facility_name: INSPIRING HOPE, LLC (CLEVELAND SMALL FAMILY HOME)

summary: Facility Evaluation

raw_content:
Narrative:
On April 26, 2024 at 1: PM, Licensing Program Analyst (LPA) Linda Haynes completed a pre-licensing inspection of Inspiring Hope LLC Cleveland Small Family Home. LPA met with Applicant Tiombe Chinnery-Cunningham who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients in placement. The home is a one story building with four bedrooms and two bathrooms which are set up as follows: · Bedroom #1 (Applicants) has one bed will sleep the applicants. · Bedroom #2 (daughters) has two beds and sleeps two daughters. · Bedroom #3 (daughter) has one bed, it sleeps one daughter. · Bedroom #5 (Client's) has 2 beds, it will sleep two clients. · A great room/living room, kitchen, dining area, two bathrooms, laundry room, two car garage and the backyard. The Client's bedrooms were arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The four smoke detectors were checked, and they were working properly. There are two carbon monoxide detectors in the home one is located in the living room and one is located in the hallway. The two carbon monoxide detectors where checked and were working properly. The home's central air conditioning module was located in the back yard. The home's hot water heater was located in the garage. The appliances were in working order. The client's files will be locked inside a locked cabinet in the kitchen. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A trash can for storage of solid waste had a tight-fitting lid and was present. The sharp knives will be in a locked drawer in the kitchen. The medications will be located in a locked cabinet in the kitchen. The hot water in bathroom one measured to be 106.8 degrees Fahrenheit, and in bathroom two was 111.0 degrees Fahrenheit. The home's First Aid kit was accessible and is located in a cabinet in the kitchen and contained all required supplies. There was one fire extinguishers present in the home it is located in the kitchen under the sink. It was observed to be properly charged and inspected by the fire department. There are fire arms in the home they are unloaded and were in a locked gun safe in the bedroom and the ammo was in a separate gun safe. There is no pool or other body of water at the home. The backyard where clients will have access to play is fenced. There are no corrections that need to be made at this time A component III was conducted. An exit interview was conducted. Application will be forwarded to the Licensing Program Manager for Licensing.

met_with: Tiombe Chinnery-Cunningham


state: CA

summary: Facility Evaluation

raw_content:
Narrative:
On July 16, 2025, at 01: PM, Licensing Program Analyst (LPA) Raina Perez-Diaz completed a Post-Licensing/Annual inspection of Inspiring Hope LLC Cleveland Small Family Home. LPA met with Licensees Tiombe Chinnery-Cunningham and Jeffrey Cunningham who led a tour of the home. The facility was toured both inside and out with the Licensee. Currently there are no clients in placement. The home is a one story building with four bedrooms and two bathrooms which are set up as follows: · Bedroom #1 (Licensees) has one bed sleeps the Licensees. · Bedroom #2 (daughters) has two beds and sleeps the licensees two daughters. · Bedroom #3 (daughter) has one bed, it sleeps the licensees one daughter. · Bedroom #4 (Client's) has 2 beds, it will sleep two clients. · A great room/living room, kitchen, dining area, two bathrooms, laundry room, two car garage and the backyard. The Client's bedrooms were arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The two smoke detectors were checked, and they were working properly. There are two carbon monoxide detectors in the home one is located in the living room and one is located in the hallway and were working properly. The home's central air conditioning module was located in the back yard. The home's hot water heater was located in the garage. The appliances were in working order. The client's files will be locked inside a locked cabinet in the kitchen. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A trash can for storage of solid waste had a tight-fitting lid and was present. The sharp knives are in a locked drawer in the kitchen. The medications will be located in a locked cabinet in the kitchen. Due to the current census being zero, Licensee was advised to maintain water temperature between 105-120 degrees (F). The home's First Aid kit was accessible and is located in a cabinet in the kitchen and contained all required supplies. There was one fire extinguisher present in the home it is located in the kitchen under the sink. It was observed to be properly charged and inspected by the fire department. There are fire arms in the home they are unloaded and were in a locked gun safe in the bedroom and the ammo was in a separate gun safe. There is no pool or other body of water at the home. The backyard where clients will have access to play is fenced. Based on the facility inspection and the current census being zero, LPA did not review any staffing or client files at the time of this inspections and there are no deficiencies cited at this time. LPA informed the Licensee to notify the Department at the time of receiving their first client in care. The Department will return to conduct staff and client file reviews to complete the inspection. An exit interview was conducted, and a copy of this report and appeal rights were provided to Licensee Jeffrey Cunningham.

report_type: Facility Evaluation

visit_type: Annual

met_with: Licensee- Tiombe Chinnery-Cunningham


facility_name: IRENE IFEADI SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On September 30, 2025, at 9: AM, Component II was conducted at the Monterey Park Children's Residential Program office with Irene Ifeadi Small Family Home applicant, Irene Ifeadi. Attendee for the Department was Licensing Program Analyst (LPA) Pamela Silva. The purpose of the meeting was to review and discuss the facility's application and plan of operation, and to assess the applicant's understanding of the regulations in place for a Small Family Home. LPA confirmed that all application documents requested for revisions have been received and reviewed. No further revisions to the application documents are needed. LPA discussed the need for the applicant's designee to be fingerprinted. LPA discussed the following sections of the facility's Plan of Operation with the applicant. · Purpose/Goals/Program Method · Description of Basic Services · Procedures for Handling Medical/Dental Care · Description on how to handle Medical Emergencies · Procedure for handling and Assisting Children with Self-Administration of Medications · Transportation Arrangements · Procedures for immediate response to incidents and complaints · Complaints and Grievance · Discipline Policies · Visitor/Provisions for Contact with parents/Placement Representatives ·Ground for Dismissal/Relocation/Removal from Placement · Admission Policies · Sample Menu · Run-away Plan/Emergency Intervention · Procedures for Handling/Monitoring Children's Funds, Personal Inventory, Clothing · Disaster Preparedness · Staff Training LPA Silva instructed Applicant to submit corrections and/or revisions to the appropriate sections of the plan of operation as discussed, via email on or before October 15, 2025. An exit interview was conducted, and a copy of this report was provided to Ms. Ifeadi.

met_with: Irene Ifeadi


summary: Facility Evaluation

raw_content:
Narrative:
On October 15, 2025, at 10: AM, Licensing Program Analyst (LPA) Pamela Silva met with Applicant, Irene Ifeadi, via Teams to discuss 2nd revisions to the Small Family Homes Plan of Operation. Revisions to the Plan of Operation, as discussed, will be submitted to LPA for review on or before October 30, 2025. Meeting ended at 11:00 am.


summary: Facility Evaluation

raw_content:
Narrative:
On November 19, 2025 at 8: AM, Licensing Program Analyst (LPA) Pamela Silva conducted an announced pre-licensing inspection at the above address. LPA met with licensee, Irene Ifeadi. A physical plant inspection was conducted. The following were observed at the time of inspection: This facility is a single level home located in a residential neighborhood. The facility consists of 4 bedrooms, 2.5 bathrooms, a living room, kitchen, dining room, 3-car garage, laundry room, and a backyard. Overall, the facility is clean, sanitary and in good condition. The facility has no bodies of water. Licensee reports no firearms in the premises. The facility has a centralized heat and air-conditioning unit. Temperatures in all rooms are maintained at 73 degrees (F). The hot water temperature was measured at 120 degrees F. Carbon monoxide and smoke alarms were tested and observed to be operational. The fire extinguisher located in the living room is fully charged. Knives, sharps, disinfectants and cleaning solutions are kept in a locked cabinet under the kitchen sink. Laundry detergents and other chemicals are kept locked in the cabinet located in the laundry room. The facility has a working telephone. The grounds are free from obstructions and hazards. Children will be utilizing bedrooms #1, #2 and #3. Each children's bedroom has 2 twin beds and has adequate closet and drawer space to accommodate children's clothing and personal belongings. Each bed has clean pillows, pillowcases, bed sheets and blankets. Bedroom #4 will be occupied by licensee. LPA also observed extra linens stored in the hallway cabinet. Medications, client and staff records will be centrally stored in a locked cabinet located in the hallway. A complete first aid kit is readily available in a central location in the facility. Licensee reports that the license, Emergency Plan (LIC 601) and facility sketch will be posted at the facility. An exit interview was conducted, and a copy of this report was provided to Ms.Ifeadi.

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On 11/25/25 at 9: AM, Licensing Program Analyst (LPA) Pamela Silva conducted a virtual Component III meeting via Teams. Present at the meeting was Irene Ifeadi, applicant/licensee. The purpose of the Component III meeting is to familiarize the applicant with general Small Family Homes Rules and Regulations, prepare the applicant to maintain and operate the facility, provide information to avoid potential problem areas during operation, provide clear description of LPA's role in operation of facility, and provide clear description of Civil Penalties. During the meeting, continuing requirements for Small Family Homes were also discussed. LPA Silva conducted the Component III Powerpoint presentation. A copy of the Small Family Home Component III Presentation Materials was provided to the applicant. Applicant's and designee's fingerprint clearances are still in-process and pending. An exit interview was conducted, and a copy of this report was emailed to the applicant for signature.


facility_name: ISON AND ESPLANA HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 08.28.24 at 9:00 am, Licensing Program Analyst, (LPA) Tina Thorn conducted a Pre-Licensing inspection at the Ison-Esplana Small Family Home. LPA Thorn met with the licensees Dulce Vida Asio Esplana and Maria Nancy Ison Pulmones. The facility will be licensed to care for 3 children ages 3-18. LPA toured the facility inside and outside. The facility is a single one-level family home and consists of 2 ambulatory bedrooms and 1 non-ambulatory bedroom and 1 bathroom for clients. The home has a master bedroom and bathroom for the licensees. The home has a living room, kitchen, dining room, laundry room and backyard. The room temperature was comfortable, and no odor was detected. Fire alarms and carbon monoxide were tested. First aid kit was checked and complete. Medication kit was in a locked cabinet and was inspected. Care Tool was completed. No staff interview was conducted. There were no youths in placement. An exit interview was conducted with the Licensees Dulce Vida Asio Esplana and Maria Nancy Ison Pulmones. A copy of this report was left with the Licensees.


summary: Facility Evaluation

raw_content:
Narrative:
On 07.03.25 at 9:30 am, Licensing Program Analyst, (LPA) Tina Thorn conducted a Post-Licensing inspection at the Ison and Esplana Small Family Home. LPA Thorn met with the licensees Dulce Vida Asio Esplana and Maria Nancy Ison Pulmones. The facility is licensed to care for 3 children ages 3-18. The single-family home consists of four (4) bedrooms, three (3) bathrooms, and a two (2) car garage. There are three (3) single bedrooms available for clients, two (2) ambulatory and one (1) non-ambulatory. There is one client currently residing in the home. LPA completed a Health and Safety Inspection of the facility. All toilets, showers, and sinks were functioning properly. The living area is spacious, with a tv, sitting area, and games for the client in the home. The home was clean and organized. The room temperature was comfortable and no odor was detected. Smoke alarms/carbon monoxide detectors were in working order, fire extinguisher was current, and a first aid kit was fully stocked. Disinfectants and medications are in locked cabinets. LPA observed the kitchen to have at least 3 days of perishable food and 7 days of non-perishable food on hand. Client's bedroom had clean bedding, along with a dresser and closet which provided ample storage space for personal belongings. There is no swimming pool or other body of water on the premises. There are no firearms or other weapons in the facility. LPA reviewed 1 client file. The client had a current Individual Program Plan (IPP) on file created by the Regional Center. Clients were current on CHDP medical exams and dental exams. LPA reviewed licensee and staff files. Staff files contained sufficient training hours and CPR and First Aid was current. Client was not present and is non-verbal so no interview was conducted. LPA interviewed 1 licensee. No citations were given on this date. An exit interview was conducted and a signed copy of this 809 was given to licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On 10.23.25 at 10:00 am, Licensing Program Analyst, (LPA) Tina Thorn conducted an Annual inspection at the Ison and Esplana Small Family Home. LPA Thorn met with the licensees Dulce Vida Asio Esplana and Maria Nancy Ison Pulmones. The facility is licensed to care for 3 children ages 3-18. The single-family home consists of four (4) bedrooms, three (3) bathrooms, and a two (2) car garage. There are three (3) single bedrooms available for clients, two (2) ambulatory and one (1) non-ambulatory. There is one client currently residing in the home. LPA completed a Health and Safety Inspection of the facility. All toilets, showers, and sinks were functioning properly. The living area is spacious, with a tv, sitting area, and games for the client in the home. The home was clean and organized. The room temperature was comfortable and no odor was detected. Smoke alarms/carbon monoxide detectors were in working order, fire extinguisher was current, and a first aid kit was fully stocked. Disinfectants and medications are in locked cabinets. LPA observed the kitchen to have at least 3 days of perishable food and 7 days of non-perishable food on hand. Client's bedroom had clean bedding, along with a dresser and closet which provided ample storage space for personal belongings. There is no swimming pool or other body of water on the premises. There are no firearms or other weapons in the facility. LPA reviewed 1 client file. The client had a current Individual Program Plan (IPP) on file created by the Regional Center. Clients were current on CHDP medical exams and dental exams. LPA reviewed licensee and staff files. Staff files contained sufficient training hours and CPR and First Aid was current. Client was not present and is non-verbal so no interview was conducted. LPA interviewed 1 licensee. No citations were given on this date. An exit interview was conducted and a signed copy of this 809 was given to licensee.

met_with: DULCE VIDA ASIO ESPLANA MARIA NANCY ISON PULMONES


facility_name: IVY HOUSE, THE

summary: Facility Evaluation

raw_content:
Narrative:
On September 4th, 2025, at 10:00AM Licensing Program Analyst (LPA) Ashley Ruacho and Licensing Program Manager (LPM) Tira Shanks-Logan conducted a Component II - Face to Face Meeting at the Monterey Park Regional Office. The following were present: Lameka Taylor, Applicant. LPA discussed their application and program statement and advised them of the following corrections. The following information must be completed and submitted to Licensing: Part A LIC Personnel Report - need to revise job titles LIC Fire Inspection - pending Part B Basic Needs Section: Laundry services, including fresh linen weekly or more often; cleaning of clients/resident's room Bedside care for minor temporary illnesses Maintenance and supervision of client/resident cash resources or property Admission Policies: Adding ambulatory status, communication abilities, level of continence to description of persons accepted Personal Rights: Adding statement to section that states: Clients/residents will be informed of their rights and their rights will not be violated. Medical Assessments: Adding items that need to be included on medical assessments, six (6) items. Sample Menu: Portion sizes Control of Property: Update ages allowed to match program statement 0- Surveillance: Include in program statement utilization of cameras (LPA will send PIN regarding camera usage) The Pre-Licensing inspection will be scheduled next week. An exit interview was conducted, and a signed copy of this report was provided to the applicant

met_with: Lameka Taylor - Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On September 10th, 2025, at 10: AM, Licensing Program Analyst (LPA) Ashley Ruacho conducted an announced pre-licensing inspection at the above address. LPA met with Lameka Taylor, applicant. A physical plant inspection was conducted. The following were observed at the time of inspection: The facility is a two-story backhouse duplex located in a residential neighborhood, with Unit 2 occupying the upper level. The facility consists of three bedrooms, two bathrooms, a living room, kitchen, laundry machines in hallway closet, and front yard space. There are two security cameras one is located on the front door and one in the living room. Overall, the facility is clean, sanitary and in good condition. The facility has no bodies of water. The facility has a centralized heat and air-conditioning unit. Temperatures in all rooms are maintained at 68 degrees (F). The hot water temperature was measured at 120 degrees (F). Carbon monoxide and smoke alarms were tested and observed to be operational. There are two (2) fire extinguishers, one in kitchen and one in the hallway by the master bedroom. Disinfectants, cleaning solutions, are kept locked under the sink. Knives and sharps will be locked in kitchen above the pantry. The facility has a working telephone. The applicant reports no firearms on the premises. The grounds are free from obstructions and hazards. Clients will be utilizing one bedroom. During inspection, LPA observed that the client bedroom has two (2) full sizes beds, and one (1) crib is in the master bedroom. There is adequate closet and drawer space to accommodate client's clothing and personal belongings. Each bed has clean pillows, pillowcases, bed sheets and blankets. LPA also observed extra linens stored in the clients bedroom closet. Client records and staff records will be stored and locked in a lock box in the applicant's master bedroom. Medications will be locked in applicants bedroom. A complete first aid kit is readily available in a central location in the facility. Pending Items -Fire inspection was completed, awaiting clearance. LPA also conducted Component III - Category Specific Orientation with the applicant. The following items were discussed and provided to the applicant: - Title 22 regulations on Small Family Homes - Continuing Requirements (General Licensing Requirements) - Personnel Records (forms) - Client Records (forms) - Reporting Requirements An exit interview was conducted a signed copy of this report was provided to the applicant.


facility_name: IVYNA CARE

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
During the investigation, a confidential interview denied pinching FC1. It was disclosed that FC1 has been placed in the home for almost two months, and the relationship has been cordial. Another confidential interview denied pinching FC1 or witnessed FC1 being pinched. The confidential interview continued stating that FC1 had self-injurious behaviors but FC1 was always being redirected. Confidential interview denied being pinched and denied reporting been pinched by anyone. Another confidential witness stated not observing FC1 being pinched. An additional confidential witness believed that FC1 had formulated the story of being pinched, however, it was specifically reported that FC1 demonstrated how FC1 was being pinched by the foster mother. Based on confidential interviews and observations, the allegation that foster mother pinched FC1 may have occurred, however, it is not supported or proven by evidence. Therefore, this allegation is unsubstantiated at this time. A copy of this report, LIC 811 and the appeal right was reviewed and provided to licensee.

Investigation Findings:
13On May 24, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at Ivyna Care Small Family Home and met with the licensee to deliver investigative finding involving the small family home. On December 7, 2022 at 11: AM, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at the small family home to initiate the investigation and conducted interviews with foster mother (FM), and foster father (FF). On April 3, 2023, LPA interviewed two of two foster children (FC1 and FC2). LPA was unable to interview County Social Worker (CSW). On November 28, 2022 a complaint report was referred to Community Care Licensing (CCL) alleging Foster parent pinched child. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Babatunde Aborchie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: IVYNA CAREFACILITY NUMBER: VISIT DATE: 05/24/2023

report_type: Complaint Investigation

met_with: Licensee

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
During investigation, confidential interview denied hitting FC2. Confidential interview stated being hit by FC2. Another confidential interview disclosed that FC2 was hitting the wall with a stick and LS took the stick from FC2. A confidential witness observed FC2 being angry but was not sure LS hit FC2 or not. Another confidential witness observed LS holding the stick but did not see LS hitting FC2. Based on the confidential interviews, the allegation that foster mother hit FC2 in care, may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is unsubstantiated at this time. A copy of this report and LIC 811 was provided to the licensee.

Investigation Findings:
13On March 15, 2024, at 01: PM, Licensing Program Analyst (LPA) Babatunde Aborchie met Ivyna Care Small Family Home Licensee Teresia Muathe to deliver the investigative finding for the above stated allegation involving the Small Family Home and foster children. On June 2, 2023, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at the small family home to initiate the investigation and conducted a safety inspection. LPA interviewed licensee (LS), biological daughter (BD), three Foster Children (FC1, FC2 and FC3). LPA was unable to interview county social worker. On May 26, 2023, a complaint report was referred to Community Care Licensing (CCL) alleging foster mother hit foster child in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Babatunde Aborchie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: IVYNA CAREFACILITY NUMBER: VISIT DATE: 03/15/2024

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

met_with: Liecense - Teresia Muathe


raw_content:
Narrative:
In regard to the allegation, it was specifically alleged that FC1 does not meet criteria for the level of care the RM can provide. During investigation, a confidential interview stated that FC1 was in the small family home (SFH) for only three days and then was removed. It was added that licensee was with FC1 during the three days trying to de-escalate FC1's behaviors and tried to contact wraparound team, psychologist, and social worker but they did not get any help. Other confidential interviews stated that FC1 pulled up a chair and unlocked the front door and walked out of the SFH on Sunday morning before the licensees were awake. It was further reported that the police came and talked to FC1 and FC1's social worker came afterward to pick FC1 up to place FC1 to a new house. A confidential interview stated that FC1 had a history of assaultive behavior and running away. It was added that the police had stated that the SFH was not a good fit for FC1. Based on confidential interviews, the allegation that the licensee is not providing adequate care and supervision to FC1 may have occurred, however, there was not a preponderance of evidence to support or deny the allegation. Therefore, the above allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report along with the appeal rights were reviewed and provided to the facility representative.

Investigation Findings:
13On May 30, 2024, Licensing Program Analysts (LPAs) Rafael Enriquez and Maryjane Perez arrived at Ivyna Small Family Home (SFH) and met with Licensee Teresia Muathe to deliver the finding for the allegation stated above involving the small family home (SFH) and foster child #1 (FC1) as listed on the Confidential Names List (LIC 811) dated May 30, 2024. On March 15, 2024, LPAs initiated the investigation at the SFH and obtained pertinent documents. Additionally, LPA conducted a safety inspection of the SFH, and no immediate health and safety hazards were observed. During investigation, LPA interviewed resource mother (RM), FC1 and County Social Worker (CSW). On Mar 12, 2024, Community Care Licensing (CCL) received a complaint alleging that the resource parent is not providing adequate care and supervision to a minor. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Rafael Enriquez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: IVYNA CAREFACILITY NUMBER: VISIT DATE: 05/30/2024

met_with: Licensee- Teresia Muathe


raw_content:
Narrative:
Regarding the allegation that licensee emotionally abuses minor in care, it was specifically alleged that licensee called C1 a pedophile. During investigation, confidential interviews stated that L1 did not call C1 a pedophile. An additional confidential interview maintained that L1 called C1 a pedophile. LPA received conflicting information. In regard to the allegation that licensee does not ensure that client in care is provided hygiene products. It was specifically alleged that licensee does not buy C1 any care products. Confidential interviews stated that L1 bought C1 and other clients hygiene products. An additional confidential interview stated that L1 did not buy hygiene products that they had to buy them themselves. LPA received conflicting information. Concerning the allegation that licensee does not ensure that minor in care is provided shoes, it was specified alleged that licensee does not buy C1 any shoes. Confidential interviews stated that L1 bought FC1 shoes, how ever since they were not designer shoes C1 would not wear them. An additional confidential interview stated that L1 did not buy C1 shoes; C1's sister had to buy C1 shoes. LPA received conflicting information. Furthermore, the allegation that licensee does not ensure that minor in care is provided clothing, it was specified alleged that the licensee does not buy C1 any clothes. Confidential interviews stated that L1 bought C1 clothing, however L1 stated that C1 would only wear designer clothes. An additional confidential interview stated that L1 did not buy C1 clothes; C1's sister had to buy C1 clothes. LPA received conflicting information. Finally, the allegation that licensee does not ensure that minor in care is provided an allowance, it was specifically alleged that licensee doesn't give C1 money. Confidential interviews stated that L2 would give C1 money only when on an outing because if not C1 would spend it on illegal activities. An additional confidential interview stated that L1 did not give C1 any allowance. LPA received conflicting information. Based on confidential interviews, the allegations that licensee emotionally abuses C1, licensee does not ensure that C1 is provided hygiene products, licensee does not ensure that C1 is provided shoes, licensee does not ensure that C1 is provided clothing, and licensee does not ensure that C1 is provided an allowance may have occurred, however, there was not a preponderance of evidence to support the alleged violations. Therefore, these allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report along with the appeal right were reviewed and provided to facility representative.

Investigation Findings:
13On October 24, 2024, Licensing Program Analyst (LPA) Rafael Enriquez arrived at Ivyna Care Small Family Home (SFH) and met with Licensee Tersia Muathe to deliver the findings for the allegations stated above involving the SFH and foster children (C1, C2, C3 and C4) as listed on the Confidential Names List (LIC 811) dated October 24, 2024. On June 28, 2024, Community Care Licensing (CCL) received a complaint alleging that licensee emotionally abuses minor in care, licensee does not ensure that minor in care is provided hygiene products, licensee does not ensure that minor in care is provided shoes, licensee does not ensure that minor in care is provided clothing, and licensee does not ensure that minor in care is provided an allowance. On July 03, 2024, LPA Enriquez initiated the investigation at the SFH and obtained pertinent documents. Additionally, LPA conducted a safety inspection of the SFH, and no immediate health and safety hazards were observed. The investigation included interviews with licensee, (L1), C1, C2, C3, and C4. LPA was unable to contact County Social Worker (CSW). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Rafael Enriquez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: IVYNA CAREFACILITY NUMBER: VISIT DATE: 10/24/2024


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

raw_content:
Narrative:
Other confidential interviews stated that the clients are not allowed to take their hair bonnets off in the house. Another confidential interview stated the clients hate the hair bonnet and don't want to wear it. During investigation, LPA observed C2 and C3 wearing hair bonnets. Based on confidential interviews and LPA observation, the preponderance of evidence standard has been met, therefore, the allegation that C2 and C3 are forced to wear bonnets is substantiated. The facility is cited for violation of Title 22, Division Chapter Article 06. Continuing Requirements Personal Rights section 80072 (a)(3) To be free from corporal or unusual punishment, infliction of pain, humiliation... or other actions of a punitive nature, including but not limited to: interference with the daily living functions... (See LIC9099D) An exit interview was conducted, and a copy of this report along with the appeal right were provided to licensee Fastac Mutua. Confidential interviews also stated that the clients are not forced to go outside but instead are recommended to go out to get sunlight and be out of their rooms for a while. LPA received conflicting information, In regard to the allegation that foster parent uses inappropriate disciple, confidential interviews stated that clients get their phone taken away for several weeks as a form of punishment. Another confidential interview stated the phone only gets taken away for 1-2 hours with an explanation. Meanwhile, other confidential interviews stated the phone gets taken away for a couple of days or weeks if clients have bad grades or bad behavior. Regarding the allegation that foster parent was rough with minor, confidential interviews stated that a client has been grabbed by the arm by a foster parent in a rough manner before school. Other confidential interviews stated no one has been rough with the clients while other confidential interviews stated clients were pulled by their arm when they were cleaning the bathroom. LPA received conflicting information. Lastly, the allegation that minors are not receiving allowance, it was specifically reported that clients are not getting their allowances for doing their chores, however, confidential interviews stated that clients get their allowances 3-4 times a month. Other confidential interviews stated that they haven't received their allowance for this week and need to remind their foster parents. Another confidential interview stated clients get it weekly but sometimes they don't get it because their foster parents forget. Another confidential interview stated that allowance is received once a week or whenever the children want it. Based on confidential interviews, review of pertinent documents, and LPA observations the allegations that client 1, 2, and 3 (C1, C2, C3) are forced to stay outside, foster parent uses inappropriate discipline, foster parent was rough with C2, and C1, C2 and C3 are not receiving allowance may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report along with the appeal right were provided to licensee Fastac Mutua.

Investigation Findings:
13On December 19,2024, at 1:00PM, Licensing Program Analyst (LPA) Maryjane Perez conducted an unannounced visit to Ivyna Care and met with Licensee Fastac Mutua to deliver the investigative finding for the allegation listed above. On November 25, 2024, LPA met with Licensee Fastac Mutua to conduct a health and safety inspection and no deficiencies were observed. In addition, LPA M. Perez obtained client roster, needs and services plans, employee schedule and other supporting documents. During investigations, LPA interviewed Licensees (LS), client 1 (C1), client 2 (C2), client 3 (C3) and biological child 1 (BC1). On November 21, 2024, Community Care Licensing received complaint allegation that minors are forced to wear bonnets. It was specifically reported that C2 and C3 are forced to wear hair bonnets every day in the house due to their hair falling out. Confidential interviews stated that clients are encouraged to wear hair bonnets so that their hair doesn't get in places like food or on the ground. Another confidential interview stated the clients don't wear hair bonnets. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: MaryJane Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: IVYNA CAREFACILITY NUMBER: VISIT DATE: 12/19/2024

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

Deficiencies:
80072: interference with the daily living functions...

met_with: Licensee- Fastac Mutua


summary: Facility Evaluation

raw_content:
Narrative:
On August 9, Licensing Program Analyst (LPAs) Babatunde Aborchie, Jessica Peete and Licensing Program Manager (LPM) Abdoulaye Traore met with applicants Teresia Ndete Muathe and Fastac Ngubi Mutua this date for a 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. Copy of this report was provided to applicant.


summary: Facility Evaluation

raw_content:
Narrative:
On August 31, 2022 at 10: AM Licensing Program Analyst (LPA) Babatunde Aborchie began a Pre-Licensing inspection for a Small Family Home license. LPA met with applicants Theresia Mauathe and Fastac Mutua led a tour of the home. The facility was toured both inside and out with the applicants. Applicants are applying for a capacity of 2 ambulatory clients. The home consists of: Downstairs: Bedroom #1, It was furnished with a queen bed. It will sleep one resident - vacant. There were also a family room, a living room, dining area and one bathroom. Upstairs: Bedroom #2, The room consisted of a queen bed. It will sleep one resident - vacant. Bedroom #3, The room was furnished with a queen bed. It sleeps biological daughter age 11 years. Bedroom #4, The room was furnished with a queen bed. It sleeps another biological daughter age 14 years. Bedroom #5, Master bedroom. The room consisted of one king sized bed. It sleeps the applicants/Licensees Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in the kitchen cabinet area. Cleansers/chemicals were locked and stored in the kitchen cabinet under the kitchen sink. Sharp knives were inaccessible and stored in a locked box in the pantry. There were no guns or weapons as stated by applicant at this time. The hot water temperature was tested and noted to be 118 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items and it was in the kitchen pantry. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed for small family home will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Applicant/Licensee

met_with: Applicants/Licensees


summary: Facility Evaluation

raw_content:
Narrative:
On November 21, 2022 at 1: PM, an announced case management inspection was conducted by Licensing Program Analyst (LPA) Babatunde Aborchie. LPA met with Licensees Theresia Mauathe and Fastac Mutua. The purpose of the inspection was to evaluate the facility for a possible increase in the ambulatory capacity of children as requested by Licensees. Currently, the home is licensed to provide care for two ambulatory children. The licensees are requesting a capacity increase of two to serve a total capacity of four ambulatory children. During this inspection, LPA and Licensee inspected the facility inside and out. The home consists of: Downstairs: Bedroom #1, It was furnished with two twin beds. It currently sleeps two clients. There were also a family room, a living room, dining area and one bathroom. Upstairs: Bedroom #2, The room consisted of a queen bed and a crib. It will sleep one child and baby age 0-2. Licensee is reminded that the baby will be out of the crib by the age of two and shall be ambulatory to remain in placement. Bedroom #3, The room was furnished with a queen bed. It sleeps biological daughter age 11 years. Bedroom #4, The room was furnished with a queen bed. It sleeps another biological daughter age 14 year. Bedroom #5, Master bedroom. The room consisted of one king sized bed. It sleeps the applicants/Licensees Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in the kitchen cabinet area. Cleansers/chemicals were locked and stored in the kitchen cabinet under the kitchen sink. Sharp knives were inaccessible and stored in a locked box in the pantry. There were no guns or weapons as stated by applicant at this time. The hot water temperature was tested and noted to be 118 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items and it was in the kitchen pantry. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request for the license capacity change will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Applicant/Licensee

visit_type: Case Management

met_with: Licensees


facility_name: JAMES NJANJU SFH

summary: Facility Evaluation

raw_content:
Narrative:
On February 4th, Licensing Program Analyst (LPA) Maryjane Perez met with applicants James Njarju and Patricia Ngechu this date for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the LIC 184, Letter of Application Revision, and additional correspondence to assist with the revisions needed for the application. A copy of this report was provided to applicants James Njarju and Patricia Ngechu.

met_with: Applicants- James Njarju and Patricia Ngechu


summary: Facility Evaluation

raw_content:
Narrative:
On March 7, Licensing Program Analyst (LPA) Maryjane Perez arrived at James Njanju Small family Home for a pre-licensing inspection for an initial license. LPA met with applicants James Njanju and Patricia Ngechu who led a tour of the entire home inside and out. Currently there are no children placed in the home. The applicants are applying to serve 2 children ages 0-17 years old. The home is a two-story building with 4 bedrooms and 3 baths. The downstairs consisted of an entry way with an office area that has a computer, printer and books. There was bedroom #1 that will be utilized for foster children and has a queen size bed with required bedding and dresser/ closet space. Bathroom #1 was fully functioning with water temperature reaching 114.6 degrees Fahrenheit. Trash cans in the bathrooms did not have lids. There was a storage closet storing first aid kit with all required elements as well as other supplies such as masks, nebulizers, and toys/games. There was a fully furnished living room with couches, TV, desk, and fire place that was properly screened. The kitchen was clean and sanitary with locked sharps/knives. The cleaning supplies under the sink were not locked. The pantry and refrigerator were fully stocked with perishable and non perishable foods. There was also fire extinguisher #1 next to the evacuation plan, visitation policy and personal rights that were posted. The laundry room had extra towels and a cabinet storing detergent that needs to be locked. The upstairs consisted of bedroom #2 that was for applicants biological sons that had queen size bunk beds and fully furnished. There was bathroom #2 that had two side by side sinks and were fully functioning. There was also bedroom #3 that was for applicants biological daughter and was fully furnished with a queen size bed. The hallway had cabinets storing extra towels, blankets, and linen. There was also another first aid kit and fire extinguisher #2. The master bedroom was accessible to clients and had a locked mini refrigerator that will store clients refrigerated medication. The master bedroom also had a cabinet that will store client files, client medication, cash resources, and personnel records that applicants will obtain a lock for. Inside the master bedroom there was bathroom #3 that had locked drawers storing medication but there was a missing lock on the cleaning supplies cabinet. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. Telephone service and appliances were in working order. All hazardous items have been properly made inaccessible to areas where clients/children will have access. As stated by applicants, there were no weapons/firearms and there were no pools or other bodies of water. The backyard where children will have access to play was completely fenced and free of hazards. The garage was free of hazards and had double garage doors front and back. However, the garage had a cabinet storing chemicals/ poisons that needs to be locked. Based on this inspection of the home, the facility will need the following corrections: A lock box for cash resources (4) Locks for master bedroom bathroom cabinet, kitchen sink cabinet, laundry cabinet, and garage cabinet Trash cans need tight fitting lids in bathrooms After corrections are completed, the applicant will notify LPA so that another inspection can be completed. Component III orientation was also completed this day of March 7, Exit interview conducted and a copy of this report was discussed and provided to applicants James Njanju and Patricia Ngechu

met_with: Applicants- James Njanju and Patricia Ngechu


facility_name: JANE AND EDGAR NGOTHO SFH

summary: Facility Evaluation

raw_content:
Narrative:
On May 1, 2025, at 9: AM, Licensing Program Analyst (LPA) Claudia Portillo conducted an announced pre-licensing inspection and Component III meeting at Jane and Edgar Small Family Home (SFH). LPA Claudia Portillo met with Administrator, Jane Nghoto and toured the home. Physical Plant This facility is located in a quiet residential community. The facility consists of three bedrooms (3) bedrooms, three (3) bathrooms, kitchen, dining area, laundry room and a 2-car garage, and a backyard. Overall, the facility is clean, sanitary and in excellent condition. Passageways are free from obstruction. Fixtures, Furniture, Equipment, and Supplies The home has toilets and wash basins for clients' use. Client bedrooms was observed to be clean, orderly, and contained twin beds. LPA observed clean pillows, bed sheets and blankets. The client's bedroom has adequate closet and drawer space to accommodate client's clothing and personal belongings. Heath Related Services and Record Keeping The first aid kit will be centrally stored in the kitchen. The kit contains all required supplies. The client, staff files will be in a locked file cabinet located in the staff's bedroom. The medication will be stored in a locked cabinet in the kitchen. A Component III meeting was also conducted to familiarize the applicant with SFH Rules and Regulations as well as best practices. The purpose of the Component III is also to prepare the applicant on how to maintain and operate their facility and provide information to avoid potential problem areas. A copy of the SFH Component III handout was provided. Prior to being licensed the following are still pending: -One staff living in the home fingerprints are still pending LPA Portillo will mail a new license once staff's fingerprints clear. An exit interview was conducted, and a copy of this form was emailed to the Administrator.

met_with: Jane Ngotho


summary: Facility Evaluation

raw_content:
Narrative:
On November 10, 2025, Licensing Program Analysts (LPA) Claudia Portillo conducted an unannounced inspection at the Small Family Home (SFH) facility and met with the licensee. The purpose of the inspection was in regard to a post licensing visit. This SFH is licensed to serve 1 ambulatory and 2 non-ambulatory children who have mental health disabilities, developmental disabilities and physical disabilities. There are currently no children in care. Physical Plant This facility is located in a quiet residential community. The facility consists of three bedrooms (3) bedrooms, three (3) bathrooms, kitchen, dining area, laundry room and a 2-car garage, and a backyard. Overall, the facility is clean, sanitary and in excellent condition. Passageways are free from obstruction. The bedrooms are ready for future placement and in compliance with all regulations. An exit interview was conducted, and a signed copy of this report was provided to the facility representative along with LIC 809 report.

met_with: Edgar Ngotho


facility_name: JENNIFER & PETER SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On June 6, Licensing Program Analyst Kayla Green conducted an announced pre-licensing facility inspection and met with and announced the reason for the inspection. Jennifer Maina and Peter Ngure Licensee's assisted with the inspection. LPA and the Licensee's conducted a joint inspection of the interior and exterior areas of the facility's physical plant. The small family home is requesting to be licensed for a capacity ages 0 to 17 years old. There were no clients in care at the time of the inspection. Clients with Special Health Care Needs (SHCN) could be admitted. The home is a one story home. The home consists of four bedrooms, three bedrooms for clients and the master bedroom licensee's live in. There are two bathrooms, a garage, and a backyard with a swimming pool. The home has a home security alarm system installed, there is one camera on as part of the door bell on the front door. The front and back yards were free of clutter; and the passageways were unobstructed. No potentially hazardous items or areas were observed. The backyard contains a swimming pool, a bbq, a seating area with a table and multiple chairs, gazebo to shade from the sun. Pool fencing surrounding the pool was of adequate height, had a self-closing and latching gate, and was within regulation. Continued on C LPA observed that the bedrooms had a single bed and bedding including mattress cover, fitted sheet, top sheet and blanket, desks with drawers for personal items, night stand, and ample closet area. The living room consisted of one couch and a television, a fireplace that is gated, and a shared sitting area/activity area consisted of two couches, and coffee tables. The facility had a working land line and the phone was located in hallway on the back counter. LPA also observed activity supplies in the living room, including a books and toys. There was one bathroom which was observed to be in working order near the bedrooms and was equipped with a shower and a shower curtain for privacy. The bathroom had a working toilet, shower, and sink faucet. The second bathroom was located in the master bedroom at the rear of the hallway in the home and was observed to have a bathtub, working toilet, bath faucet and sink faucet. The water temperature was measured to be at 105 degrees Fahrenheit. The bathrooms contained soap and paper towels for hand washing. The hallway closet outside of the bathroom contained extra towels and wash cloths. LPA observed that the dining area was off of the kitchen and the table was set up for placement of five and contained five chairs. LPA observed that the kitchen area was located off the dining and living room area of the facility and that the kitchen area had the stove, refrigerator, and oven. The pantry was located off of the kitchen in the hallway, and one next to fridge with no locks on the doors. The facility will ensure that the pantry and kitchen are stocked with ample food prior to accepting placement of clients. continued on 809-c LPA observed a working Carbon Monoxide detector in the hallway and in dining room and working smoke alarms in each bedroom, the dining area, and a living area. LPA observed that there was three fire extinguishers one in the kitchen,laundry room and one outside for the bbq. The fire extinguishers were charged and last inspected in May 2024. The facility was clean, safe, sanitary and in good repair. All reviewed elements of physical plant of home are compliant with Title Regulation and Health and Safety Codes. The program statement and application are complete and approved. The facility is prepared for licensure and pending Licensing Program Manager's Approval. An exit interview was conducted with Jennifer Maina and Peter Ngure, Licensess and a copy of this report was left with Jennifer and Peter Licensess.

met_with: Jennifer Maina and Peter Ngure- Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On 6/27/ Licensing Program Analysts (LPAs) Jean Stidman and Kayla Green met with Jennifer Maina and Peter Ngure licensee's for the purpose of a Component III. LPAs reviewed Incident Reporting Requirements, Medication Administration documentation, background clearance documentation, Physician's Reports, required records for staff and children, Provider Information Notices (PINs), Compliance and Regulatory Enforcement Tool (CARE), examination for communicable tuberculosis, and Inspection Authority, LPA's provided technical assistance on organization of facility files, using CCLD website for forms needed and Title 22 regulations, exception requests for clients turning 18. LPAs reviewed the different type of citations or technical advisory notes that can be given. Exit interview conducted and a copy of this report was left with Peter Ngure.

met_with: Jennifer Maina and Peter Ngure


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Avelina Martinez made an unannounced post inspection on January 29, 2025 at 10: AM. During the inspection LPA Martinez met with Peter Ngure who assisted with the inspection. During today's post inspection, there was one youth present. In addition, two staff and the Licensee were present during the inspection. LPA Martinez conducted a tour and inspection of the physical plant on January 29, 2025 with Peter Ngure. The facility License is located at the living room and personal rights poster is located at the hallway. Both postings are made available and are visible to visitors and youth.Refrigerator temperature at 35 degrees F. The Freezer Temperature at 0 degrees F. The facility has a seven day nonperishable food supply, and a two day perishable foods supply. The facility has a menu present and posted. The facility has a supply of utensils and dishware. The sharp knives were locked and made inaccessible to youth in care. The facility water temperature measured at 106 degrees. The facility temperature measured at 73 degrees. The carbon detectors, smoke detectors, and fire extinguishers were in good repair. Facility cleaning supplies, and toxins were stored in a locked cabinet and made inaccessible to youth in care. The facility was furnished and sanitary, and has a working telephone. All bedrooms were furnished and in good repair. The dinning area was furnished, and the dinning table and chairs were in good repair. The living room area was furnished, and the furniture was in good repair. Continued... Facility bathrooms were in good repair sanitary. The exterior of the home was clear of debris and the emergency exit gate was in good repair. The facility swimming pool was gated and the gate was locked, and the pool was made inaccessible to youth in care. LPA Martinez inspected facility vehicle and reviewed car insurance and registration documentation. The vehicle is in good repair. LPA Martinez will return at a later time and date to complete the post inspection. An exit interview was conducted, and a copy of this report was provided to Peter Ngure.

met_with: Peter Ngure


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Avelina Martinez made an unannounced post inspection on February 14, 2025 at 9: AM. During the inspection LPA Martinez met with Jennifer Ngure who assisted with the inspection. At arrival LPA Martinez, was met at the door by Jennifer Ngure. LPA Martinez was informed all staff were taking child 1 to a required medical appointment. LPA Martinez will return at a later date to complete post inspection. LPA Martinez will return at a later time and date to complete the post inspection. An exit interview was conducted, and a copy of this report was provided to Jennifer Ngure.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Avelina Martinez made an unannounced post inspection on March 05, 2025 at 11: AM. During the inspection, LPA Martinez met with Peter and Jennifer Ngure who assisted with the inspection. During today's post inspection, there was one youth present. In addition, two staff and the Licensee were present during the inspection. LPA Martinez conducted a tour and inspection of the physical plant on January 29, 2025 with Peter Ngure. LPA Martinez reviewed files at today's visit. The following deficiencies were cited: fire clearance and client records. Based on records review, the facility is operating beyond the conditions and limitation and capacity specified on the approved licensed. C1 is non-ambulatory and the facility is licensed for ambulatory only. In addition, child 1 (C1) is missing an admission agreement and a signed LIC 602 physician report. The facility has training records and employee records, which they are maintained. Based on the this post inspection, LPA Martinez will continue to follow up with the facility and plan of corrections. In addition, LPA Martinez will continue to follow up with fire clearance status, and follow up on C1's placement status due to fire clearance. As a result of this post inspection visit, the following deficiencies were cited, per California Code of Regulations, Title 22 and Health and Safety Code. An exit interview was conducted with Peter Ngure, and a copy of this 809 report, 809-D page, and appeals rights were given to Peter Ngure.

met_with: Peter and Jennifer Ngure


summary: Facility Evaluation

raw_content:
Narrative:
On March 21, 2025, at 9: AM, Licensing Program Analyst (LPA) Avelina Martinez arrived at facility unannounced to conduct a plan of correction (POC) visit. LPA Martinez met with Jennifer Ngure explained the purpose of the visit. This POC visit is to clear citations from the following date: March 05, 2025. The citations are the following: client records and Limitations on Capacity and Ambulatory Status. During the March 21, 2025, visit, the LPA reviewed the following deficiency: Client Records 80070(b)(6)(8. The deficiency was cited on the day of March 05, 2025 visit. Moreover, LPA Martinez requested the following to be corrected by March 26, 2025 and the plan of action term submitted to Community Care Licensing by: 5: PM. However, the Licensee completed the POC prior to March 26, 2025. As a result, LPA Martinez conducted the POC visit prior to March 26, 2025. LPA Martinez toured the home with Jennifer Ngure, and discuss the facility capacity limitation. Licensee has modified the facility sketch to obtain non-ambulatory fire clearance. LPA Martinez obtained a facility sketch during today's visit, and fire inspection is pending. Based upon this inspection, LPA Martinez reviewed child 1 (C1) facility file. The Medical file was complete. The deficiency cited has been cleared. Licensee complied with the terms of the plan of correction and corrected the deficiency by plan of correction due date. Limitation of capacity POC has been completed, and LPA Martinez will continue to follow up on fire inspection and clearance. An exit interview was held, and a copy of this report was provided to Jennifer Ngure.

met_with: Jennifer Ngure


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Avelina Martinez made an unannounced Annual inspection on July 21, 2025 at 9: AM. During the inspection LPA Martinez met with Jennifer Ngure (Licensee) who assisted with the inspection. LPA Martinez explained the purpose of the visit to Jennifer Ngure (Administrator). LPA Martinez conducted a walk-through of the facility inside and out with Jennifer Ngure (Administrator) on July 21, 2025. Facility staff-client ratio at time of inspection: two staff and one child. LPA Martinez observed four bedrooms and two bathrooms. Posting of license x Personal Rights x Disinfectants/Cleaning solutions inaccessible x Refrigerator Temperature at or below 45 degrees F x Freezer Temperature at or below 0 degrees x Nonperishable Foods one week and fresh perishable foods two days minimum x Menu present and posted x Working telephone x Carbon monoxide detectors x Smoke Detector x First Aid Kit fully stocked x Common Room available x Dining area (enough seating, furniture good condition, not broke or damaged) x Medication centrally stored, locked/inaccessible x Office (locked and privacy) x Hot Water 105 degrees Fire Extinguisher Last inspected on May 09, 2025. Smoke detectors and carbon detectors were in good repair. All above areas were inspected and in compliance. Continued... Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature X Soap and Paper towels X Laundry Facilities(available, work assign dates) X Bedrooms- required linen and furnishings X Motor Vehicle properly maintained , lights, tires, registration/insurance and working seat belts X Facility free of vermin X Locked Facilities (open locked storage area/building/sheds) bedrooms (required bedding/furniture, furniture in good repair) X Pool is gated and locked and made inaccessible X All above areas were inspected and in compliance. LPA Martinez will return at a later date and time to conduct a continuation annual inspection. The continuation annual inspection will consist of a completion of file reviews. An exit interview was conducted with Jennifer Ngure (Administrator). A copy of this report was provided to Jennifer Ngure (Licensee). There were no citations given at this annual inspection visit.

met_with: Jennifer Ngure (Licensee)


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Avelina Martinez made an unannounced continuation annual inspection on August 08, 2025 at 10: AM. During the inspection LPA Martinez met with Jennifer Ngure (Licensee) who assisted with the inspection. LPA Martinez explained the purpose of the visit to Jennifer Ngure (Administrator). During this continuation annual, LPA Martinez conducted a file review. Facility staff-client ratio at time of inspection 1 staff and 1 child. Disaster Preparedness Disaster and mass casualty plan updated and available Quarterly Drills conducted and documented Disaster preparedness supplies verified: Completed-Last Fire Drill 06/30/ Staffing/Volunteers Number of Staff files reviewed X Criminal record clearances verified X First Aid Certificate X Certified Administrators certificate valid and current X Job title/qualification verified X Hours required training verified X Hours required annual training verified X Continued... Client Records Number of Clients files reviewed Needs and Services Plan X Centrally Stored Medication and log reviewed X JV Reviewed N/A Psychotropic Medication and log reviewed NA Cash Resources NA Compatible Assessment Yes, Census Core/Therapeutic Services Trauma Informed Practices are implemented as needed (including specialty mental health services and extracurricular activities and social supports) Yes Special Health Care Needs (SHCN) SHCN plan created by licensed professional and implemented as required Yes Staff received training Completed An exit interview was conducted, and no deficiencies were observed during this annual inspection. A copy of the report was provide to Jennifer Ngure (Licensee).


facility_name: JETERS HOUSE OF VALUES

summary: Facility Evaluation

raw_content:
Narrative:
On September 4, 2025, at 10:15 am, Licensing Program Analyst (LPA) Charmaine Linley, met with applicant Jeanice Jeters for Component II Orientation for a Small Family Home. The following questions were discussed and answered: Applicant stated their computer crashed and they are unable to retrieve their original documents. LPA will follow up with Licensing Program Manager (LPM) to ask about giving copies of the documents to the Applicant. Applicant stated they will take four training's from the list identified in the regulations and will provide the training certificates along with the revisions. Applicant will contact LPA prior to September 18 if they need additional time to submit the revisions. LPA sent a copy of the LIC 184, LIC 281, and CRP PIN 24-09, to assist with the revisions needed to the application via email. Submit the Section A and B documents in the same sequence as they are in the application booklet (LIC 281). A copy of the revised documents are due to the Riverside Office before 5:00 pm on September 18, 2025. The following areas were covered, including the revisions that need to be corrected: Overall Notes:  Remove Tele-Orientation Guide as cover sheets.  Submit the Section A and B documents in the same sequence as they are in the application booklet and identify with a cover sheet or at the top of the individual sections.  When submitting revisions, do not staple, tape, or paper clip any pages or place the documents in a binder or in page protectors.  Remove references to foster home, a Small Family Home is not a Foster home. *** Section A Documents: A1. Application (LIC 200):  #8, alternative public phone number needs to be rewritten so it is clearly read.  #14, days of operations needs to be filled out.  #15a, Address and Phone Number of Property Owner needs to be filled out.  #16 is incorrect.  #19 is not the correct licensing number.  After all updates are made, resign with an original or electronic signature and date the form. A2. Applicant Information (LIC 215):  Education: provide a clean copy without areas "crossed out."  References: Provide a second reference.  Provide training certificates in the topics specified below. We encourage applicants to carefully evaluate the training topics if you are taking the trainings through the Foster Parent College as the topics listed below are not designed for Foster Parents or Foster Homes: (1) Child development (2) Recognizing and/or dealing with learning disabilities (3) Infant care and stimulation (4) Parenting skills (5) Complexities, demands and special needs of children in placement (6) Building self-esteem, for the licensee or the children (7) First aid and/or CPR (8) Record keeping (9) Bonding and/or safeguarding of children's property (10) Licensee rights and grievance process (11) Licensing and placement regulations (12) Rights and responsibilities of family home providers A3. Applicant Information (LIC 308):  A licensee cannot designate themselves on this form. If you are not designating another individual on this form, you do not need to fill out this form. *** A5. Affidavit Regarding Client Cash Resources (LIC 400):  Provide an explanation of how the facility will not handle cash for the clients as all clients will be receiving an allowance from the facility and Regional Center consumers have Personals and Incidentals Money. A6. Surety Bond (LIC 402):  LPA will review if a bond is needed once the information is provided regarding handling clients money. A9.a Budget Information (LIC 420):  Loans stated $3573.00, however lease form indicates lease is $3536.00, indicate why the amounts are different. A10. Personnel Report (LIC 500):  Correct last name spelling error.  Fill out date employed.  As a reminder, Small Family Homes are not required to have Administrators or staff members as the regulations state the licensee shall be regularly present in the home when children are in the home full time. A12. Health Screening Report - Facility Personnel (LIC 503):  Duty Statement needs to be filled out.  Date of Health Screening needs to be filled out.  Form with original signature needs to be returned. A14. Emergency Disaster Plan (LIC 610C):  Full name of facility needs to be filled out in all sections.  Facility Address is in the wrong section, move to correct section.  Remove "crossed out sections," and provide a clean copy.  Section II: Emergency Names and Telephone Numbers, provide the name and phone number of the Police or Sheriff.  First Aid Kit/Location needs to be filled out.  Individual homes and other licensed facilities cannot be used. Facilities need to indicate two temporary relocation sites. ***  Indicate two relocation sites away from the facility that are able to accommodate the number of clients/children in the facility.  Provide two letters from the relocation sites managers/owner stating they are able to accommodate the number of clients in the facility with a printed name, along with their signature.  Form with original signature needs to be returned. A15. Facility Sketch (LIC 999):  Will the facility use video cameras. If so, the information below must be provided.  An original copy of the Facility Sketch must be provided.  Sketch must give dimensions of all rooms and designate their use not state, "room, fc/fc."  Designate rooms to be used by non-ambulatory child.  The number of clients in each bedroom needs to be identified.  Indicate exit routes by number as shown on the LIC 610/LIC 610A Emergency Disaster Plan.  Indicate all driveways, fences, storage areas, gardens, recreation areas and other space used by clients/residents. If the facility will have Video Cameras (including Ring doorbell/outside cameras) the information below needs to be provided: (1) Where video cameras are - or will be - located, include on the Facility Sketch. (2) The purpose of the video cameras. (3) How children and authorized representatives will be informed of the location of video cameras and their purpose. (4) How licensees will work with placing agencies to address situations in which a child objects to video cameras. (5) How video cameras will be used in a trauma-informed manner. (6) Whether video cameras will be livestreamed only or recorded. (7) If recorded, who will have access to the recordings and how will the recordings be stored and safeguarded. *** A16. Fire Inspection (LIC 9054):  Has the Fire Department contacted you to schedule the inspection? Section B Documents: B7: Facility Program Description:  This section needs to be identified correctly.  Remove references to licensed foster care home.  Remove all references to foster care settings.  Remove all references to foster parents.  Remove Program Statement as Small Family Homes do not have a Program Statement, they have a Plan of Operation (B Section from the LIC 281).  Ages are inconsistent with what is listed on the LIC 200 that you will accept one child (0-5 years of age) and three children between the ages of 6-17.  Provide a statement of the purpose, goals and program methods (program philosophy) that is specific to Small Family Homes.  Provide the days and hours of operation in this section.  General Services provided needs to reflect services provided in the Small Family Home. Remove Title 22, Division 6, Chapter 9.5 as these regulations apply only to Foster Family Homes.  The daily schedule of activities to be provided by the facility should state who plans, conducts and assists clients in participating in these activities.  The one month schedule of planned social, educational and recreational activities list is different than the actual calendar. The schedule should state who plans, conducts, and assists clients in participating in these activities.  Provide a description of the basic services provided by the facility as listed in the admission agreement.  Provide a description of the optional services provided in the facility as listed in the admission agreement.  Provide a description of how the facility is going to handle medical emergencies if a client becomes ill or injured, not just calling 911. Medication (areas listed below need to be in this section):  Describe the specific procedure for handling and assisting clients/residents with self-administered medications. ***  Describe what medical forms will be used. For reference, see the Centrally Stored Medication Record and Medication Administration Records listed on CCL's website that can be used.  Indicate specifically where the medication will be stored.  Describe the medical Assessment/TB Test prior to or within 30 days of acceptance and where the document will be stored in this section.  Describe where first aid supplies and a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency will be stored in this section.  Describe how staff that are responsible for providing direct care and supervision shall receive training in first aid from persons qualified by agencies including but not limited to the American Red Cross.  Describe how psychotropic medication shall only be used in accordance with the written directions of the physician prescribing the medication and in accordance with authorization requirements specified in Sections 369.5(a)(1) and 739.5(a)(1) of the Welfare and Institutions Code and Section 83070(b)(11).  Describe how the facility will obtain a copy of the current court order, or written authorization of the child's parent or guardian, for each psychotropic medication.  Describe the use of Psychotropic Medication Administration Records (PMAR LIC 622B) and how a separate log for each psychotropic medication prescribed to the child is used.  Describe or provide the consent forms, completed by the child's authorized representative(s), to permit the facility to authorize medical care.  Provide a statement that medication errors will need to be reported and documented to CCL, according to the timeframes for reporting requirements.  Provide a statement that any medication refusal by a client is considered a "Special Incident" and a report will be sent to Community Care Licensing. Transportation arrangements:  Describe how the motor vehicles used to transport clients shall be maintained in a safe operating condition.  Describe how the licensee and their staff are prohibited from smoking a tobacco product, or permitting any person from smoking a tobacco product in a motor vehicle that is regularly used to transport children, regardless of when the children are present. This prohibition applies when the motor vehicle is moving or at rest. ***  Describe how the licensee shall provide transportation for a child in a timely manner to and from the following: (1) Health-related services. (2) School. (3) Extracurricular, enrichment, cultural, and social activities, in accordance with the reasonable and prudent parent standard.  Describe how the facility shall ensure that the transportation provided safeguards the health and safety of a child and shall not violate the personal rights of a child.  Provide a list of community resources and a list of consultants to be used by the facility that is specific to the children placed in the facility.  Describe the procedure for the facility's immediate response to incidents and reporting incidents to CCL.  Describe the facility's complaint/grievance procedure for clients issuing a complaint/grievance against the Facility/Licensee and where the procedure will be posted. Describe the timeframes including how to submit a grievance/complaint, who responds, the timeframe of the Licensee to respond, how the outcome is documented, where the procedures are documented in the Facility. B8: Rules of Discipline/Personal Rights:  Remove the regulation of Personal Rights reference Section 84072, this regulation is for Group Homes. Small Family Homes follow Title 22, Section 83072.  Remove the form Your Rights as a child in Foster Care, you can update this form with providing the Personal Rights Form LIC 613B.  Provide a statement that discipline does not include a violation of personal rights.  Describe the conditions for each type of discipline that will be used.  Provide more information on removing electronics, are these the youth's electronics or the facility shared electronics? As a reminder, belongings cannot be removed from the clients unless they are written into a Needs and Services Plan with the reason and the Needs and Services Plan is signed off.  Describe the grounds for planned/unplanned discharges, remove the word "dismissal," and "terminated."  A clear statement that there will be no corporal or unusual punishment used.  Describe how the child will sign the personal rights form at intake and each time a new right has been added. ***  Provide a copy of the discipline policy that the client and Authorized Representative will sign in this section. Describe how the client will sign this form and where it will be stored. B9: Admission Policies:  Provide the Admission Agreement in this section.  As a reminder, the LIC 604 is a Guide and is not to be used as the Admission Agreement.  Describe specifically the children accepted for care in this section.  Describe how you will use the criteria for assessing the appropriateness of placement given an individual client's needs (i.e., interviews, procedures for obtaining and developing the necessary paperwork, etc.). The section is too vague and needs to be more specific.  Needs and services plan, remove the statement a child will have input if appropriate, you could indicate something along the ages of infant/toddler, but this statement is too vague.  Describe how clients and Authorized Representative will be included in any updates or modifications to the Needs and Services Plan and how they will sign off.  Provide a statement that clients/residents will be informed of their rights and that client's/resident's rights will not be violated in this section.  Describe how the facility will obtain emergency information in this section.  Provide a specific allowance amount and how often is given out in this section. B10: Sample Menu: The sample menu will include:  This form states children from ages 5-16, which are not the ages indicated on the LIC 200. All ages in all sections must be the same as indicated on the LIC 200.  Provide the portion sizes of all meals/snacks.  Provide the times meals/snacks are served. B11: Control of Property:  Letter from Invitation Homes needs to be provided authorizing Jeanice Jeters to operate a Small Family Home at the property. ***  A letter from Janyi Walkins needs to be provided authorizing Jeanice Jeters to operate a Small Family Home at the property as they are listed on the rental agreement.  A letter from Risha Miller needs to be provided authorizing Jeanice Jeters to operate a Small Family Home at the property as they are listed on the rental agreement. B12. Bacteriological Analysis of Private Water Supply (When Water for Human Consumption is from a Private Source):  This section is missing. A statement needs to be provided with the Section Number indicated according to the LIC 281. B16. First Aid Card:  Need a CPR/1st Aid card, current copy states eligible for skills session in 90 days. A copy of this report was provided to the applicant along with the signed Orientation form indicating Component II has been completed. A copy of this report will be placed in the facility file.

met_with: Jeanice Jeters


summary: Facility Evaluation

raw_content:
Narrative:
On the date listed above, Licensing Program Analyst (LPA) Charmaine Linley conducted Component III for Small Family Homes with Applicant, Jeanice Jeters. A copy of this report was emailed to the Applicant for signature, along with the signed Orientation certificate. A copy of this report will be placed in the facility file.


summary: Facility Evaluation

raw_content:
Narrative:
On March 11, 2026, at 9:00 am, Licensing Program Analyst (LPA) Val Wilson arrived at the home to conduct a pre-licensing inspection of the facility. LPA met with applicant, who led a tour of the facility. The facility was toured inside and outside and there were no clients in placement and no firearms in the home. The facility is a two-story building with four bedrooms and three bathrooms which are set up as follows: Downstairs: Entryway, living room, fireplace with a metal screen and a second glass covering, formal dining room, kitchen dining area, kitchen, kitchen breakfast bar, family room, closet storage, office, laundry room, applicant locked bathroom #1, and garage. Upstairs: Stairwell, master bedroom #1 with bathroom #2 and fireplace with a metal screen and a second glass covering, hallway linen closet, client bedroom #2, licensee's children bedroom #3, client bedroom #4, bathroom #3. Outdoors: Garage with door exits to the side breezeway where the electrical panel and gas meter are located; unlocked rod iron gate, fencing surrounds the backyard, river rock filled pond that no longer has water, covered patio, outdoor furniture, barbecue island, and plenty of open activity space. The front yard is mostly paved like the driveway. There is a non-functioning camera on the garage eve and the front doorbell. The client's bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. There was adequate closet and drawer space for the client's belongings. LPA observed a three-tier bunk bed in bedroom #3. Bedrooms #2, #3 and #4 have permanent closets and adequate drawer space. Each bed has a quilt, two sheets, and a mattress pad. *** ***PAGE 2*** The hot water in the laundry room was measured and registered at 117.7 degrees, which is within the regulatory requirements. Disinfectants, cleaning solutions, poisons, sharps, and other items that could pose a danger if readily available to clients are stored in the locked supply closet downstairs. There was adequate food storage space in the kitchen. LPA observed a three-day supply of non-perishable food and a filled fruit basket on the kitchen table. The menu is posted on the kitchen refrigerator; However, the sample menu did not account for the morning, afternoon, and evening snack. This will need to be updated. The home appliances were checked and in working order at the time of this inspection. The high-back dining room table has four chair stools and a bench in the kitchen. There is also a breakfast bar located in the kitchen with two chair stools. Provided tableware, dishes and utensils are of the quantity necessary to serve the clients. A trash can for storage of solid waste had a tight-fitting lid and was present in the kitchen. There is a cordless telephone with charging base available in the kitchen area. There was one fire extinguisher present in the home located in the family room near the kitchen and it was observed to be properly charged and inspected by the fire department. The home's First Aid kit was accessible and is located in the kitchen with required supplies. There was one fire extinguisher present in the home located in the family room near the kitchen and it was observed to be properly charged and inspected by the fire department. Functioning carbon monoxide detectors were located in the downstairs entryway and upstairs hallway. Functioning smoke alarms are located upstairs in bedroom #1, #2, #3, and #4. There is a smoke alarm also located at the top of the stairs on the vaulted ceiling that could not be tested. Downstairs functioning smoke alarms are located in the entryway and in the office. The home is equipped with an ADT chime system that alerts when downstairs door or windows are open. The hot water heater is located in the garage. The Plan of Operation is located in the staff office. There is file storage to maintain complete records and a scanner/printer for use in the office area. The medications will be located in a locked downstairs office in a medication box and/or medication refrigerator. Cash resources can be locked in the lock box in the office. The following forms were posted in the office hallway: Grievance Procedure, LIC 610/Emergency Disaster Plan, Facility sketch, Complaint hotline, Discipline Policy, and Monthly activity calendar. Toys, video games and board games are located downstairs in the family room. *** ***PAGE 3*** During the inspection LPA observed tiling is missing on the step from the entryway towards the kitchen hallway and the window screen in the kitchen corner by the table has a missing square of screening. LPA also observed chipped paint and punctures noted throughout the home: kitchen area, breakfast bar, dining area, downstairs entryway, hallways, door jambs and baseboards surrounding the sink in the laundry room, the stairwell, upstairs hallway, bedroom #2 #3 #4, and bathroom #3. The following corrections need to be made to the home: • Update sample menu with morning, afternoon, and evening snack. • Remove and replace the three-tier bunk bed in bedroom #3 for the applicants two children. • Repair the missing tile on the step from the entryway towards the kitchen hallway. • Repair the window screen in the kitchen corner. • Repair chipped paint and punctures noted throughout the home: kitchen area, breakfast bar, dining area, downstairs entryway, hallways, door jambs and baseboards surrounding the sink in the laundry room, the stairwell, upstairs hallway, bedroom #2 #3 #4, and bathroom #3. Applicant was reminded to notify LPA when all corrections have been made for a follow up inspection. Once all corrections have been cleared, a Licensing Program Manager will review the application and this report. Once approved, the Facility License will be printed out and emailed to the applicant. LPA reminded the applicant that once they have received their license, they will then need to notify LPA upon their first placement. An exit interview was conducted, and a copy of the report was provided to Jeanice Jeters. A copy of this report will be placed in the facility file.


facility_name: JOHNSON FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On June 24, Licensing Program Analyst (LPA) Maryjane Perez met with applicant Amy Johnson this date for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the LIC 184, Letter of Application Revision, and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant Amy Johnson.

met_with: Applicant Amy Johnson


summary: Facility Evaluation

raw_content:
Narrative:
On July 23, Licensing Program Analyst's (LPAs) Maryjane Perez and Cynthia Ramos arrived at Johnson Family Home Small Family Home (SFH) for a pre-licensing inspection for an initial license. LPAs met with applicant Amy Johnson who led a tour of the entire home. Currently there are no children placed in the home. The applicant is applying to serve three ambulatory children ages 6-17 years old. The home is a two- story building with four bedroom and three bathrooms. The downstairs consisted of an entryway that leads to the formal living room with two couches. LPAs observed the Emergency Plan, Facility Sketch, Personal Rights and Visitor Sign in at the entrance. Behind the formal living room there is a laundry room which contained cleaners/chemicals and locked medication box, this room is locked at all times. Bedroom #1 is designated for future foster children, LPAs observed two twin beds with adequate bedding, TV, closet space, dresser space and lighting. Bathroom #1 was observed to be clean and organized. Water temperature was measured at 106.7 degrees F. There is also a family room with a TV, seating, desks, toys and a screened fireplace. A land- line was also observed to be working and accessible to clients. Next to the living room, there was a kitchen which was clean and organized, there was a locked box for cleaners under the sink. The fridge was inspected and there was a at least three days of perishable and seven days non-perishable foods. One of the fire extinguishers was located downstairs in the kitchen with a complete first aid kit. Next to the kitchen there was a play area with plenty of toys, extra food and high chairs. There was also a linen closet with extra household items. In the upstairs of the home, there was bedroom #2 that was the Master bedroom which sleeps Applicant and husband, office and Bathroom #2, per Applicant this room will remain locked at all times. The upstairs also consisted of a loft with additional couches, TV and games. A second fire extinguisher was also observed in the loft. Bedroom #3 will be utilized for one foster child and one biological child, this room consisted of 2 twin beds with required bedding, dresser, closet space and lighting. Bathroom #3 consisted of dual sinks, clean and had a trash can with tight fighting lid. Bedroom #4 contains a queen bed that is currently used for biological child. In the hallway, there was an additional closet space with extra linen and extra comforters. The carbon monoxide and fire alarms were tested and were working properly. LPAs observed there to be security cameras inside and outside the home. There was four security cameras throughout the house in the common areas and four security cameras outside the home. The backyard was inspected and was free of hazards with accessible space for children to play. The garage was a three car garage that will remain locked at all times, there was an additional freezer with food and extra household items that were observed. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. All hazardous items have been properly made inaccessible to areas where clients/children will have access. As stated by applicant, there were no weapons/firearms and there were no pools or other bodies of water. There are no corrections needed at this time. Based on this inspection, the home is appropriate for a capacity of three ambulatory clients. The request for licensure will be forwarded to Licensing Program Manager for final approval. Component III orientation was also completed this day of July 23, 2025. An exit interview was conducted. A copy of this report was provided to applicant Amy Johnson

met_with: Applicant- Amy Johnson


summary: Facility Evaluation

raw_content:
Narrative:
On April 20, Licensing Program Analyst (LPA) Cynthia Ramos arrived at Johnson Family Home Small Family Home (SFH) for the purpose of conducting a post licensing inspection. LPA met Licensee Amy Johnson who led a tour of the entire home. There are two children placed in the home at this time. The home is a two- story building with four bedroom and three bathrooms. Upon entering the home, there was a formal living room and dining table. Behind the formal living room there was a laundry room which contained cleaners/chemicals, this room is locked at all times. There was also a family room with a TV, properly screened fireplace. Next to the living room, there was a kitchen which was observed to be clean and organized. There cleansers/chemicals were in locked box under the kitchen sink. The fridge was inspected and there was at least three days of perishable and seven days non-perishable foods. Next to the kitchen there was a play area with plenty of toys and an additional refrigerator containing extra food. One of the fire extinguishers was located downstairs in the kitchen, the first aid kit was inspected and contained all required items. There was also a linen closet with extra household items. Bedroom #1 contained two twin size beds, this room sleep Licensee's 10-year-old daughter. Per Licensee's this room can also be occupied for one more client. The upstairs consisted of a loft with additional couches, TV, and a second fire extinguisher was also observed. Bedroom #2 is the master bedroom, which sleeps Licensee and spouse. Per Licensee, this room remains locked at all times. LPA observed the medication box to be locked in Licensee's bedroom. Bedroom #3 consisted of two twin size beds with required bedding, dresser, closet space, and light, this room currently sleeps two female clients ages 8 and 4-year-old. Bedroom #4 contains a queen size bed that was currently occupied by Licensee's adult daughter. All bathrooms were inspected and were working properly. Water temperature was measured at 119.8 degrees F. In the hallway, there was an additional closet space with extra linen and extra comforters. ... Bedrooms were arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. The backyard was inspected and was free of hazards with accessible space for children to play. The garage was inspected and an additional freezer with food and extra household items were observed, Per Licensee the garage remains locked at all times. The carbon monoxide and fire alarms were tested and were working properly at the time of inspection. LPA observed there to be security cameras inside and outside the home. There were four security cameras throughout the house in the common areas and four security cameras outside the home. Per Licensee, there are no weapons nor firearms in the home at this time. LPA observed the Emergency Plan, Facility Sketch, Personal Rights and Visitor Sign in at the entrance. A total of 3 staff files and 2 client files were reviewed and were in compliance. Based on today's inspection, there are no deficiencies being cited at this time. An exit interview was conducted and copy of this report was provided to licensee Amy Johnson.

met_with: Licensee, Amy Johnson