towels. The facility has a sensory media room equipped with activity station and items. Facility has a medication room where medications are dispensed to clients. Medications are locked and inaccessible to clients. LPA observed medications are centrally stored. First Aid kit is stored in the medication room and is complete with all first aid items. The facility has a staff office and is inaccessible to clients. Staff office stores extra supplies of linens, personal hygiene products, and emergency food supply. Facility has a separate "annex" building that will be utilized for educational purposes and activities. All required forms are posted. Facility is a delayed egress facility. The delayed egress is a 15 second delay. An alarm sounds as soon as the bar is pushed, and the gate opens at 15 seconds. Continued on Page 2... Continued from Page 1... ...The system requires a key turn by staff to deactivate the alarm. A facility has two vehicles and two vans and are in safe operable conditions and provide adequate seating for all clients. There are no firearms or weapons are allowed in the facility. There are no bodies of water. LPA reviewed 3 client and 5 staff files. A review of staff files indicated that all facility staff have received child abuse index clearances and fingerprint clearances. Agency staff meet requirements of respective job descriptions. Agency Employs Program Director, Administrator/Unit Supervisor, Program Assistant Director/Licensed Social, Senior Psych. Technician, Psych. Technicians, and Psych. Technicians Assistants. There were no deficiencies issued today. A copy of this report was provided to Norma Garcia at the conclusion of the inspection.

visit_type: Annual

met_with: Norma Garcia


summary: Facility Evaluation

raw_content:
Narrative:
On September 23, 2023, Licensing Program Analyst (LPA) Vanessa Galvan traveled Central Valley Star #1 located in Springville, CA, to conduct a Required Inspection and met with Norma Garcia, Administrator/Unit Supervisor. The facility currently has 3 clients and a capacity for 5 clients. A tour of the facility was conducted; a physical plant inspection was completed and included the following observation: Facility grounds are clean and free of debris. Adequate indoor and outdoor activity space and materials observed. All required forms are posted. The temperature of the facility was a comfortable temperature of 73 degrees. All facility smoke detectors are in appropriate working order and all fire extinguishers are properly charged and serviced. The kitchen has a full-size refrigerator and is operating at safe temperature. Facility maintains an adequate supply of perishable and non-perishable foods and food menu is posted. Knives and sharps are key locked and inaccessible to clients. Chemical, disinfectants, and cleaning solutions are key locked and inaccessible to clients. The dining room is equipped with a large table and chairs accommodating all the clients. There are five bedrooms- two ambulatory and three non-ambulatory, single occupancy, all located on one single level. Bedrooms are accommodated with all required furnishings and storage space. All rooms are equipped with a fire alarm and trash can. Individual beds were observed and appropriate clean linens and are in good repair. The facility has two full restrooms and a half restroom, all are operable. All restrooms are stored with hand soap, toilet paper, and paper towels. The facility has a sensory media room equipped with activity station and items. Facility has a medication room where medications are dispensed to clients. Medications are locked and inaccessible to clients. LPA observed medications are centrally stored. The first Aid kit is stored in the medication room and is complete with all first aid items. The facility has a staff office and is inaccessible to clients. Staff office stores extra supplies of linens, personal hygiene products, and emergency food supply. Facility has a separate "annex" building that will be utilized for educational purposes and activities. All required forms are posted. Facility is a delayed egress facility. The delayed egress is a 15 second delay. An alarm sounds as soon as the bar is pushed, and the gate opens at 15 seconds. Continued on Page 2... Continued from Page 1... ...The system requires a key turn by staff to deactivate the alarm. The facility has two vehicles, and one van that are in safe operable condition and provide adequate seating for all clients. There are no firearms or weapons allowed in the facility. There are no bodies of water. LPA reviewed 2 client and 5 staff files. A review of staff files indicated that all facility staff have received child abuse index clearances and fingerprint clearances. Agency staff meet the requirements of respective job descriptions. Agency Employs Program Director, Administrator/Unit Supervisor, Program Assistant Director, Social Worker, Senior Psych Technician, Psych. Technicians, and Psych Technician Assistants. There were no deficiencies issued on today's inspection. A copy of this report was provided to Norma Garcia at the conclusion of the inspection.


facility_name: FRED FINCH CRISIS HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
It was reported that the reason why staff did not want to take C1 back was due to C1's behavior and staff were afraid of C1. Confidential interview indicated the facility maintained constant communication with the hospital regarding C1's discharge. Confidential interviews indicated the facility did not want to bring C1 back to the facility and for C1 to only be released to the Probation Department. Confidential interviews indicated facility staff were afraid of working with C1. Confidential interviews indicated the facility was looking for alternative placements for C1. Confidential interview indicated the facility was not able to bring C1 back to the facility due to lack of staff. Conflicting confidential interview denied discharging C1, and C1 was picked up from the hospital and returned to the facility. Based on confidential interviews and records reviewed, the allegation that staff did not follow facility's discharge policies and procedures may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, due to conflicting statements, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Jennifer Phillips, Administrator.

Investigation Findings:
13On September 4, 2025 at 10: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Jennifer Phillips, Administrator to discuss the investigative finding for the allegation noted above. LPA Jauregui conducted an inspection of the facility on December 04, 2024, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed two staff (S1, S4), one Service Coordinator, and one Probation Officer. LPA attempted to interview Client 1 (C1); however, C1 refused to be interviewed. Pertinent documents were obtained. On November 25, 2024, Community Care Licensing (CCL) received allegation that staff did not follow facility's discharge policies and procedures. It was reported that C1 was placed on a 5150 hold at the hospital. It was reported that facility staff were not allowing C1 to return to the facility and would not pick up C1 when discharged from the hospital. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: FRED FINCH CRISIS HOMEFACILITY NUMBER: VISIT DATE: 08/12/2025

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

met_with: Jennifer Phillips, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On June 1, 2023 at 10: AM Licensing Program Analyst (LPA) Lucero Jauregui and Licensing Program Manager (LPM) Abdoulaye Traore conducted an announced pre licensing inspection for a Community Crisis Home (CCH). LPA and LPM met with Jennifer Phillips, Program Manager and Bruce Wexler, Senior Director. Program Manager provided LPA and LPM a guided indoor and outdoor tour of the facility. The facility will serve two ambulatory and two non-ambulatory clients ages 12-17 years old. The facility is a four-bedroom and two-bathroom for client use. The facility consists of living room, kitchen, dining area, staff office, staff bathroom, reception area, therapy room, hygiene closet, laundry room and two space garage that will be used as a storage and client activity room. Bedroom one and two will serve ambulatory clients. Bedrooms three and four will serve non ambulatory clients. Bathroom one will be used for ambulatory client only. Bathroom two will be used by non ambulatory clients only. Bedrooms were arranged so that no more than two children share a room, and there was one child per bedroom. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. All beds were observed to have appropriate clean linens and mattress in good repair. There was adequate drawer and closet space for clients' belongings. The living room and kitchen is set up as an open concept. The living room is furnished with couches, dining table with four chairs and a television. The kitchen was observed to be free from observable hazards. Sharps, cooking utensils, and silver wear will be maintained locked in kitchen draws and cabinets. Meal menu, activity schedule, house rules and daily schedule was observed on the refrigerator. All hazardous items have been properly made inaccessible in the laundry room where children will not have access. The medication cart is maintained locked in the staff office. First Aid kit was accessible and stored in the kitchen cabinet. Continued.... A physical plant inspection was completed and included the following checks: Facility is a fenced perimeter with double locked doors at the entrance and delayed egress system. Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Backyard contained two swinging benches and a gazebo. Art supplies, clay, and yoga balls were observed for children's recreation time in the activity room. All facility smoke detectors and carbon monoxide detectors are in appropriate working order. The hot water temperature was measured in the kitchen and is currently 135.0 degrees. Applicants understands that the water temperature must be maintained within the regulation range of 105-120 degrees Fahrenheit. Trash cans for storage of solid waste had tight fitting lids. Per facility staff, no firearms or weapons are allowed in the facility. LPA observed the following items posted in the reception area Personal Rights, Emergency Disaster Plan, Facility sketch, house rules and ombudsman poster. The facility had the emergency intervention plan. The facility has operable automatic fire sprinkler system. LPM completed the component III Orientation and discussed Incident reporting, including incidents related to Assembly Bill 388 law enforcement contacts as well as incidents involving emergency interventions. Based on this inspection, the facility will need the following corrections: the water temperature must be maintained within the regulation range of 105-120 degrees, phone line to be installed, preservation of the medication requiring refrigeration and lid for recycling container. After corrections are completed. the applicant will notify LPA so another inspection can be completed. A Community Crisis Home shall not be licensed by the Department until the Certificate of Program Approval, granted by the Department of Developmental Services has been received in accordance with Health and Safety Code section 1567.80. Exit interview was conducted. A copy of this report was discussed and provided to Jennifer Phillips, Program Manager


summary: Facility Evaluation

raw_content:
Narrative:
On May 21, 2024 at 9: AM Licensing Program Analyst (LPA) Lucero Jauregui conducted an unannounced post licensing inspection for a Community Crisis Home (CCH). LPA met with Jennifer Phillips, Administrator who provided LPA with a guided indoor and outdoor tour of the facility. The facility serves two ambulatory and two non-ambulatory clients ages 12-17 years old with currently one client in placement. The facility is a four-bedroom and two-bathroom for client use. The facility consists of living room, kitchen, dining area, staff office, staff bathroom, reception area, therapy room, hygiene closet, laundry room, two space garage, and client activity room. Bedroom one and two serve ambulatory clients. Bedrooms three and four serve non ambulatory clients. Bathroom one will be used for ambulatory client only. Bathroom two will be used by non ambulatory clients only. Bedrooms are arranged so that no more than two children share a room, and there is one child per bedroom. No room is commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. All beds were observed to have appropriate clean linens and mattress in good repair. There is adequate drawer and closet space for clients' belongings. The living room and kitchen is set up as an open concept. The living room is furnished with couches, dining table with four chairs and a television. The kitchen was observed to be free from observable hazards. Sharps, cooking utensils, and silver wear was observed to be locked in kitchen draws and cabinets. Meal menu, activity schedule, house rules and daily schedule was observed on the refrigerator. LPA observed all hazardous items have been properly made inaccessible in locked cabinets in the laundry room where clients will not have access. The medication cart is maintained locked in the staff office. First Aid kit are accessible and stored in the kitchen cabinet, staff office, and garage. Continued.... A physical plant inspection was completed and included the following checks: Facility is a fenced perimeter with double locked doors at the entrance and delayed egress system. Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Backyard contained two swinging benches and a gazebo. Art supplies, clay, and yoga balls were observed for children's recreation time in the activity room. All facility smoke detectors and carbon monoxide detectors are in appropriate working order. The hot water was measured in the client bathroom and is currently 107.4 degrees. Trash cans for storage of solid waste had tight fitting lids. Per facility staff, no firearms or weapons are allowed in the facility. LPA observed the following items posted in the reception area Personal Rights, Emergency Disaster Plan, Facility sketch, house rules and ombudsman poster. The facility had the emergency intervention plan. The facility has operable automatic fire sprinkler system. All staff files and client files are kept electronically. LPA reviewed five out of five staff files (S1-S5) and one out of one client flies (C1). All files contained the required items. Based on todays inspection, there are no deficiencies observed at this time. An exit interview was conducted. A copy of this report was discussed and provided to Jennifer Phillips, Program Manager


summary: Facility Evaluation

raw_content:
Narrative:
On April 9, 2025 at 9: AM Licensing Program Analysts (LPA's) Lucero Jauregui and Lisa Bernabe conducted an unannounced annual inspection for a Community Crisis Home (CCH). LPA's met with Jennifer Phillips, Administrator who provided LPA's with a guided indoor and outdoor tour of the facility. The facility serves two ambulatory and two non-ambulatory clients ages 12-17 years old. There are no clients in placement. The facility is a four-bedroom and two-bathroom for client use. The facility consists of living room, kitchen, dining area, staff office, staff bathroom, reception area, therapy room, hygiene closet, laundry room, two space garage, and client activity room. Bedroom one and two serve ambulatory clients. Bedrooms three and four serve non ambulatory clients. Bathroom one will be used for ambulatory client only. Bathroom two will be used by non ambulatory clients only. Bedrooms are arranged so that no more than two children share a room, and there is one child per bedroom. No room is commonly used for other purposes used as a bedroom, and no bedroom serves as a passageway to another room. All beds were observed to have appropriate clean linens and mattress in good repair. There is adequate drawer and closet space for clients' belongings. The living room and kitchen is set up as an open concept. The living room is furnished with couches, dining table with four chairs and a television. The kitchen was observed to be free from observable hazards. Cooking utensils, and silver wear was observed to be locked in kitchen drawers and cabinets. Sharps are maintained locked in staff office. Continued.... LPA's observed all hazardous items have been properly made inaccessible in locked cabinets in the laundry room where clients will not have access. The medication cart is maintained locked in the staff office. First Aid kit are accessible and stored in the kitchen cabinet, staff office, and garage. A physical plant inspection was completed and included the following checks: Facility is a fenced perimeter with double locked doors at the entrance and delayed egress system. Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Backyard contained one swinging bench and a gazebo. Art supplies, clay, and yoga balls were observed for children's recreation time in the activity room. All facility smoke detectors and carbon monoxide detectors are in appropriate working order. The hot water was measured in the client bathroom and is currently 112. 8 degrees. Trash cans for storage of solid waste had tight fitting lids. Per facility staff, no firearms or weapons are allowed in the facility. LPA Jauregui observed the following items posted in the reception area Personal Rights, Facility sketch, and important hotline numbers. Administrator will be updating Emergency Disaster Plan LIC610C for posting. The facility has operable automatic fire sprinkler system. All staff files and client files are kept electronically. LPA Jauregui reviewed five out of five staff files (S1-S5). Three out of five staff are in the process of becoming a Registered Behavior Technician (S2, S3, S5) Based on todays inspection, there are no deficiencies cited at this time. An exit interview was conducted with Jennifer Phillips. Due to printer technical difficulties, LPA Jauregui emailed report to Jennifer Phillips, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On September 4, 2025 at 10: AM, Licensing Program Analyst (LPA) Lucero Jauregui conducted an unannounced case management visit at the facility and met with Jennifer Phillips, Administrator. The purpose of the case management visit is to deliver an amended version of the LIC 9099 originally delivered on August 12, 2025. An exit interview was conducted with Jennifer Phillips, Administrator. Copies of this report, the amended report, and appeal rights were provided to Jennifer Phillips, Administrator.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On April 22, 2026 at 9: AM Licensing Program Analysts (LPA's) Lucero Jauregui and Stephanie Arreola conducted an unannounced annual inspection for a Community Crisis Home (CCH). LPA's met with Roland Williams, Administrator who provided LPA's with a guided indoor and outdoor tour of the facility. The facility serves two ambulatory and two non-ambulatory clients ages 12-17 years old. There is one client in placement. The facility is a four-bedroom and two-bathroom for client use. The facility consists of living room, kitchen, dining area, staff office, staff bathroom, reception area, therapy room, hygiene closet, laundry room, two space garage, and client activity room. Bedroom one and two serve ambulatory clients. Bedrooms three and four serve non ambulatory clients. Bathroom one will be used for ambulatory client only. Bathroom two will be used by non ambulatory clients only. Bedrooms are arranged so that no more than two children share a room, and there is one child per bedroom. No room is commonly used for other purposes used as a bedroom, and no bedroom serves as a passageway to another room. All beds were observed to have appropriate clean linens and mattress in good repair. There is adequate drawer and closet space for clients' belongings. The living room and kitchen is set up as an open concept. The living room is furnished with couches, dining table with four chairs and a television. The kitchen was observed to be free from observable hazards. Cooking utensils, and silver wear was observed to be locked in kitchen drawers and cabinets. Sharps are maintained locked in staff office. Continued.... LPA's observed all hazardous items have been properly made inaccessible in locked cabinets in the laundry room where clients will not have access. The medication cart is maintained locked in the staff office. First Aid kit is accessible in staff office and contained all required items. A physical plant inspection was completed and included the following checks: Facility is a fenced perimeter with double locked doors at the entrance and delayed egress system. Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Backyard contained one swinging bench and a gazebo, trampoline and boxing bag. Art supplies, clay, and yoga balls were observed for children's recreation time in the activity room. All facility smoke detectors and carbon monoxide detectors are in appropriate working order. The hot water was measured in the client bathroom and is currently 138 degrees Farenheit. LPA Jauregui issued Technical Violation for Section Furniture, Fixtures, Equipment, and Supplies 80088(e)(1) [SEE LIC9102]. Trash cans for storage of solid waste had tight fitting lids. Per facility staff, no firearms or weapons are allowed in the facility. LPA Jauregui observed the following items posted in the reception area Personal Rights, Facility sketch, Therapy Session Rules, Facility License, Grievance forms, Foster Care Ombudsman telephone number, Rights of Individuals with Developmental Disability, DDS Heath and Safety Rights, and emergency hotline numbers. The facility has operable automatic fire sprinkler system. LPA Jauregui reviewed five out of five staff files (S1-S5) and one client file (C1). Staff files are maintained electronically and are available for LPA review. Based on todays inspection, there are no immediate deficiencies cited at this time. An exit interview was conducted and a copy of this signed report, LIC811, LIC9102 and appeal rights were provided to Roland Williams.

met_with: Roland Williams, Adminsitrator


facility_name: KALA HOUSE JR.

raw_content:
Narrative:
Confidential interviews also revealed that the alleged victim made a phone call around the time the incident was alleged to have occurred and there was no mention of the incident during the one-hour phone call. It was also revealed that the alleged victim was asleep and was awakened by the incident. Even though they could not see the perpetrator clearly, they were able to identify their voice, and the other staff members who were on shift during the time the incident was alleged to have occurred, but there were no witnesses who could confirm this information. Records reviewed also showed the list of all staff working during the shift when the incident was alleged to have occurred and the alleged perpetrator was not on the list of staff on that shift. Lastly, email received on 11/1/23 also revealed that the police report of the alleged incident is not available and cannot be produced. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted. A copy of this report and the Appeal Rights were provided to Jessie Ward, Lead 1.

Investigation Findings:
13On 11/30/23 about 3: PM, Licensing Program Analyst, (LPA) Uchenna Ajaero made an unannounced complaint investigation visit to deliver finding for this allegation. LPA Ajaero met with Jessie Ward, Lead 1 and informed her of the purpose of the visit. During the investigation, LPA Ajaero visited Kala House on 10/04/23 and met Glenda Stanley, the Facility Administrator. LPA Ajaero requested the following client and staff information: Client Roster, Staff Roster, Needs and Services Plans, Admission agreements, police report, emergency contact information for client and Case notes for the past six month. LPA Ajaero conducted confidential interviews with parties involve between 10/10/23 and 11/1/23. Based on interviews conducted during the investigation, the allegation that staff sexually abused a minor in care cannot be substantiated because statements given in one of the confidential interviews conducted 10/10/23 explained that the allegation could not have happened, because the alleged staff did not work the shift when the incident was alleged to have occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Uchenna Ajaero LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: KALA HOUSE JR.FACILITY NUMBER: VISIT DATE: 11/30/2023

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

met_with: Jessie Ward, Lead 1


raw_content:
Narrative:
it was unclear when the staff shortage took place because no dates and times were provided. Although the allegation may have happened is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted. A copy of this report along with Appeal Rights were provided to Chris Cross.

Investigation Findings:
13On April 16, 2024 at approximately 10: AM, Licensing Program Analyst (LPA) Farhaan Sarangi arrived unannounced at Kala House Jr for the purposes of delivering complaint findings. LPA met with Administrator, Chris Cross and was granted access into the facility. During the investigation process, LPA Sarangi reviewed the complaint history, criminal background check, facility personnel report summary and timecards between December 28, 2023, through February 3, 2024, for a total of 19 staff members. Based on interviews conducted, the allegation above cannot be substantiated because there were inconsistent statements made throughout the course of the investigation process. LPA could not obtain corroborating evidence that the facility is out of ratio. LPA was able to interview one client in care and seven staff members. 2 out of 3 clients refused to be interviewed due to behavior issues during the inspection. Even though 3 staff members disclosed of staff shortages in the past, (Report continued on LIC 9099C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Farhaan Sarangi LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: KALA HOUSE JR.FACILITY NUMBER: VISIT DATE: 04/16/2024

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

met_with: Administrator, Chris Cross


raw_content:
Narrative:
out of 11 interviews confirmed that staff attended medical appointments, provided meals, ensured health care needs were met, staff followed behavioral care plans, and supervised clients in care. In addition, LPA Turner was not able to qualify one client during the interview process, and was not able to obtain exact dates and times of incidents reported. During the investigation LPA Turner was informed that C1 was removed from the facility without prior notification. Staff was not aware of C1 being discharge. Staff advised LPA Turner that C1 lost personal belongings in bedding and no other clients or staff took belongings. It was also confirmed that appointments were missed due to mis-communication between the parties involved. It was confirmed by staff members that C1 was the one listening to inappropriate music in the facility. Staff denied that there was a lack of supervision in the facility while client was in care. Lastly, LPA Turner was notified by staff that C1 was provided snacks when RP randomly picked them up from the facility. Staff were unable to provide fully cooked meals before they left the facility. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted, copy of this report and the Appeal Rights were discussed and provided to the licensee.

Investigation Findings:
13On October 28, 2024 at 9: AM Licensing Program Analyst (LPA) Zaria Turner and Licensing Program Manager (LPM) Rosa Rodriguez made an unannounced visit to deliver findings to the above facility and met with Chris Cross, Facility Administrator. Prior to the meeting LPA Turner and LPA Shulz initiated the complaint investigation on September 10, 2024. No deficiencies were cited during that inspection. LPAs requested the following documents: staff and client rosters, staff schedule, medication logs, meal and grocery logs, incident reports, intake logs, and needs and services plans for each client. LPA Turner attempted 1 confidential interview and conducted 10 interviews between September 23, 2024 and September 30, 2024. Based on evidence obtained and confidential interviews conducted during the investigation process the above allegations cannot be substantiated because there were inconsistent statements throughout the investigation process. Report continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Zaria Turner LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: KALA HOUSE JR.FACILITY NUMBER: VISIT DATE: 10/28/2024

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

met_with: Chris Cross, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Tana Kinder and Alyssa Burgess conducted an announced prelicensing inspection with the Licensee, Michelle Wagner on 8/9/2021 at 10:30 am at the facility. LPAs utilized the CARE Tool for the inspection. LPAs conducted the walk through of the facility with the Licensee and observed 4 bedrooms, 2 offices, 2 common areas, 2 bathrooms a kitchen, garage, laundry room, front yard and back yard. All spaces were were clean, sanitary, free of insects, and had unobstructed pathways. LPAs observed 7 days worth of non-pershable, food for 4 potential clients. The facility does not utilized protective separation rooms. All the bedrooms are furnished with a bed, dresser, night stand, closet and is well-lit. The grounds have a garden and recreation area with plenty of space for activities. There are no staff associated to the facility. There are currently no clients at the facility. There are (3) individuals associated to the facility; the licensee, administrator and clinical director. LPAs have observed the following that need to be brought into compliance before issuance of the license. LPAs have given Technical Assistance Advisories for the following: 1. The land line phone is set-up, but the land line is not hooked up. 2. The cilent bathrooms have a faucet with a button to deliver water that does not stay on long enough to deliver hot water. Additionally, the faucet angle/pressure makes the water splash out of sink and on person standing in front of sink. 3. Currently the propane tank is accessible. 4. The rug in the multi-purpose visit room shall have anti-slip material added underneath the rug. 5. No statement regarding back-up power/generator in the Emergency Disaster Plan. 6. Emergency Disaster Plan needs to address storage of medications, including medications that require refrigeration. 7. Facility will have one set of keys for evacuation with each of the following keys: facility vehicles, all client rooms, exit doors, cabinets, cupboards for supplies. 8. Facility needs to compile the Disaster Supply Kit to the specifications in their Program Statement, section Emergency Disaster Plan. Licensee will submit evidence that the above listed issues have been corrected to LPA Kinder before the license can be issued. LPA Kinder and Licensee Wagner agreed upon 9/10/2021 for the above items to be resolved by. Exit interview was conducted with Licensee Wagner and a copy of this report was emailed to mwagner@advancekids.com

met_with: Licensee


summary: Facility Evaluation

raw_content:
Narrative:
LPA Kinder conducted a Post Licensing inspection on 12/29/2021 at 1130am. During this inspection, LPA Kinder inspected the facility interior and exterior which includes the following: · The facility is licensed for 4 placements and currently has 1 client · The facility vehicles (2) were inspected and clean and in good repair with insurance and registration · Facility is clean, safe, sanitary and in good repair · Facility and outdoor area is free of safety hazards · Facility has enough perishable/nonperishable food for 1 client for 4/12 days · Toxic materials are inaccessible, locked in cabinet in laundry room · There are games and in-home entertainment including board and video games · Medications are locked and kept out of reach of children · Smoke detectors and carbon monoxide monitors are operable and there are fire extinguishers (3) fully charged · The facility has adequate personal hygiene supplies and linens for up to 4 clients · Personal Rights, Monthly Menu Plan, Emergency Exit Plan, and Disaster Plan are posted · 1 client file and medications were reviewed and 4 staff files were reviewed. - Water temperature was logged at 108.7 - First Aid Kit (3) were observed to be fully stocked an additional one is in one of the vehicles Based on the files and inspection, the facility appears to be in compliance with Title Regulations. Permanent licensing is recommended at this time.

met_with: Administrator


summary: Facility Evaluation

raw_content:
Narrative:
An annual required inspection was conducted by Licensing Program Analyst (LPA) Tana Kinder on 9/29/2022 with Facility Administrator. Community Care Licensing file, incident reports, facility roster, facility profile and complaint history were reviewed prior to visit at the agency. The licensing fees are owed on this date. This information was provided to the administrator. The Facility has a capacity of 4 and currently has 2 residents. There are 40 staff members associated to the license and 4 currently working at the Facility. LPA reviewed 4 staff files, all that were reviewed were complete and up to date. Staff files reviewed have required training hours, education, and fingerprint clearances. 3 youth files were reviewed. The youth's needs and services plan/Individual Program Plan, Behavioral Plan (IBST) and quarterly reviews were complete and up to date. Immunization records were current. Medical consent forms were signed by authorized representative and current. Additionally, the youth's files had a record of personal property. Personal rights, menu, license, and emergency exit plan were posted. The facility was inspected jointly with the Facility Administrator. LPA interviewed 1 client. There are 4 bedrooms and 2 bathrooms. Each bedroom has a bed for 1 client, as the facility has single occupancy bedrooms. Three bedrooms had a firm mattress, with a bed cover, sheets, blanket, and pillows. One bedroom was being repaired as a client destroyed much of the room during a behavioral episode. The common area has couches and chairs to sit in, and a TV. The facility is in good repair. There are locked cabinets in the laundry room with cleansers and detergents. Additional linen if needed for the bedrooms and the bathrooms are kept in a hall closet. Client and staff files are in locked cabinets. The passageways from the front to the back of the facility are unobstructed. LPA observed the backyard and saw a patio table with chairs and play equipment for the clients. LPA observed enough perishable/non-perishable food for 3 clients for 4 days/3 weeks. Smoke detectors are in working order. There is a carbon monoxide monitor and 2 fully charged fire extinguisher. Sharps were kept locked in the kitchen. Additional sharps are kept locked in the laundry room. The kitchen was stocked with plates, utensils and drinking cups sufficient for 4 clients. The garage is set up for the client's to play ping-pong and do crafts. The clients' hygiene kits were stocked. A fully stocked first aid kit is kept in the laundry room. LPA observed an emergency disaster kit for evacuation, kept in the garage. An exit interview was conducted and discussed with the Facility Administrator. No Citations were issued.


summary: Facility Evaluation

raw_content:
Narrative:
On 9/28/23 at 10:13 a.m. Licensing Program Analyst (LPA) Jacqueline Carmona made an unannounced annual inspection using the Compliance and Regulatory Enforcement (CARE) tools and met with Glenda Stanley, Community Crisis Home (CCH) Facility Manager. LPA toured the interior and exterior of the facility during the inspection today. The facility consists of 4 client bedrooms, which had all the furniture, linens and lighting as required. There is 1 bedroom used as a game room/ visitation room. LPA observed 2 bathrooms available to clients which were appropriately equipped with toilet paper, paper towels and running warm water as required. LPA observed that the shower and toilet were in working condition as required. The kitchen had a adequate supply of perishable and nonperishable food for the clients in care. LPA observed that the facility appliances, refrigerator, and freezer to be clean and function as required. LPA observed that sharps, disinfectants, and cleaning supplies were appropriately stored and were not accessible to clients in care. LPA observed a menu posted in the facility. LPA observed the laundry services available for the youth to complete their own laundry. LPA observed working carbon monoxide detectors and a fully charged fire extinguishers. LPA observed that the facility has a functioning telephone in the facility. The living room and dining room were free of obstruction and had furniture in good repair. The office used by the administrator and staff has locked cabinets for client's files and a locked cabinet for medication. All the posting requirements were available in a visible area. First aid kits were fully stocked and available. LPA observed that the facility vehicle appeared to be in good operating condition. The back yard and front yard were free of debris and in compliance. There are no bodies of water located on the property. Currently the facility has 2 clients in care. LPA reviewed 2 client files and 5 staff files. A review of the staff files indicated the staff have current CPR and First Aid training. They also have DOJ, FBI, and Child Abuse check clearances. The client's file contained all required documentation. Continue to page LPA interviewed 4 staff and 2 clients. A review of the Licensing Information System indicates the facility is current with their facility fees at the time of the inspection. Exit interview was conducted. A copy of report was provided to the CCH Facility Manager.

met_with: Glenda Stanley,CCH Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 10/25/23 at 11:25 a.m. Licensing Program Analyst (LPA), Jacqueline Carmona made an unannounced visit to the Community Crisis Home (CCH) to conduct a case management regarding the facility staff not having knowledge of Mandated Reporting Requirements. LPA met with Glenda Stanley, Facility Manager(who assisted with the inspection). The home is a one story. It consists of two living spaces, one dining room, one kitchen, four bedrooms (three client bedrooms), one bedroom used as a game room/visitation room, 2 bathrooms, a laundry room, an office for staff, and a conference room, A walk through was conducted during today's inspection, the facility was observed to be in compliance. On 9/28/ LPA Carmona conducted the facilities annual inspection. During the staff interviews, 3 out of 4 staff members were unable to answer questions regarding Mandating Reporting. On 10/10/ LPA Carmona received staff members Mandated Reporting Training Log. An exit interview was conducted with Glenda Stanley, Facility Manager and a copy of this report was provided. There were no citations during today's visit. This case management investigation is closed.

met_with: Glenda Stanley, Facility Manager


facility_name: MILE HIGH EMPIRE AVENUE

summary: Facility Evaluation

raw_content:
Narrative:
On 5/7/25 at 1PM, Licensing Program Analyst (LPA) Mariah Hawkins met with Applicant Mile High Director Tegre Miles and Facility Administrator Reyes Bonilla for the scheduled Component II face-to-face meeting. During the meeting, the following topics were discussed. Goal/Purpose of the Facility Basic Services and Planned Activities Needs and Services Plans Care and Supervision Policies Emergency Intervention Policies Emergency Disaster Procedures Reporting Requirements Background Clearance/Guardian Process At the conclusion of the meeting, LPA discussed that the prelicensing inspection will be scheduled upon receipt of the fire clearance. LPA thanked Director and Administrator for attending the meeting. A copy of this report was emailed to Director.

met_with: Tegre Miles, Director Reyes Bonilla, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 9/4/25, Licensing Program Analyst (LPA) Mariah Hawkins conducted a scheduled prelicensing inspection. LPA met with Director Tegre Miles and Administrator Reyes Bonilla. The inspection was conducted using the CARE Inspection Tool. LPA toured the facility site and grounds and observed the facility to be a single-story home in a residential area. There is a fence around the property and an access gate in front of the driveway. There is a pathway and ramp up to the front door and a ramp to the backyard from the back door. There are designated secured storage areas for sharps, chemicals, and medications, and there are designated confidential storage areas for staff and client files. LPA discussed the following with Director and Administrator: The water is currently off for repairs to the pipes. Director will notify LPA once the repair is complete. Grievance procedures need to be posted. Director will notify LPA once posted. The facility phone will be installed next week. Director will notify LPA once installed. Pending background clearances and the Guardian system Pending application approval by the licensing agency's management Pending application approval by the Department of Disability Services Upon completion of the above items, the facility will be ready for licensure. An exit interview was conducted, and a copy of this report was provided to Director Tegre Miles.

met_with: Director Tegre Miles, Administrator Reyes Bonilla


facility_name: NORTH STAR #2

raw_content:
Narrative:
During confidential interviews, all parties agreed that C1 has shown some sexual behaviors, however, agree that the behavior is "typical, not excessive or out of the ordinary" for a teenager. Lastly, all parties interviewed denied witnessing minor being sexually abused by anybody at the facility while in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. Exit interview was conducted with Shelita Mejied. A copy of this report, 856C and appeal rights were provided.

Investigation Findings:
13Licensing Program Analyst (LPA) Monica Roberts conducted an unannounced inspection to the above agency on 10/3/23 at 10:00 a.m. to discuss the complaint allegation. LPA Roberts met with Shelita Majied, LCSW. LPA Roberts informed Ms. Majied that the complaint investigation included an initial 10-day inspection on 9/18/2023, where LPA conducted a file review and collected the following documents: Child 1 (C1)'s SIRs for the past 6 months, Child's Needs and Services Plan and Staff Contact List. On 10/16/2023 at a subsequent visit, LPA Roberts collected Behavior Event Reports from C1's school dated 8.30.2023. On 10.19.2023, LPA Roberts confirmed the Behavior Event Reports with the school. Behavior was witnessed and documented over a two-day period. File review was conducted on 9/19/23, and interviews were conducted between the dates of 9/19/2023 and 10/19/2023. Lastly, LPA Roberts was not able to interview C1 during the investigation due to his medical condition and being non-verbal. Based on LPAs record review and interviews conducted during the investigation process, the preponderance of evidence standard has not been met, meaning that the allegation may have happened or is valid, but there are no witnesses, no specific dates/times when the incident took place. (Continued on LIC 9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Hall LICENSING EVALUATOR NAME: Monica Roberts LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: NORTH STAR #2FACILITY NUMBER: VISIT DATE: 11/03/2023

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

met_with: Shelita Majied, LCSW


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts, (LPAs) Tana Kinder and Nino Sanders conducted an announced prelicensing inspection with the Administrator, Adlaine Alfonso on 8/24/2021. LPAs utilized the CARE Tool for the inspection. LPAs conducted a walk through of the facility and observed 5 bedrooms, 2 bathrooms, 2 common areas, a large entry area, a kitchen with dining area, a garage converted into an office area for staff with locked cabinets that can store records. There is a locked medication room with a locked cabinet inside to store medications and a refigerator dedicated for medications that require refrigeration. LPAs observed a laundry room, a front yard and back yard area. All spaces were clean, sanitary, free of insects and had unobstructed pathways. LPAs observed 3/7 days worth of perishable/non-perishable food for 5 potential clients.The facility does not utilize protective separation rooms. All the bedrooms are furnished with a bed, dresser, nightstand, closet and is well-lit. The grounds have raised beds for a potential garden and plenty of space for recreational activities. LPAs observed 2 fully charged fire extinguishers, 2 working carbon monoxide monitors and working smoke detectors throughout the home that close the fire doors when triggered. There is a van for transport that is in working condition with current registration. No cameras are in use in the facility. Technical Advisories were issued. No citations were issued. An exit interview was conducted and a copy of this report was emailed to the administrator.

met_with: Adminstrator


summary: Facility Evaluation

raw_content:
Narrative:
LPA Kinder conducted a Post Licensing inspection on 1/20/2022 at 1100am with the Administrator. During this inspection, LPA Kinder inspected the facility interior and exterior which includes the following: · The facility is licensed for 5 placements and currently has 3 clients · The facility vehicles (2) were inspected and clean and in good repair · Facility is clean, safe, sanitary and in good repair · Facility and outdoor area is free of safety hazards · Facility has enough perishable/nonperishable food for 3 clients for 4/12 days · Toxic materials are inaccessible, locked in cabinet in laundry room · There are games and in-home entertainment including board and video games · Medications are locked and kept out of reach of children · Smoke detectors and carbon monoxide monitors are operable and the fire extinguishers (2) are to date and fully charged · The facility has adequate personal hygiene supplies and linens for up to 5 clients · Personal Rights, Monthly Menu Plan, Emergency Exit Plan, and Disaster Plan are posted · 3 client files and medications were reviewed and 4 staff files were reviewed · Water temperature was logged at 109.5 · First Aid Kit (2) were observed to be fully stocked and one is in one of the vehicles


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst, (LPA) Tana Kinder conducted an unannounced case management inspection with the Administrator regarding 3 incident reports related to C1 dated: 1/22/2022,1/30/2022, and 2/1/2022. LPA reviewed the incident reports with the Administrator and discussed the issues related to C1 and C2. The Administrator provided information related to the incidents and how staff were addressing the issues to prevent future incidents from occurring. No citations were given and a copy of this report was provided to the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 3/15/ Licensing Program Analyst (LPA) Stephanie Lor conducted a case management phone call with the Administrator to follow up on an incident report received on 3/13/23 regarding lack of supervision. LPA Lor discussed the incident report and gathered further information. It was determined that another staff was on site during this incident. No citation was given and a copy of this document was emailed to the agency for their records. This case management investigation is closed.

met_with: Adlaine Alfonso, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 11/20/ Licensing Program Analyst (LPA) Jacqueline Carmona arrived to the above facility with the purpose of conducting an unannounced annual required inspection. LPA Carmona met with Adlaine Alfonso, Administrator and explained the reason for the visit. LPA Carmona asked for the census, and it was 3. During the inspection 3 clients and 6 staff were present. LPA Carmona conducted a walk through of the interior and exterior of the facility. The facility is a one story home that consists of 5 bedrooms, 2 bathrooms, 2 common areas, kitchen, and dining area. There is a patio area outside, a basketball hoop in the front driveway, and a covered patio area on the front of the facility. The furniture throughout the common areas and bedrooms were in good repair. Each bedroom has a bed for 1 client, as the facility has single occupancy bedrooms. Each bedroom had firm mattresses with a bed cover, sheets, blanket, and pillows. The kitchen has a pantry and a refrigerator which were fully stocked with two days of perishable food and seven days' worth of non-perishable food. Client and staff files are in locked cabinets in the office, which is located in the garage. The laundry room has a working washer and dryer. The bathrooms are clean, sanitary, and functioning with warm water temperature of 105 degrees. The front and back yard are clear and free of debris. LPA checked all fire alarms and carbon monoxide alarms, and they are fully functioning. The first aid kit (s) was fully stocked, and readily available. The fire extinguishers were fully charged. There is adequate lighting throughout the home. Clients live in a safe, healthy, comfortable home and are treated with respect. Overall, the home was observed to be clean, safe, sanitary and in good repair. LPA Carmona completed the physical plant domain due to time restraint and will return at a later time to complete the rest of the CARE tool. Exit interview was conducted. No deficiencies cited during this inspection. A copy of this report was provided to Adlaine Alfonso, Administrator .


summary: Facility Evaluation

raw_content:
Narrative:
On 12/12/23 at approximately 10:53 a.m. Licensing Program Analyst (LPA) Jacqueline Carmona made an unannounced annual inspection to the above facility using the Compliance and Regulatory Enforcement (CARE) tools. LPA Carmona met with Adlaine Alfonso, Administrator who assisted with the inspection. LPA Carmona continued the inspection of the following domains: Operational Requirements, Disaster Preparedness, Emergency Intervention Plan, Staffing Records, Client Records, Core Therapeutic Services and Clients With Special Health Care Needs Currently the facility has 3 clients in care. LPA reviewed 3 client files and 5 staff files. A review of the staff files indicated the staff have current CPR and First Aid training. They also have DOJ, FBI, and Child Abuse Check clearances. The client's file contained all required documentation. LPA Carmona attempted to interview 2 clients, interviewed 1 client, and interviewed 3 staff. A review of the Licensing Information System indicates the facility is current with their facility fees at the time of the inspection. An exit interview was conducted. No deficiencies cited during this inspection. A copy of this report was provided to Adlaine Alfonso, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 2/16/24 at approximately 5:08 p.m. Licensing Program Analyst (LPA) Jacqueline Carmona conducted a Case Management regarding an incident report received by the Department on 2/05/24. LPA contacted Adaline Alfonso, Administrator. The incident report disclosed abuse to a client from a staff member. The alleged staff was immediately removed from the floor and no longer providing care to clients after the incident. LPA Carmona gathered contact information for facility staff, Office of Protective Services commander and facility cellular phone number. An exit interview was conducted with Adaline Alfonso, Administrator and a copy of this report was provided. This case management investigation needs further investigation.

met_with: Adaline Alfonso, Administrator


facility_name: SOUTH STAR #1

summary: Facility Evaluation

raw_content:
Narrative:
On February 16, 2022, Licensing Program Analyst (LPA) Michael Almaraz and Licensing Program Manager (LPM) Abdoulaye Traore met with applicant Oscar Mejia and Kim Royse via Microsoft teams to cover orientation component II. LPA and LPM went over revisions needed for the application prior to licensure. LPA and LPM gave a copy of the LIC 184, Notice of Incomplete Application and additional correspondence to assist with the revisions needed to the application. A copy of this report was emailed to Oscar Mejia.

met_with: Oscar Mejia


summary: Facility Evaluation

raw_content:
Narrative:
On March 03, 2022 at 10: AM Licensing Program Analyst (LPA) Michael Almaraz and Licensing Program Manager (LPM) Abdoulaye Traore began a pre-licensing inspection for a Community Crisis Home (CCH) license. LPA met with applicants Kimberly Hamilton-Royse and Oscar Mejia who led a tour of the home. The home was toured inside and out with the applicants. Applicants were applying for a maximum capacity of five clients. The home was approved for three non-ambulatory clients and two ambulatory clients ages 12-17-year-old. The home is a one-story residence with five bedrooms and three bathrooms. The home is set as: Bedroom # The room consist of a queen-size bed. It sleeps one ambulatory client- vacant. Bedroom # The room consist of a queen size bed. It sleeps one non-ambulatory client- vacant Bedroom # The room consist of a queen size bed. It sleeps one non-ambulatory client- vacant Bedroom# The room consist of a queen size bed. It sleeps one ambulatory client- vacant Bedroom# The room consist of a queen-size bed. It sleeps one non-ambulatory client- vacant. Bedrooms were arranged so that no more than two children share a room, and there was one child per bedroom. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. Additionally, there was kitchen with a long island, a living room furnished with couches, an office, a medication room and a media room furnished with couches and a television. There was adequate drawer and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked and were working properly. All hazardous items have been properly made inaccessible to areas where children will not have access. The medication will be stored in the medication room. Sharp knives were inaccessible and stored in the kitchen island drawer. Cleansers/chemicals were locked and stored in a cabinet in the garage. (continued...) First Aid kit was accessible and stored in the medication room. There were no guns or weapons as stated by Mrs. Hamilton-Royse. The hot water temperature was tested and noted to be at 114 degrees. Applicants understands that the water temperature must be maintained within the regulation range of 105-120 degrees. Trash cans for storage of solid waste had tight fitting lids. Personal Rights, The Facility Sketch, Emergency Disaster Plan, house rules and ombudsman posters were posted in the kitchen by the garage door. The facility had the emergency intervention plan and COVID-19 mitigation plans were in place. Outside the facility, there was two patio areas furnished with couches, tables, and chairs. The backyard was observed to be clean and free of hazards. The facility had two delayed egress system on the front gate and the side gate. LPM and LPA verified and confirmed the delayed egress doors were functional during the inspection. LPM completed the component III Orientation and discussed Incident reporting, including incidents related to Assembly Bill 388 law enforcement contacts as well as incidents involving emergency interventions. Based on this inspection, the home is appropriate for a capacity of 2 ambulatory clients and 3 non-ambulatory clients. The request of License will be forwarded to Licensing Program Manager for final approval and pending the Department of Developmental Services Certificate of Program Approval. A Community Crisis Home shall not be licensed by the Department until the Certificate of Program Approval, granted by the Department of Developmental Services has been received in accordance with Health and Safety Code section 1567.80. Exit interview conducted and a copy of this report was discussed and provided to Kim Hamilton-Royse.

met_with: Kimberly Hamilton-Royse


summary: Facility Evaluation

raw_content:
Narrative:
On December 13, 2022 at 9:01AM Licensing Program Analyst (LPA) Adrian Mendez conducted an unannounced visit at the facility. The purpose of the visit was to interview one client regarding an incident at a prior placement. No other information needed at this time. No deficiencies were cited. Exit interview was conducted and a copy of this report was explained to Clinical Social Worker Beverly Corona. Due to printer malfunction, this report will be emailed to Clinical Social Worker Beverly Corona.

met_with: Beverly Corona


summary: Facility Evaluation

raw_content:
Narrative:
On July 27, 2023 at 10: AM Licensing Program Analyst (LPA) Babatunde Aborchie conducted an annual unanounced inspection for South Star #1. LPA met with the home administrators Oscar Mejia and Lommel Tumbokon who led a tour of the home. The home was toured inside and out with administrator. The home is set as: Bedroom # The room consist of a queen-size bed. It sleeps one ambulatory client. Bedroom # The room consist of a queen size bed. It will sleep one client- vacant Bedroom # The room consist of a queen size bed. It sleeps one ambulatory client Bedroom# The room consist of a queen size bed. It sleeps one ambulatory client Bedroom# The room consist of a queen-size bed. It sleeps one ambulatory client Bedrooms were arranged so that no more than two children share a room, and there was one child per bedroom. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. Additionally, there was kitchen with a long island, a living room furnished with couches, an office, a medication room and a media room furnished with couches and a television. There was adequate drawer and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked and were working properly. All hazardous items have been properly made inaccessible to areas where children will not have access. The medication were stored in the medication room. Sharp knives were inaccessible and stored in the kitchen island drawer. Cleansers/chemicals were locked and stored in a cabinet in the garage. (continued...) First Aid kit was accessible and stored in the medication room. There were no guns or weapons as stated by administrator. The hot water temperature was tested and noted to be at 120 degrees. Administrators understands that the water temperature must be maintained within the regulation of 105 - 120 degrees. Trash cans for storage of solid waste had tight fitting lids. Personal Rights, The Facility Sketch, Emergency Disaster Plan, house rules and ombudsman posters were posted in the kitchen by the garage door. The facility had the emergency intervention plan plans were in place. Outside the facility, there was two patio areas furnished with couches, tables, and chairs. The backyard was observed to be clean and free of hazards. The facility had two delayed egress system on the front gate and the side gate. LPA verified and confirmed the delayed egress doors were functional during the inspection. A sample of four clients and four staff files were reviewed during the inspection. Four clients files were reviewed and there were no deficiencies issued. All staff that work at the facility had proof of Department of Justice and Child Abuse Clearance Index clearances. Based on the facility inspection and file reviews this date, there are no deficiencies found at this time. A copy of this report was reviewed and emailed to Administrator, Oscar Mejia. Exit interview conducted and a copy of this report was discussed and provided to Oscar Mejia.


summary: Facility Evaluation

raw_content:
Narrative:
On March 21, 2024 at 09: AM Licensing Program Analyst (LPA) Jacqueline Garcia and Licensing Program Manager (LPM) Ann Valenzuela conducted an annual unannounced inspection for South Star #1. LPA and LPM met with the home administrator Oscar Mejia who led a tour of the home. The home was toured inside and out with administrator. The home is set as: Bedroom # The room consist of a queen-size bed. It sleeps one ambulatory client. Bedroom # The room consist of a queen size bed. It will sleep one client- vacant Bedroom # The room consist of a queen size bed. It sleeps one ambulatory client Bedroom# The room consist of a queen size bed. It sleeps one ambulatory client Bedroom# The room consist of a queen-size bed. It sleeps one ambulatory client Bedrooms were arranged so that no more than two children share a room, and there was one child per bedroom. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. Additionally, there was kitchen with a long island, a living room furnished with couches, an office, a medication room and a media room furnished with couches and a television. There was adequate drawer and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked and were working properly. All hazardous items have been properly made inaccessible to areas where children will not have access. The medication is stored in the medication room. Sharp knives were inaccessible and stored in the cabinet in the garage. Cleansers/chemicals were locked and stored in a cabinet in the garage. ****. First Aid kit was accessible and stored in the medication room. There were no guns or weapons as stated by administrator. The hot water temperature was tested and noted to be at 105 degrees. Administrator understands that the water temperature must be maintained within the regulation of 105 - 120 degrees. Trash cans for storage of solid waste had tight fitting lids. Personal Rights, The Facility Sketch, Emergency Disaster Plan, house rules and ombudsman posters were posted in the kitchen by the garage door. The facility had the emergency intervention plan plans were in place. Outside the facility, there was two patio areas furnished with couches, tables, and chairs. The backyard was observed to be clean and free of hazards. A sample of four clients and five staff files were reviewed during the inspection. Four clients files were reviewed and there were no deficiencies issued. Five staff files were reviewed and there were no deficiencies issued. All staff that work at the facility had proof of Department of Justice and Child Abuse Clearance Index clearances. Based on the facility inspection and file reviews this date, there are no deficiencies found at this time. Exit interview conducted and a copy of this report along with LIC 811 was printed and provided to Oscar Mejia.

met_with: Administrator-Oscar Mejia


summary: Facility Evaluation

raw_content:
Narrative:
On March 5, 2025 at 10: AM Licensing Program Analyst (LPA) Guadalupe Munoz conducted an annual unannounced inspection for South Star #1. LPA met with the home administrator Oscar Mejia who led a tour of the home. The home was toured inside and out with administrator. The home is set as: Bedroom # The room consist of a queen-size bed. Bedroom # The room consist of a queen size bed. Bedroom # The room consist of a queen size bed. Bedroom# The room consist of a queen size bed. Bedroom# The room consist of a queen-size bed. Bedrooms are for individual client use. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. Additionally, there was kitchen with a long island, a living room furnished with couches, an office, a medication room and a media room furnished with couches and a television. There was adequate drawer and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked and were working properly. All hazardous items have been properly made inaccessible to areas where children will not have access. The medication is stored in the medication room. Sharp knives were inaccessible and stored in the cabinet in the garage. Cleansers/chemicals were locked and stored in a cabinet in the garage. ******* First Aid kit was accessible and stored in the medication room and one in the garage. Administrator reported that there are no guns or weapons on premise. The hot water temperature was tested and noted to be at 111.2 degrees which meets the regulation range of 105 - 120 degrees. Trash cans for storage of solid waste had tight fitting lids. Personal Rights, Client Grievance Policy,The Facility Sketch, Emergency Disaster Plan, house rules and ombudsman posters were posted in the kitchen by the garage door. Outside the facility, there was two patio areas furnished with couches, tables, and chairs. The backyard was observed to be clean and free of hazards. A sample of three clients and five staff files were reviewed during the inspection. Three clients files were reviewed and there were no deficiencies issued. Five staff files were reviewed and there were no deficiencies issued. All staff that work at the facility had proof of Department of Justice and Child Abuse Clearance Index clearances. Based on the facility inspection and file reviews this date, there are no deficiencies found at this time. Exit interview conducted and a copy of this report along with LIC 811 was printed and provided to Oscar Mejia.


summary: Facility Evaluation

raw_content:
Narrative:
On August 29,2025, at 12:30 pm, Licensing Program Analyst (LPA) Guadalupe Munoz conducted an unannounced case management visit of the facility. LPA conducted a walk through of the facility with Chris Venegas, Lead/Senior Psychiatric Technician, and no physical plant deficiencies were observed. LPA informed facility that an investigation will be conducted regarding an incident that was reported on 08/25/25. On 08/25/25, Community Care Licensing (CCL) was notified of an incident regarding possible Personal Rights violations of clients at the facility. The incident reported that clients are alleging that they are treated unfairly, touched without consent in the mornings to wake up, not afforded privacy in shower and on phone calls with family and that client are threatened by staff. LPA interviewed one staff during the visit and one client. LPA requested and obtained documents needed for the investigation. Further information and interviews are required to resolve the concern therefore this investigation is being extended. The outcome of the investigation will be provided to the Facility Administrator. The facility is reminded not to discuss the ongoing investigation with any interested parties. Based on LPA observations, file reviews and interviews, the facility is being cited for being in violation of Title Section 80019(e)(1): Criminal Record Clearance regarding three staff (S1-S3) who do not have necessary clearance eligibility on Guardian and are listed on the LIC500 . This is in violation of Title Section 80019(e)(1): Criminal Record Clearance and Civil Penalties may be assessed at a later time. *** **** LPA conducted exit interview with designee, Chris Venegas. A copy of this report, LIC 811 dated 8/29/25 and appeal rights were provided to designee.

met_with: Chris Venegas


summary: Facility Evaluation

raw_content:
Narrative:
On September 19, 2025, at 9:00 am, Licensing Program Analyst (LPA) Guadalupe Munoz conducted an a follow up unannounced case management visit to complete the case management inspection that was started on 8/29/25. LPA met with Facility Administrator and conducted a walkthrough of the facility. The purpose of the inspection was to follow up on information reported to Community Care Licensing on August 26, 2025. On 08/26/25, Community Care Licensing (CCL) was notified of an incident regarding safety, supervision and Personal Rights of clients at the facility. Investigation was concluded and closed. No further follow up needed. On 8/29/ LPA observed that the facility does not have a designated Facility Manager onsite when children are present during all shifts. LPA interviewed two staff (S1-S2) during the visit and one clients (C1). LPA obtained and reviewed documents needed for the investigation. Based on confidential interviews and records reviewed, Community Care Licensing (CCL) has determined that the licensee does not have a designated facility manager present at the facility at all times when one or more children are present as per Title General Licensing Requirements Article 06. Continuing Requirements Section 84065.2(a)(A)(3) Personnel Duties. The Group Home (GH) facility is being cited for violation of Title General Licensing Requirements Article 06. Continuing Requirements Section 84065.2(a)(A)(3) Personnel Duties. An exit interview was conducted with Chris Venegas and Randy Tyer. A copy of this report, LIC 811 and appeal rights were provided to designees. A copy of the signed report will be placed in the facility file.

met_with: Chris Venegas and Randy Tyer


facility_name: UNEXPECTED POSSIBILITIES EBH HOME INC

summary: Facility Evaluation

raw_content:
Narrative:
On October 15, 2025, at 1: PM, Licensing Program Analyst (LPA) Lucero Jauregui met with Applicant Loretta Talia and Administrator Shevell Sterling for a Component II orientation at the Community Care Licensing San Diego Office. LPA and applicant discussed needed revisions to the application and program statement prior to today's meeting. At this time, updates and revisions have been received by Community Care Licensing. LPA advised applicant the department will proceed with the application process. A signed copy of this report was provided to Loretta Talia.

met_with: Loretta Talia and Shevell Sterling, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On October 31, 2025 at 10: AM Licensing Program Analyst (LPA) Lucero Jauregui conducted an announced pre-licensing inspection for a Community Crisis Home (CCH). LPA Jauregui met with Licensee Loretta Talia, Administrator Shevell Sterling, Assistant Felecia Steward Assistant and Facility Manager Jamersion Sterling. LPA was provided an indoor and guided tour of the facility. The facility will serve two ambulatory and two non-ambulatory clients ages 7-12 years old. The facility is a one story home with four bedrooms, three bathrooms, family room, living room, dinning room, kitchen, laundry room, sensory room, medication station room, staff office and a garage. Bedrooms are set up for one client per bedroom with one full size bed, desk and chair, dressers, and closet space for clients personal belongings. Beds were observed with appropriate clean linen and mattress in good repair. Bedroom #1, bedroom #3 and one bathroom is designed for non- ambulatory clients. LPA observed cabinets in the hallway storing toilet paper. Additionally, there is a hygiene closet and closet for bedding, linens and towels. The laundry room is equipped with washer, dryer and eye washing station. Chemicals were observed maintained locked in cabinets in laundry room. Laundry room will remained locked at all times. The family room is equipped with furniture and ample space for client relaxation. The living room is equipped with furniture, toys and games for client use. LPA observed the kitchen to be clean and free from observable hazards. Kitchen is well equipped with appliances, cooking utensils, and non- perishables/ perishable food items. Sharps are maintained locked in the laundry room. Medication will be kept locked in the medication room. LPA observed First Aid kit with all the required items, medical supplies, blood borne pathogen kit, refrigeration for medication, and extra set of facility keys. Continued...... Medication binder and client files will be kept in the medication room and room will remain locked at all times. Sensory room is for client use with sensory toys. The garage will be utilized as a staff lounge and break room area. There is furniture, refrigerator, microwave and coffee station for staff use. Garage will remain locked and for staff use only. The staff office is equipped with desks, chairs and office equipment. LPA observed telephone and is in working order. Staff files will be kept in the staff office and office will remain locked at all times. LPA conducted a physical plant inspection of the facility. Patio area is clean and free from observable hazards. Delayed egress door was inspected and in proper working conditions. There are two fire extinguishers inside the home and one in the back patio, all were observed to be serviced and charged. There are a total of 11 cameras in common areas inside and outside of the home. LPA reviewed the following items posted: Department of Developmental Services (DDS) hotline and non emergency line, If you See something Say something poster, Rights of Individuals with developmental disabilities, Personal Rights, Grievances procedures, visitation guidelines, Emergency Disaster Plan, Facility Sketch and a Facility Sketch in each bedroom. LPA Jauregui completed Component III Orientation, provided Officer of the Day contact information and answered relevant questions. Based on this inspection, the facility needs to service water heater for temperature to be maintained within the regulation range of 105-120 degrees. After corrections are completed. the applicant will notify LPA Jauregui. A Community Crisis Home shall not be licensed by the Department until the Certificate of Program Approval, granted by the Department of Developmental Services has been received in accordance with Health and Safety Code section 1567.80. An exit interview was conducted. A copy of this report was discussed and provided to Licensee Loretta Talia..

met_with: Licensee Loretta Talia, Administrator Shevell Sterling, Assistant Felecia Steward & Facility Manager Jamersion Sterling.


summary: Facility Evaluation

raw_content:
Narrative:
On November 14, 2025 at 9: AM Licensing Program Analyst (LPA) Lucero Jauregui conducted an announced follow up pre-licensing inspection visit at the facility. LPA met with Licensee Loretta Talia. The purpose of the visit is to follow up on the corrections needed to complete the pre license process. LPA Jauregui measured the hot water temperature of the home to be 113.1 degrees Farenheit. Based on this inspection, the facility has demonstrated to be within Community Care Licensing requirements. The application will be forwarded to management for final review and approval. A Community Crisis Home shall not be licensed by the Department until the Certificate of Program Approval, granted by the Department of Developmental Services has been received in accordance with Health and Safety Code section 1567.80. An exit interview was conducted with Loretta Talia. Due to printer technical difficulties this report was emailed to Licensee Loretta Talia.

met_with: Loretta Talia, Licensee


facility_name: YAI BYRON COMMUNITY CRISIS HOME

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

met_with: Facility Lead Mykiesha Peacock


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

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

met_with: Sharon Poole, Lead RBT


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13On 05/14/25 at 9: AM, Licensing Program Analyst (LPA) Jonathan Medina conducted a complaint inspection at YAI Byron CCH and spoke with Imara Nakooka, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. Based on LPA's interviews with staff, clients, and record reviews, the preponderance of evidence standard has been met. Therefore, the allegation- Staff did not provide child's medication as prescribed-is SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6, Chapter 5, Section 80075(b)(5)(B) Health Related Services. Please refer to the attached 9909D. At this time, one deficiency was given. Aditionally a civil penalty of $250 was assesed as a result of a repeat violation being issued. An exit interview was conducted, appeal rights were provided and discussed, and a copy of this report was given to Imara Nakooka, Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Jonathan Medina LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: YAI BYRON COMMUNITY CRISIS HOMEFACILITY NUMBER: 075650162

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

met_with: Imara Nakooka - Administrator

complaint_status: SUBSTANTIATED


raw_content:
Investigation Findings:
13On 6/6/24 at 11: AM, Licensing Program Analyst (LPA) Jonathan Medina conducted a complaint investigation visit to deliver findings. LPA met with the Director of Residential Services, Terrance Harris, and informed him of the purpose of the visit. Based on confidential interviews, although the above allegation may have occurred or is valid, there is not a preponderance of evidence to prove that the allegation did or did not happen. Therefore, the allegation is determined to be UNSUBSTANTIATED. Multiple staff witnesses were present at the time of the incident and all reported that staff did not push the client. The correct use of the Ukeru pad was implemented. However, the Training Director conducted additional training with staff to improve movement techniques during a client's escalated state in order to increase safety for staff. An exit interview was conducted, and a copy of this report was provided to Terrance Harris, Director of Residential Services, whose signature below confirms receipt. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Jonathan Medina LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Terrance Harris - Director of Residential Services