facility_name: CALENDA

raw_content:
Investigation Findings:
13On August 27, 2021 at 10:30am Out of State Group Home Analyst Sarah Waklee conducted an announced telephone call with Calenda's Facility Manager to deliver the findings for the above allegation. Analyst Waklee was unable to reach the reporting party and therefore not interviewed. Based on confidential interviews with two staff and two youth, and documentionation review, Analyst Waklee determined that there is not sufficiant evidence to support the above allegation. Therefore the above allegation is unsubstantiated. An unsubstantiated finding means although the allegation may have happened, the preponderance of evidence does not prove it. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Sarah Waklee LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

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

met_with: Arlene Carlos, Facility Manager


state: CA

summary: Facility Evaluation

raw_content:
Narrative:
On 08/12/2021 at 12: PM Licensing Program Analyst (LPA's) Rosslyn Gray made an unannounced to CALENDA GROUP HOME to conduct Post Licensing Inspection. LPA met with Staff#1 (S1) who granted access to the facility. The entire physical plant was inspected. The facility obtained a Provisional licensed on 12/15/2020. The Group Home is to provide care and supervision for six (6) children, ages 12-17 years Ambulatory Only. There is a (10 feet gated pool on the premises that meets regulations (self-latching; unlocked 10 feet pool; 4 feet gate); currently the pool is drained for repairs. Staff has keys to lock if necessary. The Director of Operation confirmed that there are no guns or weapons on the premises. This is a 1-story four (4) bedrooms; 4 1/2 bathrooms. There is a fully furnished living room, dining room and Central Air conditioning unit. The outdoor perimeter front yard, side yard and backyard were inspected and found cleared of debris and hazards materials. There is a Ping pong table and Water proof patio furniture. LPA observed all windows, screens and blinds from the inside and outside of the facility were observed to be in good condition. The windows are retractable with no on the windows in the event of an emergency evacuation. The passageways and porches are unobstructed. All posting requirements were met, (food menu, regulations, licenses, emergency disaster plan and personal rights). Posting are in the common area accessible to clients (i.e Personal Rights and Grievance forms and a comment box). The cleaning supplies solutions, disinfectants are stored in the hallway locked closet; sharp knives are also inaccessible in separate box in the key locked closet as well. All the children prescribed medications are 2 locked in the nursing closet station two (2) locked system behind the nurse door and a wall mounted locked box). LPA observed a hard wired enter connected combined Smoke detector and Carbon Monoxide; tested to be operable. The Living Room/Dining room/Kitchen: Observed to be clean and organized; fully furnished, book shelf, games and an exit French door. The Kitchen stove is gas operated with 5 burners a double door refrigerator with bottom freezer. The dining table Dining area six (6) chairs, two 2 bar stool chairs. Report continues on LIC-809-C LPA observed coverage trash cans in the kitchen, bathroom and staff office. The Linen closet is located adjacent to the single bedroom. LPA observed There are three (3) Fire Extinguisher- Special K Grease Fire. The Hot Water Heater is enclosed with a secured strap. Bedrooms: There are four (4) Bedrooms each bedroom twin size beds six feet apart, with a mattress clean linen, adequate closet and drawer space. Bedroom #1 is occupied by one (1) client. BR#2, is occupied by one (1) clients. BR#3, is occupied by one (1) client; Bedroom #4 is identified as the master bedroom occupied by two (2) clients. LPA observed a full size bathroom that is locked accessible during the day for safety issues. Bathrooms- 4-1/2: The bathrooms were inspected and found to be clean. LPA observed S1 test the water temperature, bathroom sinks and ensured that all toilets flushed. The community restroom has 2 sinks, 1 toilet, and 1 shower. The ½ bath inside bedroom #2 has 1 toilet and 1 sink. The on-suite inside bedroom #4 has 2 sinks, 1 toilet, and 1 shower. The is a Classroom six (6) computers desk and six (6) additional employee desk. There are three (3) offices; Program Director, Therapist office and office Staff. There is a Well-ness station for the medication logs and medical devices. The First Aid kit has the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. The garage has been converted in a gym with weights and exercise equipment that is monitored by staff. The school is located inside the house and school supplies are provided by the facility. The facility has a working telephone and clients can use the telephone unless restricted by court order. The staff accompanies clients to local recreational facilities based on the rules of the COVID-19. Other outside extracurricular activities and social events that take place into public or crowded places are conducted at outside. Clients are accorded dignity in personal relationships with staff and others. The facility uses the "Token Economy System" for exhibiting appropriate behaviors and compliance. LPA observed that facility ensures that CDC Guidelines are implemented in effort to prevent other from contracting the COVID-19 virus (i.e wash hands with alcohol based hand sanitizer, display colorful preventative hygiene posters, temperature checks, Report continued on LIC-809-C maintain social distancing (six feet of space), disinfect commonly used areas and items (remote controls, mouse's, playing, cards cell phones, practice "cough etiquette". The facility keeps an inventory of the PPE supplies and to report when they are depleted. The Facility operates within license conditions and limitations including capacity limitations. Facility has a current, written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. LPA will return to the facility at later date to complete the Post Licensing(i.e Clients records, Staff Records review, Staff and client interviews). There were no deficiencies cited at this time. Exit Interview was conducted and a copy of this report was left at the facility.

report_type: Facility Evaluation

met_with: Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On 08/31/2021 at 12:05PM Licensing Program Analyst (LPA') Rosslyn Gray, made an announced visit to CALENDA GROUP HOME to continue the Post Licensing Inspection. LPA met with the Program Director Staff#1 (S1) who granted access to the facility and provided the Clients Records. S1 also linked LPA to the Human Resources Director to access the Staff records. LPA reviewed the following during the inspection: Staff Records Review; Clients Records Review. LPA reviewed the Clients Records stored in the facilities specific online Portal with Kipuworks.com LPA met with the Human Resources Director online via ZOOM conference call and and viewed the the details of the Staff Records in PDF form via shared screen. LPA interviewed five (5) Staff and four (4) clients that were present. There were no deficiencies cited at this time. Exit Interview was conducted and a copy of this report was left at facility.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On 12/21/2021 at 12: PM Licensing Program Analyst (LPA's) Rosslyn Gray made an unannounced to CALENDA GROUP HOME to conduct Annual/Required Inspection. LPA met with Staff#1 (S1) who granted access to the facility. The entire physical plant was inspected. The facility obtained a Provisional licensed on 12/15/2020. The Group Home is to provide care and supervision for six (6) children, ages 12-17 years Ambulatory Only. There is a (10 feet gated pool on the premises that meets regulations (self-latching; unlocked 10 feet pool; 4 feet gate); currently the pool is repaired and filled with water. Staff has keys to lock if necessary. The Director of Operation confirmed that there are no guns or weapons on the premises. There is two (2) facility vehicles parked outside garage inspected to be in good operating condition. This is a 1-story four (4) bedrooms; 4 1/2 bathrooms. There is a fully furnished living room, dining room and Central Air conditioning unit. The outdoor perimeter front yard, side yard and backyard were inspected and found cleared of debris and hazards materials. There is a Ping Pong table and water roof patio furniture. LPA observed all retractable windows, screens and blinds from the inside and outside of the facility were observed to be in good condition. The passageways and porches are unobstructed. All posting is in the common area accessible to clients (i.e Personal Rights, Grievance forms and a comment box; food menu, regulations, licenses, emergency disaster plan and personal rights). The cleaning supplies solutions, disinfectants, sharp knives are also inaccessible in separate box in the key locked closet in the hallway. All the children prescribed medications are locked in the nursing closet station two (2) locked system behind the nurse door and a wall mounted locked box). LPA observed a hard wired enter connected combined Smoke detector and Carbon Monoxide; tested to be operable; three (3) Fire Extinguisher- Special K Grease Fire. The Hot Water Heater is enclosed with a secured strap. The First Aid kit has the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. The two (2) car garage has been converted in a gym with weights and exercise equipment that is monitored by staff. The Washer and Dryer Unit is located inside the garage. The clients are permitted wash their own clothes and the detergent is distributed by staff according to size of the load. The Living Room/Dining room/Kitchen: Observed to be clean and organized; fully furnished, book shelf, games and a French door that exits to the backyard. There is non-operable gas fireplace inaccessible to clients to ensure protection of the clients' safety. The Kitchen stove is gas operated with 5 burners a double door refrigerator with a bottom freezer. The dining table Dining area six (6) chairs, two (2) bar stool chairs. LPA observed ample fresh perishable and nonperishable food in the home in a quantity to meet the needs of the next three meals and the between meal snacks, and alternative options for food. All dishes and utensils used for eating and drinking and in the preparation of food and drink, were observed to be cleaned and sanitized. LPA observed coverage trash cans in the kitchen, bathroom and staff office. All containers, including movable bins, used for storage of solid wastes were observed to be tight-fitting covers kept on the containers; and in good repair, leakproof and rodent-proof. The Linen closet is located adjacent to the single bedroom. Bedrooms: There are four (4) Bedrooms each bedroom twin size beds six feet apart, comfortable mattress, clean linens, blankets, and pillows, as needed, all in good repair, adequate drawer, walk in closet. Bedroom #1 is occupied by one (1) client. BR#2, is occupied by two (2) client. BR#3, is currently unoccupied. BR #4 is identified as the master bedroom occupied by two (2) clients. Bathrooms- 4-1/2: The bathrooms were inspected and found to be clean. LPA test the water temperature, bathroom sinks and ensured that all toilets flushed. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. The is a full-size bathroom that is locked accessible during the day for safety issues. The community restroom has 2 sinks, 1 toilet, and 1 shower. The ½ bath inside bedroom #2 has 1 toilet and 1 sink. The on-suite inside bedroom #4 has 2 sinks, 1 toilet, and 1 shower. Clients basic personal hygiene items kept in a separate container in cabinet located near the client's bedrooms in the hallway. Items including but not limited to shampoo, feminine napkins, non-medicated soap, toothbrush, toothpaste, and comb. The bathrooms are stocked with supplies; additional supplied are stored in hallway closet. Report continues on LIC-809-C Page 2 of There is school is located inside the facility. There is a classroom is equipped with classroom furniture six (6) Apple desk top computers desk; six (6) additional employee desk and ample school supplies provided by the facility. There are three (3) offices; Program Director, Therapist office and office Staff. There is a Well-ness station for the medication logs and medical devices. LPA observed an operable facility telephone service shall be readily accessible in the facility. Clients are permitted to make and receive confidential telephone calls, unless prohibited by court order. The staff accompanies clients to local recreational facilities based on the rules of the COVID-19. Clients are accorded dignity in personal relationships with staff and others. The facility uses the "Token Economy System" for exhibiting appropriate behaviors and compliance. LPA observed that facility ensures that CDC Guidelines are implemented in effort to prevent other from contracting the COVID-19 virus (i.e wash hands with alcohol based hand sanitizer, display colorful preventative hygiene posters, temperature checks maintain social distancing (six feet of space), disinfect commonly used areas and items (remote controls, mouse's, playing, cards cell phones, practice "cough etiquette". The facility keeps an inventory of the PPE supplies and to report when they are depleted. The Facility operates within license conditions and limitations including capacity limitations. Facility has a current, written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. LPA confirmed staff records with the Human Resources Director. LPA reviewed Staff Records and Clients Records stored in the facilities specific online Portal with Kipuworks.com LPA interviewed four (4) Staff and five (5) clients that were present. There were no deficiencies cited at this time. An Exit Interview was conducted, and a copy of this report was left at the facility with the Program Director. LIC-809-C Page 3 of 3

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
On May 10, 2023, at 12: PM, Licensing Program Analyst (LPA), Rosslyn Gray and Licensing Program Manager (LPM), JoAunne Griffin arrived at Calenda to conduct a Case Management - Incident visit in response to a client death. LPA and LPM met with the Facility Manager, Mary Joo. During the visit, LPA and LPM inquired about the chronology of events leading up to Client 1's death, actions taken by the facility staff at the time of Client 1's death and immediately following it. LPA and LPM obtained documents pertaining to supervision and case notes. LPA's requested a copy of the client's treatment and meetings notes, Safety Plan,and prior hospitalization notes. There were no deficiencies cited at this time. Exit interview was conducted. A copy was left at the facility with the Facility Manager, Mary Joo.

met_with: Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 12/12/2023 at 10:15AM Licensing Program Analyst (LPA's) Rosslyn Gray made an unannounced visit to CALENDA GROUP HOME to conduct Annual/Required Inspection. LPA met with Staff#1 (S1) who granted access to the facility. The entire physical plant was inspected. The Group Home is to provide care and supervision for six (6) children, ages 12-17 years Ambulatory Only. There is a (10) feet gated fence at entrance of the facility and there pool on the premises that meets regulations (self-latching; unlocked 54 feet gate); currently the pool is repaired and filled with water. Staff has keys to lock and unlock if necessary. The Assistant Regional Director confirmed that there are no guns or weapons on the premises. There is two (2) facility vehicles parked outside garage inspected to be in good operating condition. This is a 1-story four (4) bedrooms; 4 1/2 bathrooms. There is a fully furnished living room, dining room and Central Air conditioning unit.The outdoor perimeter front yard, side yard and backyard were inspected and found cleared of debris and hazards materials. There is a Ping Pong table and water roof patio furniture. LPA observed all retractable windows, screens and blinds from the inside and outside of the facility were observed to be in good condition. The passageways and porches are unobstructed. All posting is in the common area accessible to clients (i.e Personal Rights, Grievance forms and a comment box; food menu, regulations, licenses, emergency disaster plan). The cleaning supplies solutions, disinfectants, sharp knives are also inaccessible in separate box in the key locked closet in the hallway. All the children prescribed medications are locked in the nursing closet station two (2) locked system behind the nurse door and a wall mounted locked box. LPA observed a hard wired enter connected combined Smoke detector and Carbon Monoxide; tested to be operable; three (3) Fire Extinguisher- Special K Grease Fire. The Hot Water Heater is enclosed with a secured strap. The First Aid kit has the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. The two (2) car garage has been converted in a gym with weights and exercise equipment that is monitored by staff. The Washer and Dryer Unit is located inside the garage. The clients are permitted wash their own clothes and the detergent is distributed by staff according to size of the load. The Living Room/Dining room/Kitchen: Observed to be clean and organized; fully furnished, book shelf, games and a French door that exits to the backyard. There is non-operable gas fireplace inaccessible to clients to ensure protection of the clients' safety. The Kitchen stove is gas operated with 5 burners a double door refrigerator with a freezer. The dining table sits six (6) chairs, two (2) bar stool chairs. LPA observed ample fresh perishable and nonperishable food in the home in a quantity to meet the needs of the next three meals and the between meal snacks, and alternative options for food. All dishes and utensils used for eating and drinking and in the preparation of food and drink, were observed to be cleaned and sanitized. LPA observed coverage trash cans in the kitchen, bathroom and staff office. All containers, including movable bins, used for storage of solid wastes were observed to be tight-fitting covers kept on the containers; and in good repair, leakproof and rodent-proof. The Linen closet is located adjacent to the single bedroom. Bedrooms: There are four (4) Bedrooms each bedroom twin size beds, comfortable mattress, clean linens, blankets, and pillows, as needed, all in good repair, adequate drawer, walk in closet. Bedroom #1 is occupied by one (1) client. BR#2, is occupied by two (2) client. BR#3, occupied by one (1) client. BR#4 is identified as the master bedroom occupied one (1) client. Bathrooms- 4-1/2: The bathrooms were inspected and found to be clean. LPA test the water temperature, bathroom sinks and ensured that all toilets flushed. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. The is a full-size bathroom that is locked accessible during the day for safety issues. The community restroom has 2 sinks, 1 toilet, and 1 shower. The ½ bath inside bedroom #2 has 1 toilet and 1 sink. The on-suite inside bedroom #4 has 2 sinks, 1 toilet, and 1 shower. Clients basic personal hygiene items kept in a separate container in cabinet located near the client's bedrooms in the hallway. Items including but not limited to shampoo, feminine napkins, non-medicated soap, toothbrush, toothpaste, and comb. The bathrooms are stocked with supplies; additional supplied are stored in hallway closet. Report continues on LIC-809-C Page 2 of There is school is located inside the facility. There is a classroom is equipped with classroom furniture six (6) Dell desk top computers. two (2) additional employee desk and ample school supplies provided by the facility. There are three (3) offices; Program Director, Therapist office and office Staff. There is a Well-ness station for the medication logs and medical devices. LPA observed an operable facility telephone service shall be readily accessible in the facility. Clients are permitted to make and receive confidential telephone calls, unless prohibited by court order. The staff accompanies clients to local recreational facilities. Clients are accorded dignity in personal relationships with staff and others. The facility transitioned from "Token Economy System" to distribution of allowance on a weekly bases. LPA observed that facility ensures that CDC Guidelines are implemented in effort to prevent other from contracting the COVID-19 virus (i.e wash hands with alcohol based hand sanitizer, display colorful preventative hygiene posters, disinfect commonly used areas and items (remote controls, mouse's, playing, cards, practice "cough etiquette". The facility keeps an inventory of the PPE supplies and to report when they are depleted. The facility operates within license conditions and limitations including capacity limitations. Facility has a current, written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. LPA reviewed the Personnel Report (LIC 500) LPA confirmed that All staff have required criminal record clearance. DOJ, FBI and Child Abuse Response; which meet qualification. LPA observed staff training certificates in RELIAS electronic training platform with various topics including Trauma Informed. LPA confirmed staff records with the Human Resources Director. LPA reviewed Staff Records and Clients Records stored in the facilities specific online Portal with Kipuworks.com On 12/15/ LPA returned to conduct Staff and clients interviews. There were no deficiencies cited at this time. An Exit Interview was conducted, and a copy of this report was left at the Facility Manager Mary Joo LIC-809-C Page 3 of 3

met_with: Assistant Regional Director/Kaz Katseanes


summary: Facility Evaluation

raw_content:
Narrative:
On December 15 2023 at 10:08AM Licensing Program Analysts (LPA) Rosslyn Gray made an announced visit to CALENDA GROUP HOME to conduct Case Management - Annual Continuation LPA met with Staff#1 (S1) who granted access to the facility. During the inspection LPA Gray conducted Client and Staff interviews. Client Interviews: LPA conducted confidential interviews with two (2) of the five (5) clients according to the census, available and willing to be interviewed. Staff Interviews: LPA conducted a confidential interview with three (3) on duty staff. LPA ensured to thoroughly review active staff (i.e Group Home Administrator, the Facility Manager; and Operations Manager. There were no deficiencies cited at this time. LPA concluded the Annual/Required Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Clinical Director/Tara Farazian on 12/15/2023

met_with: Clinical Director/Tara Farazian


summary: Facility Evaluation

raw_content:
Narrative:
On March 5, 2024, at 1: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up Case Management-Incident inspection to deliver findings concerning self-reported incident dated May 8, 2023. LPA Martin met with Toni Jackson-Rainey, Director of Operations to discuss the investigative outcome. On May 9, 2023, Community Care Licensing Division (CCLD) received an incident report from CALENDA facility reporting the death of youth #1 (Y1) who eloped from the facility by walking out the front door resulting in youth's fatality as Y1 was struck and killed on the Northbound Freeway (see LIC811, dated 3/5/2024). The incident was referred to and investigated by CCLD Investigations Branch, Investigator Douglas Real. On May 10, 2023, LPA Rosslyn Gray and Licensing Program Manager, JoAunne Griffin conducted a Case Management-Incident visit in response to the incident report, met with facility representative and obtained related documentation. The investigation, including confidential interviews with facility residents and employees as well as review of facility incident report, program, and protocols, determined a lack of evidence to support neglect or lack of supervision. The interviews revealed the residents felt safe in the facility and there was no concern for neglect or lack of supervision. There was no external factor such as conflict which triggered Y1 to elope from the facility. The staff members attempted to talk with Y1 and encourage Y1 to remain in the facility; however, their efforts were unsuccessful, and Y1 left the facility without warning on May 8, 2023, at approximately 10: PM. The facility was operating within approved staff to client ratios at the time of the incident. --(Continued on page LIC809-C)-- Based on employee interviews and the written report submitted by the facility the staff member followed the facility elopement policy. Y1 left the facility on their own free will and went onto the freeway where Y1 was struck by a vehicle. The staff called 911 immediately when Y1 eloped and reported the elopement as per facility policy. Based on confidential statements and documentary evidence, the investigation findings concerning neglect/lack of supervision are determined unsubstantiated. There are no deficiencies per California Code of Regulations cited at this time. Exit interview completed. A copy of this report and LIC811 was provided to Facility Representative.

met_with: Kaycie Peterson, Trainer Toni Jackson-Rainey, Director of Operations


facility_name: CAMP RECOVERY CENTER, LLC, THE

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility main office to inform them of the findings for the above listed allegations. LPA met with Tea Beradze, Clinical Director at 11: AM on 6/27/24. LPA made multiple attempts to contact the individual invovled in the incident to get more information on the allegation but as of 6/27/24 has not gotten a response. Due to the description of the incident being vague LPA was unable to determine if the facility committed any violations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. As a result of this visit, there were no title 22 deficiencies observed. Exit interview was conducted and a copy of this report was provided to Tea Beradze, Clinical Director. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Paul Simien LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

report_type: Complaint Investigation

met_with: Tea Beradze, Clinical Director

complaint_status: unsubstantiated


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility main office to inform them of the findings for the above listed allegations. LPA met with Tea Beradze, Clinical Director (CD) at 2: PM on 8/26/24. Based on confidential interviews conducted it was determined that the allegations listed above are Unsubstantiated. Based on witnesses interviewed, LPA was unable to find evidence of staff not providing adequate supervision, not managing youth medication, and the facility not providing a safe environment. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. As a result of this visit, there were no title 22 deficiencies observed. Exit interview was conducted and a copy of this report was provided to CD UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Paul Simien LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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


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

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility office to inform them of the findings for the above listed allegations. LPA met with Tea Beradze, Administrator at 11: AM on 11/8/24. Based on confidential interviews conducted it was determined that the allegations listed above are Substantiated. Based on witnesses interviewed and records reviewed, LPA was able to find evidence that staff did not prevent minors from engaging in sexual activity. The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. As a result of this visit, there is one General Licensing Standards violation (84065. Personal Duties (b)(1)). The facility will be cited (see 809-Ds for details). Appeal rights were discussed and provided. Exit interview was conducted and a copy of this report was provided to Tea Beradze, Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Paul Simien 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN JOSE RO, N. First Street, Ste. FACILITY NAME: CAMP RECOVERY CENTER, LLC, THEFACILITY NUMBER: 445200283

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

Deficiencies:
84065.2: (1) Supervision, protection and care of children individually and in groups at all times.

met_with: Tea Beradze, Administrator

complaint_status: SUBSTANTIATED

title: Personal Duties (b) Child care staff shall perform the following duties


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility office to inform them of the findings for the above listed allegations. LPA met with Tea Beradze, Administrator at 11: AM on 11/8/24. Based on confidential interviews conducted it was determined that the allegations listed above are Substantiated. Based on witnesses interviewed and records reviewed, LPA was able to find evidence that staff did not prevent inappropriate sexual interaction between children. The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. As a result of this visit, there is one General Licensing Standards violation (84065. Personal Duties (b)(1)). The facility will not be cited due to already being cited for this incident (See complaint 26-CR-20240306170132). Exit interview was conducted and a copy of this report was provided to Tea Beradze, Administrator SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Paul Simien LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN JOSE RO, N. First Street, Ste. This is an official report of an unannounced visit/investigation of a complaint received in our office on 03/21/2024 and conducted by Evaluator Paul Simien PUBLICCOMPLAINT CONTROL NUMBER: 26-CR- FACILITY NAME:CAMP RECOVERY CENTER, LLC, THEFACILITY NUMBER: ADMINISTRATOR:TEA BERADZEFACILITY TYPE: ADDRESS: GLEN CANYON ROAD, STE 1TELEPHONE: (831) 438- CITY:SCOTTS VALLEYSTATE: CAZIP CODE: CAPACITY:21CENSUS: 3DATE: 11/08/ UNANNOUNCEDTIME BEGAN: 11: AM MET WITH:Tea Beradze, AdministratorTIME COMPLETED:12: PM 9Staff did not ensure that child attended school Staff did not ensure child's mental health needs were met Staff did not return child's personal property at discharge Staff did not ensure that the children and adults from another facility were kept separate at all times INVESTIGATION FINDINGS: 13Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility main office to inform them of the findings for the above listed allegations. LPA met with Tea Beradze, Administrator at 11: AM on 11/8/24. LPA made multiple attempts to contact the reporting party to get more information on the allegations but as of 11/8/24 has not gotten a response. Due to not being able to get additional information LPA was unable to determine if the facility committed any violations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. As a result of this visit, there were no title 22 deficiencies observed. Exit interview was conducted and a copy of this report was provided to Tea Beradze, Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Paul Simien LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of 2

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:


summary: Facility Evaluation

raw_content:
Narrative:
On 6/29/2022 at 11:15AM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the above licensed facility. The purpose of the visit is to conduct the required annual inspection. LPA met with Phyllis Meagher, CEO, and Alisha Eipp, HR Coordinator at the facility office at 11:35AM. LPA conducted a review of ten staff files. LPA conducted an interview with 1 staff member. The facility is in the process of putting files digitally. There were some documents missing from the staff files, but the facility was able to provide the documentation before the end of the inspection. LPA reviewed the emergency binder, which documented the training plan, emergency contacts, and quarterly emergency drills. LPA observed that the office was organized and in good repair. At 2:10PM, LPA Hood went to the facility grounds at Glen Canyon Rd. Scotts Valley, CA 95066. LPA was met by Ty Newcomb, Director of Facility Operations and Lydia Beall, Administrator. LPA, Director of Facility Operations, and Licensee conducted a walk through of the grounds. The facility had a current census of seventeen resident youth. The grounds include both adolescent and adult treatment centers, but the facility has multiple ways to keep the populations separated. The facility currently has female residents in the lower unit and male residents in the upper unit. LPA observed all rooms, bathrooms, common eating area, outdoor gym, outdoor pool, and kitchen. LPA observed that the pool had a fence over five feet tall. All chemicals and cleaning supplies are kept behind locked closets. Due to the nature of the residents' needs at this facility, staff also keep personal items such as mouthwash that may contain alcohol locked in the staff offices as well. The facility has cooks which provide three meals and two snack times for the residents. LPA observed a posted menu and sufficient amounts of food in the kitchen. LPA measured water temperature in the bathroom of the male "suite" unit, which measured 111 degrees which is appropriate. LPA observed the facility to be clean, tidy, and in good repair. During the inspection, LPA observed that the facility had Naloxone in multiple places in the facility in locked first aid kits. The medical unit did have prescriptions on file for some residents as well as a statement about the use of Naloxone. LPA will follow up with a case management with the Health Assistant Director, Hillary Brandt, regarding training that staff have received on Naloxone. LPA was assisted by Lydia Beall, Administrator, in receiving the resident roster and client files. LPA observed the emergency binder which contained a face sheet for all of the residents with their names, authorized representatives, current medications, and physicians names. Of the seventeen residents, six of the residents had been at the facility for longer than thirty days. LPA reviewed the six residents files. LPA also reviewed the immunization records, medication logs, and medication binders which are kept in a separate health office on the grounds. LPA did not interview any residents at this time. All residents present had legal guardians or authorized parents, so LPA would need to ask permission from their guardian's before speaking with the residents. LPA did not observe any Title 22 deficiencies during this inspection. Due to the different offices, LPA conducted an exit interview via phone call with Phyllis Meagher, CEO, at 4:49PM. LPA will provide this report to CEO virtually to sign and return.

met_with: Phyllis Meagher


summary: Facility Evaluation

raw_content:
Narrative:
On 7/10/2023 at 11:58AM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the office of the licensed facility, located at Glen Canyon Rd. Scotts Valley 95066. The purpose of the visit was to conduct the annual inspection. LPA met with James Schmidt, Director of Quality and Risk at 12:16PM. LPA reviewed the files for five staff members utilizing the CARE Tools. LPA conducted a site inspection at the facility address at 2:02PM. LPA met with Administrator, Tea Beradze. LPA observed the outdoor area, nurse's station, dining area, kitchen, female sleeping quarters, male sleeping quarters, and bathrooms. LPA observed the facility to be clean and in good repair. LPA observed there to be a sufficient amount of perishable and non-perishable foods. LPA surveyed the pool, which had a locking fence that was five feet high. The facility location services both adult and minor clients, the living quarters are separate and meal times are staggered to prevent the two groups coming in contact. LPA returned to the office at Glen Canyon Rd. Scotts Valley, 95066 to conduct the rest of the file review. Administrator, Tea Beradze assisted obtaining the files. LPA reviewed the e-files for four clients, LPA also reviewed medical binders and intake assessments. LPA will return at a later date to review operations, emergency management, and conduct interviews. No deficiencies were cited at this time. LPA conducted an exit interview with James Schmidt, Director of Quality and Risk, at 4:02PM whose signature confirms the receipt of this document.

met_with: James Schmidt


summary: Facility Evaluation

raw_content:
Narrative:
On 3/6/2024 at 11:35am, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. LPA was escorted from the office to the facility by Christie Hernandez, Administrative Assistant. LPA met with Tea Beradze, Administrator and Eric Forestal, CEO. LPA conducted interviews with two staff members. There were no clients present at the time of the inspection. The facility had a census of three clients, there were no foster care youth in care. LPA reviewed the emergency binder and the facility's board minutes. No deficiencies were cited at this time and the annual inspection has been completed. LPA conducted an exit interview with Tea Beradze, Administrator and Eric Forestal, CEO at 12:40pm.

met_with: Tea Beradze


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility. The purpose of this visit was to conduct a Case Management inspection. LPA discussed this with Adriana Rivera, Adolescent Program Manager (APM) at 12: PM on 5/15/24. This case management was opened to discuss an incident report the department received on 5/9/24. Please see LIC 812 for details. Exit interview was conducted and a copy of this report was provided to Adriana Rivera, APM whose signature on this form confirm receipt of these documents.


facility_name: CAPELLA RESIDENTIAL CARE

summary: Facility Evaluation

raw_content:
Narrative:
On September 20, 2021 at 1: PM Licensing Program Analyst LPA Nicolette David conducted a component 2 tele-visit with applicant ( Mr.and Mrs. White) for the purpose of discussing the group home application revisions. LPA David informed Applicant that several revisions will need to be resubmitted in a effort to continue to more forward in approving the facility application for a license. LPA David provided applicant with a copy of the revisions and discussed each one in detail. LPA outlined section II section Program specialize in 6 clients ages 0-17 years old, however in farther review into the application LPA observed program indicated that it will specialize in ages 12-18. Part II section Social workers have or will have the following education-Credentials (nothing was checked to indicate or state education or Credentials). Part II section 6, Mental Health treatment is funded: ( nothing was checked).Part II Alcohol-Drug treatment services was marked as not applicable, however on page 8 of the application the facility indicated Drug-alcohol use is marked as (previously treatment for-drug abuse and previously treated for alcohol abuse. Statement of Program purpose, Methods and Goals: Part III in section purpose, It is indicated that the program will accept referrals from San Bernardino County of Department of Public Social Services (DPSS). However, in Part ll section 2 it is indicated that the facility program will specialize in children with developmental disabilities (regional center clients.) Program Curriculum has a duplicate page, Page 9- 10 (self -help and self -care) Facility did not indicate who will be responsible for training and initiating care. Page 14 (employing emancipate clients to work at the facility to provide support services to the group home staff and mentors for incoming clients). Page Description of program space: Facility indicated that the facility has 6 bedrooms and 4 bathrooms, and then in the 2nd paragraph the facility indicates the facility has 6 bedrooms and 5 bathrooms. Page Quality Assurance: program indicate facility will work in partnership with the placement agency to ensure the highest quality of service available to support our (three) clients in their everyday routines, however it should indicate six clients. who is McCoy group home mentioned in the 2nd paragraph? Page 27 reduction in restraints and containment and 5150 holds. (will the facility be using restraints) Section 4: Page Community integration: Clarity the statement " personal items that may not necessarily be age appropriate may be kept and used by the client in his own room away from public ridicule. Section Five Page 50: There are two duplicate pages. Page 59 (Task Analysis) please explain instilling self-pride, presentation and body language to clients "Dignity " Page Self-help training: Who will teach the training, how will it be funded, number of days conducted per hour, per week training is provided. # Eating- explain the language used supporting the facility method of training dealing with eating habits of clients with disabilities. Page Grooming: explain the comments used concerning African Americans and the texture of the hair. Section 6: Dental and Medical Page 73 indicate inset DPSS 4113 or IRC special incident report-Group home (explain page and why DPSS is being refer to when LPA explained to provider that clients can only be referred from regional center or probation. Page Incident reporting Procedures: include reporting regulation code for procedures referring to. Page Appointment Setting: Staff position who administer medications, (reference to Title Regulations) Section 8: Page Admission and intake: Please remove DPSS from intake progress in which clients will be referred. Page Admission Statement: remove DPSS from Admission Statement indicating that all clients to be considered will be determined by the regional center, San Bernardino County of Department of Social Services and Probation. Page Responsibility for Providing Care and Supervision: A random phone number is indicated on the page. Section 10: Discharge and Removal - Delete DPSS for Paragraphs, include regional center and probation. Page Section 11: Visitation Rules and Policy: Page 90- Explain visitation policy Section 12: Clients rights and Rules: Page 92- Are restraints being used Section 13: Discipline Policies: Page 95- Prone containment (Explain) also McCoy Home is mentioned. What group home is this (pg. 97) Section 14: revise emergency plan to new requires Section 15: Remove county Social worker for document Section 16: Page Remove County social Worker from document Section 17: Page Remove County Social Worker from document Section 18: Page Statement made Capella realize client are not hired help Section 21: Provide a work schedule for facility site, can use a 500 personnel report Number of hours, Section 22: provide copies of resumes, if employees have not started yet provide a letter of acceptance and or commitment for the position, and hours of administrator. Please reference to Title CCP concerning Job descriptions and classifications Section 25: Provide documents for this section Section 27: Provide documents for this section Section: 28: provide required document for this section Section 29: Provide Board of directors' statement Application-Program Statement will be pick up by providers at the CCL office on 9-21-22 and returned back to LPA by providers on 9-29-21. Pre-licensing schedule for 10-8-21 at 10: AM

met_with: Mr. and Mrs. White


summary: Facility Evaluation

raw_content:
Narrative:
On November 8, 2021 at 9: AM Licensing Program Analyst (LPA) Noubar Yerkatyan conducted an announced Pre-licensing inspection at the above address. Upon arrival, LPA met with, Administrator, Michelle White (MW). LPA and MW toured the external and internal area of the facility. The following was observed at the time of inspection: Physical Plant This facility is a single level home located in a residential neighborhood. The facility consists of 5 bedrooms, 3 bathrooms, living room, mud room, kitchen, pantry, dining room, 3-car garage, laundry room, patio and backyard and a gated pool. Overall, the facility is clean, sanitary and in excellent condition. Knives and sharps item are kept locked in the mud room storage with disinfectants, cleaning solutions and first aid kits which contains all required supplies. Per MW, there are no firearms on the premises. The facility has a centralized heat and air-conditioning unit. Temperatures in all rooms are maintained at 71 degrees (F). The hot water temperature was measured at 115 degrees (F). Carbon monoxide and smoke alarms were tested and observed to be operational. The fire extinguisher located by the kitchen is fully charged. The facility has a working telephone including WIFI. A fire inspection was requested on November 1, 2021 conducted by Los Angeles County Fire Department for ambulatory clients. (cont...) Fixtures, Furniture, Equipment, and Supplies Facility has five (2)(toilets), five (3) wash basins, and four (2) showers for clients' use. LPA observed adequate hygiene supplies including but not limited to shampoo, soap, toothbrush, toothpaste, and toilet paper. Clients will be utilizing bedroom #1 that has two twin size beds, one dresser and a closet. Bedroom #2 has two twin size beds, one dresser and a closet. Bedroom #3 has two twin sized beds, dresser and a closet. Bedroom #2 and bedroom #3 have a shared bathroom that has a lock for privacy. Bedroom #4 is a staff bedroom with a separate closet and bathroom. Bedroom #5 is a staff bedroom with a separate closet and bathroom. Each bed has clean pillows, pillow cases, bed sheets and blankets. Facility sketch, emergency disaster plan, house rules, grievance policy, menu, sexual and reproductive health care related rights, foster youth bill of rights and foster youth mental health bill of rights are posted on the wall in the kitchen area. Heath Related Services and Record Keeping Medications, client and staff records will be centrally stored and locked in the mud room locked door. An exit interview was conducted, and a signed copy of this report was provided to the Administrator.

visit_type: Prelicensing

met_with: Michelle White, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 08/22/2022 at 2: PM, Licensing Program Analyst (LPA) Noubar Yerkatyan, LPA Carrie Palmer, Licensing Program Manager (LPM) Tira Logan-Shanks, and San Bernardino Child Welfare Service Manager, Tracy Raymond conducted an meeting with facility representatives Michelle and Bruce White. The purpose of the meeting was to discuss the issues of being dually licensed as a Group Home and County Resource Home. Michelle and Bruce White stated they are planning on moving out with their San Bernardino placement dependent to another address in order to keep both licenses. There is currently no clients in care in the Group Home. It was discussed that licensee cannot currently accept any placement's until licensee has relocated their Resource Family Home license. Michelle and Bruce White stated they will submit a timeline plan relocation of their County Resource Home license to Community Care Licensing (CCL) on or before Thursday, August 25, 2022. A copy of the report was provided to licensees.

met_with: Michelle White & Bruce White


summary: Facility Evaluation

raw_content:
Narrative:
On October 12, 2022 at 09: AM, Licensing Program Analyst (LPA) Noubar Yerkatyan conducted an unannounced inspection to the facility above for conducting a Post Licensing inspection of the Group Home (GH). The LPA met with above staff. LPA and above staff provided the LPA tour of the facility. The physical plant layout for the Group Home remains the same as was observed by the LPA during the Pre-Licensing Inspection conducted on November 08, 2021. The group home is adequately equipped to provide privacy for interviewing and is conveniently located for the public. The LPA observed locked file cabinets in storage rooms. The license is posted in a prominent and public location. There are currently no placements at this time. There is no other hired staff at the moment other than the Administrator and Facility Manager. LPA observed the licensee to be occupied in the home, however they are in the process of moving out. A new residence has been secured for the licensee to move in to. The lease agreement has been signed for the new residence. Licensee is waiting for county representatives to make a visit to the new residence in order for them to fully move in. Licensee will be moving out of this location within the next couple weeks. Licensee will send a weekly update to the Regional Office via e-mail every Monday until they are fully moved out. During today's inspection, the LPA observed no deficiencies. An exit interview was conducted and copy of this report was provided to above staff.

met_with: Michelle White, Administrator & Bruce White, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On March 23, 2022 at 08: AM Licensing Program Analyst (LPA) Noubar Yerkatyan conducted an unannounced inspection at the above facility for the purpose of conducting an annual/required inspection. LPA met with facility Administrator, Michelle White & facility manager, Bruce White. LPA and Administrator toured the facility. LPA obtained and reviewed the following updated documentation: · LIC Personnel and Client Roster · LIC C Emergency Disaster Plan · Crisis Prevention Intervention Training's · Emergency Preparedness: Disaster and Mass Casualties Drills · Emergency Evacuation Routes · Emergency Intervention Plan · Complaint Procedures Facility currently has no placement's. The facility was in full compliance with 7 applicable areas of the Compliance and Regulatory Enforcement (CARE) tools for Children's Residential Licenses. Annual compliance review consisted of the following domains: Physical plant, operations, disaster preparedness plan, emergency intervention, staffing, and client records. Community Care Licensing (CCL) focuses its efforts on three priority areas: prevention, compliance, and enforcement. There are 2 fire extinguishers throughout the facility, all fully charged and all last serviced on 03/23/23. This facility is a single level home located in a residential neighborhood. The facility consists of 5 bedrooms, 3 bathrooms, living room, mud room, kitchen, pantry, dining room, 3-car garage, laundry room, patio and backyard and a gated pool. Overall, the facility is clean, sanitary and in excellent condition. Knives and sharps item are kept locked in the mud room storage with disinfectants, cleaning solutions and first aid kits which contains all required supplies. Per Administrator, there are no firearms on the premises. The facility has a centralized heat and air-conditioning unit. The hot water temperature was tested and was in working order. Carbon monoxide and smoke alarms were tested and observed to be operational. The facility has a working telephone including WIFI. Facility has five (2)(toilets), five (3) wash basins, and four (2) showers for clients' use. LPA observed adequate hygiene supplies including but not limited to shampoo, soap, toothbrush, toothpaste, and toilet paper. Clients will be utilizing bedroom #1 that has two twin size beds, one dresser and a closet. Bedroom #2 has one twin size bed, one dresser and a closet. Bedroom #3 has one twin sized bed, dresser and a closet. Bedroom #2 and bedroom #3 have a shared bathroom that has a lock for privacy. Bedroom #4 is a staff bedroom with a separate closet and bathroom. Bedroom #5 is a staff bedroom with a separate closet and bathroom. Each bed has clean pillows, pillow cases, bed sheets and blankets. Facility has 2 empty bedrooms that will be used for isolation rooms or visitation/relaxation with friends or family if needed. Facility has a outdoor patio, pool, and mini golf course located on the side. Facility pool is securely gated. Facility has cameras facing the entrance of the home, two camera's in the corner looking at the driveway and RV gate on the side of the facility. There is a camera inside the facility looking at the living room to the hallway. Facility sketch, emergency disaster plan, house rules, grievance policy, menu, sexual and reproductive health care related rights, foster youth bill of rights and foster youth mental health bill of rights are posted on the wall in the kitchen area. Medications, client and staff records will be centrally stored and locked in the mud room. An exit interview was conducted, and a signed copy of this report was provided to the Administrator. No deficiencies at the time of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On May 8th, 2025, at 9: AM Licensing Program Analyst (LPA) Ashley Ruacho conducted an unannounced inspection at the above facility for the purpose of conducting an annual/required inspection. LPA met with facility Administrator, Michelle White & facility manager, Bruce White. LPA and Administrator toured the facility. LPA obtained and reviewed the following updated documentation: · LIC Personnel and Client Roster · LIC C Emergency Disaster Plan · Crisis Prevention Intervention Training's · Emergency Preparedness: Disaster and Mass Casualties Drills · Emergency Evacuation Routes · Emergency Intervention Plan · Complaint Procedures Facility currently has no placements. Facility currently has no placements. The facility was in full compliance with 7 applicable areas of the Compliance and Regulatory Enforcement (CARE) tools for Children's Residential Licenses. Annual compliance review consisted of the following domains: Physical plant, operations, disaster preparedness plan, emergency intervention, and staffing. Community Care Licensing (CCL) focuses its efforts on three priority areas: prevention, compliance, and enforcement. There are 2 fire extinguishers throughout the facility, all fully charged and all last serviced on 01/01/25. This facility is a single level home located in a residential neighborhood. The facility consists of 5 bedrooms, 3 bathrooms, living room, mud room, kitchen, pantry, dining room, 3-car garage, laundry room, patio and backyard and a gated pool. Overall, the facility is clean, sanitary and in excellent condition. Knives and sharps item are kept locked in the mud room storage with disinfectants, cleaning solutions and first aid kits which contains all required supplies. Per Administrator, there are no firearms on the premises. The facility has a centralized heat and air-conditioning unit. The hot water temperature was tested and was in working order. Carbon monoxide and smoke alarms were tested and observed to be operational. The facility has a working telephone including WIFI. Facility has five (5)(toilets), five (5) showers, and three (3) tubs two (2) of which are for clients' use. LPA observed adequate hygiene supplies including but not limited to shampoo, soap, toothbrush, toothpaste, and toilet paper. Clients will be utilizing bedroom #1 which contains one (1) full size bed, one dresser and a closet. Bedroom #2 a full-size bed, one dresser and a closet. Bedroom #3 has one full sized bed, dresser and a closet. Bedroom #2 and bedroom #3 have a shared bathroom that has a lock for privacy. Bedroom #4 is a staff bedroom with a separate closet and bathroom. Bedroom #5 is a staff bedroom with a separate closet and bathroom. Each bed has clean pillows, pillowcases, bed sheets and blankets. Facility has 2 empty bedrooms that will be used for isolation rooms or visitation/relaxation with friends or family if needed. Facility has a outdoor patio, pool, and mini golf course located on the side. Facility pool is securely gated. Facility has cameras facing the entrance of the home, two cameras in the corner looking at the driveway and RV gate on the side of the facility. There is a camera inside the facility looking at the living room to the hallway. Facility sketch, emergency disaster plan, house rules, grievance policy, menu, sexual and reproductive health care related rights, foster youth bill of rights and foster youth mental health bill of rights are posted on the wall in the kitchen area. Medications, client and staff records will be centrally stored and locked in the mud room. An exit interview was conducted, and a signed copy of this report was provided to the Administrator. No deficiencies at the time of the inspection.


facility_name: CAREY'S CARE CENTER

summary: Facility Evaluation

raw_content:
Narrative:
On this date, Licensing Program Analyst (LPA) Cynthia Galindo conducted an unannounced annual inspection at Carey's Care Center. LPA met with facility representative Lena Graves. LPA inspected the facility, inside and out. The following was inspected: Centrally stored medications are maintained in kitchen in a locked cabinet. Sharps are maintained in the office in a cabinet. All facility smoke detectors appear to be in appropriate working order, fire extinguisher is properly charged and was last serviced June 29, 2019. There is at least one week supply of nonperishable but not enough supply of perishable foods. The facility is maintained at 65 degrees. Hot water temperature measures is in compliance to the regulations. Facility does not have any cameras in the facility. There are no bodies of water at the facility. No firearms or weapons are allowed in the facility. LPA discussed with Lena the placement for NMD. Deficiencies will be issued for this visit. A copy of the report was left at the facility.

met_with: Lena Graves


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA), Cynthia Galindo traveled to Carey's Care Center to continue conducting the annual inspection. LPA met with Administrator Lena Graves. LPA conducted six staff file reviews and three client file reviews. LPA interviewed two staff and three clients. Two clients were nonverbal and one client was verbal. LPA discussed with Administrator Reporting Requirements, Emergency Intervention Plan, Disaster Preparedness and Program Statement updates. Deficiencies are being issued. A copy of the report was left at the facility.

Deficiencies:
84361(f): Documentation and Reporting Requirements

(f) The licensee must maintain a monthly log of each use of manual restraints. The log must include


summary: Facility Evaluation

raw_content:
Narrative:
On June 7, 2022, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced case management inspection to clear a deficiency that was issued on May 6, 2022. Met at the facility by Administrator Lena Graves. An inspection of the doors was conducted and the door knobs have been changed. There are no deficiencies to be cited on this date. A copy of this report is give to Administrator Lena Graves on this date.


summary: Facility Evaluation

raw_content:
Narrative:
On 08/24/22, Licensing Program Analyst (LPA) Lisa Slusher conducted an unannounced annual inspection following a pre-visit Covid Assessment. Met at the facility by Facility Administrator Lena Graves 1. Facility Grounds were inspected. 2. Outdoor space observed. No bodies of water observed. 3. Chemicals were stored in locked closets/cabinets. 4. Locked and centrally stored medications were observed on this date 5. First aid kit complete with appropriate manual was present upon inspection. 6. Adequate storage space observed. 7. Individual beds in good repair observed. 8. The house has 4 bedrooms, single or double occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings. At this time, because there are only 4 clients, each client has their own bedroom. 9. Adequate food storage space observed. 2 days of perishable foods and 7 days of non-perishable foods observed 10. Weekly menu observed 11. Dining room observed. Table and seating provided for all clients.. 12.Facility has two full restrooms, both for client use. Water temperature was within the regulatory range. 13. Licensee has a vehicle for use at the facility. insurance and registration are both current. Client files (4) were reviewed. Annual Inspection to be continued at a later date. No citations issued at this time.


summary: Facility Evaluation

raw_content:
Narrative:
On this date, LPA (Licensing Program Analyst) Lisa Slusher continues the annual inspection from 12/12/2022. Present during this inspection were administrator Lena Graves. LPA arrived at the facility at 9:30 am. A review of personnel files and training records was started shortly after. LPA Reviewed 4 client files and 6 (six) personnel records as well as reviewed fingerprint/association records for all personnel. Citations are issued on this date for the following regulation sections: 84072(d)(6) Personal Rights 80010(a) Limitations on facility license 84365(a) Emergency Intervention Staff Training 80075() f) Health Related Services 80066(a)(2) Personnel Records 84065(d) Personnel Requirements LPA also provided technical assistance and technical violations on this date in multiple areas.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 12/01/2023, Licensing Program Analysts (LPA) Tamara Melikian travelled to the above agency to conduct an Annual inspection. Met by Administrator Lena Graves. At 9:00AM, an inspection of the physical plant was conducted. The license and all appropriate forms were observed as well as the locked area for files. At 9:30AM, an inspection of staff files was conducted. Interviews of staff members #1 and #5 (see LIC811 dated 12/01/2023) was conducted. At 10:30AM, an inspection of client files was conducted. None of the clients were at home so interviews will be conducted at a later date. The exit interview was conducted at 12:00PM and a copy of this report given to the Administrator. Deficiencies on the attached page. It is requested that the licensee submit the following updated forms to CCL: LIC 308, 309, 500 and emergency disaster plan. In addition, the minutes for the Board of Directors meetings.

Deficiencies:
84068.3(a): Modifications to Needs and Services Plan

(a) The needs and services plan specified in Section 84068.2 shall be updated at least every six months to determine the following


summary: Facility Evaluation

raw_content:
Narrative:
On 12/05/2024, Licensing Program Analysts (LPA) Lisa Slusher travelled to the above agency to conduct an Annual inspection. Met by Administrator Lena Graves. At 9:00AM, an inspection of the physical plant was conducted. The license and all appropriate forms were observed as well as the locked area for files. At 11: AM, an inspection of staff files was conducted. Interview of Administrator and Observation of client were conducted. At 9: AM, an inspection of client files was conducted. One client was in the home, further interviews will be conducted at a later date. The exit interview was conducted at 2: PM and a copy of this report given to the Administrator. Deficiencies are noted on the attached pages for violations of the California Code of Regulations. It is requested that the licensee submit the following updated forms to CCL: LIC 308, 309, 500 and emergency disaster plan. In addition, the minutes for the Board of Directors meetings for 2024 are to be submitted by 12/9/2024.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, LPA (Licensing Program Analyst) travelled to the above facility for the purpose of obtaining signatures for a revised report. Additionally, LPA conducted interviews related to the Annual inspection conducted 12/6/24. Discussed with Administrator status of program design, Vendor Status, for the pending Adult facility application. Also discussed with Administrator documents submitted for plan of corrections for annual inspection, all corrections have been made.


facility_name: CASA BONITA

summary: Facility Evaluation

raw_content:
Narrative:
On April 11, 2022 at approximately 10: AM, Licensing Program Analyst (LPA) Raymond Wu conducted a visit at the facility for the purposes of initiating a Year Required inspection. LPA met with the representative listed above and discussed the purpose of the visit. During the visit, a walk-through of the facility was conducted. The facility is currently vacant and the last client moved out approximately 2 years ago according to the Administrator. PHYSICAL PLANT A walk-through of the physical plant was conducted at approximately 10: AM. The facility is a single-story home situated in a quiet residential area. The exterior of the facility was observed to be well-maintained and in good repair. After entering the front door, postings, including the License, Emergency Disaster Plan, and Complaint hotline numbers were prominently placed for any potential clients. Towards the left, a living room was observed to be clean, in good repair, and furnished with furniture and entertainment items for potential clients. Moving up, there is a kitchen and dining room. All kitchen cabinets and appliances were observed to be in good repair. No perishable food was observed due to the facility being vacant. There were a total of 3 bedrooms and 2 bathrooms for client use. All rooms were observed to be clean and furniture was observed to be in good repair. Mattresses were outfitted with mattress covers and linens were clean and tidy. Bathrooms were observed to have paper towel dispensers, trash bins with covered lids, and soap for potential client use. Smoke detectors and carbon monoxide detectors were observed to be functional and a fire extinguisher was observed to have been serviced in the past year. Sharp objects, chemicals, and medication were securely stored in the staff office. In the back, there is a secure garage used for storing supplies. All indoor and outdoor passageways were free from obstruction. LPA advised that an annual continuation visit would need to be conducted. No deficiencies were observed or cited during this date.

met_with: Administrator Sergio Castaneda


summary: Facility Evaluation

raw_content:
Narrative:
On March 22, 2024 at 9: AM, Licensing Program Analyst (LPA) Juliet Robles conducted a visit at the facility for the purpose of an Annual inspection. LPA met with Luis Tobar, Supervisor and discussed the purpose of the visit. During the visit, a walk-through of the facility was conducted. The facility is currently vacant, with no clients. LPA observes that rooms 1 & 2 flooring needs to be replaced. Per Supervisor, the repair is scheduled after the basement flooring dries up well. The facility Supervisor will email LPA Robles once the repair is completed sometime in Summer. During the inspection, LPA conducted a physical tour (inside and out) and reviewed operational requirements: (physical plant; operations; disaster preparedness; emergency intervention plan and staff files). LPA was provided with the LIC 500, current LIC 610C, LIC 309, LIC 308. The new Group Home Administrator documents will be mailed to the Regional Office. LPA observes postings, after entering the front door. The License, Emergency Disaster Plan and complaint hotline numbers were prominently placed for potential clients. No perishable food was observed due to the facility being vacant. Smoke detectors and carbon monoxide detectors were observed to be functional, and a fire extinguisher was observed. Sharp objects, chemicals, and medication were securely stored in the staff office. In the back, there is a secure garage used for storing supplies. All indoor and outdoor passageways were free from obstruction. LPA reviewed two (2) staff files that were provided by Human Resources staff, Sheila Davis. A review of Guardian and Licensing Information System on 03/21/24, indicates that all facility staff associated with facility have DOJ, FBI, and child abuse index clearances. LPA interviewed one (1) staff at the facility. Based on the physical inspection of the facility and the records review, there are no violations of Title 22, Division 6 of the California Code of Regulations and no deficiencies were cited. An exit interview was conducted with the facility representative and a copy of LIC 809, and LIC 811 were provided to the facility representative Luis Tobar.

met_with: Luis Tobar


facility_name: CASA DE ESPERANZA

raw_content:
Narrative:
The investigation, including confidential interviews with resident and staff members, revealed C1 made sexual abuse allegations a month after they no longer resided at the facility and almost a year after the alleged incidents occurred. Staff were not informed nor observed any sexual activity between C1 and other clients. Interviews produced no additional alleged victims or witnesses to the alleged abuse. As to claims that staff failed to prevent drugs in the facility, the investigation revealed that C1 and other client at the facility would at time smuggle illegal drugs into the facility after they returned from home visits. Clients were also suspected of using the internet to purchase narcotics and have them delivered by the facility's fence area and sidewalk. It was revealed, due to client's personal rights, staff were not able to search clients who were suspected of possibly being involved in drug activity. The investigation did not produce any independent witnesses to the allegation. Observations of the facility physical plant during the investigation on unannounced complaint inspections, found facility grounds in substantial compliance. The facility was observed overall to be clean and or orderly. On site inspections produced no deficiencies concerning a lack of cleanliness. Due to a lack of evidence, the allegations can not be substantiated at this time. Although the allegations may have happened or may be valid, there is not a preponderance of the evidence to prove or disprove the allegations occurred; therefore, the allegations are determined Unsubstantiated. There were no deficiencies cited during the investigation. Exit interview conducted; appeal rights discussed and a copy of this report will be emailed to Facility Administrator.

Investigation Findings:
13On June 29, 2021 at 1: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection to deliver findings concerning the above-mentioned allegations. LPA Martin met with Facility Representative, Lupe Rodriguez to discuss the investigative outcome. The investigation was conducted by the California Department of Social Services (CDSS), Investigator Olivia Spindola of the Community Care Licensing (CCL) Investigations Bureau. On November 6, 2020, CCL received complaint allegations concerning neglect and lack of supervision. It was reported that a lack of supervision resulted in inappropriate interactions between minors in care as Client #1 (C1) was allegedly sexually abuse by another minor resident; that staff failed to prevent drugs in the facility; and that the facility is not clean. (Continued on page LIC9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: CASA DE ESPERANZAFACILITY NUMBER: VISIT DATE: 06/29/2021

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

met_with: Lupe Rodrigriguez, Facility Administrator


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Narrative:
The investigation, including confidential interviews with staff members and a tour of the facility revealed the ceiling was damaged due to excessive rains and doors were damaged due to clients having anger episodes. Observations of the facility physical plant during the investigation on unannounced complaint inspections, found facility doors to be repaired, however the ceilings have not been repaired in the therapist office or laundry room. Based on observations, AGPA Woodard has determined the preponderance of evidence standard has been met. Therefore, the allegations are found to be substantiated. Deficiencies were cited to the facility for physical plant. Exit interview conducted; appeal rights discussed and a copy of this report will be left at the facility.

Investigation Findings:
13On January 28, 2022 at 11:15AM, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted a followup complaint inspection to deliver findings on the above allegations. Upon arrival, AGPA was greeted by Marina Herrera, Facility Manager. On January 18, CCL received complaint allegations concerning issues with building and grounds. It was reported that the ceiling was falling down in a couple of rooms with insulation, wires and beams exposed. Doors were also off the hinges, there was a pot under the bathroom sink and a hole in the ceiling where a missing bath fan should be. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: CASA DE ESPERANZAFACILITY NUMBER: VISIT DATE: 01/28/2022

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

met_with: Marina Herrera


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Narrative:
continued from page A query of Zillow resulted that the property at this location is currently on the market and in pending sale status. An official eviction notice was not done (meaning the legal steps for doing an eviction was not taken), however the Landlord did leave a 60-day Notice to Vacate under the front door mat. AGPA Woodard has determined the preponderance of evidence standard has not been met. Therefore, the allegation is found to be unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

Investigation Findings:
13On February 19, 2022 at 2: PM, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted a follow-up complaint inspection to deliver findings on the above allegation. Upon arrival, AGPA was greeted by Hassan Kalantari, Mental Health Rehabilitation Specialist. On December 28, 2022, CCL received a complaint allegation concerning an eviction notice given to the facility due to non-payment of the lease. The investigation included confidential interviews with reporting party and staff members. Supporting documentation provided did not support that payment was not received or that it was in fact paid. It was also reported that as a result of non-payment the homes were under foreclosure. AGPA queried the Housing of Urban Development (HUD) website and didn't see the homes listed under properties for sell and/or auction. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: CASA DE ESPERANZAFACILITY NUMBER: VISIT DATE: 02/19/2022

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

met_with: Hassan Kalantari


summary: Complaint Investigation - Substantiated - 1 allegation

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Narrative:
continued from Based on observations and interviews, AGPA Woodard has determined the preponderance of evidence standard has been met. Therefore, the neglect/lack of supervision allegations are found to be substantiated. Deficiencies were cited to the facility for Personnel Duties. Exit interview conducted; appeal rights were discussed, and a copy of this report will be left at the facility.

Investigation Findings:
13This is an amended Report On March 25, 2022 at 11: AM, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted a follow-up complaint inspection to deliver findings on the above allegations. Upon arrival, AGPA was greeted by Marina Herrera, Facility Manager. On November 22, CCL received complaint allegations concerning issues with a resident setting a fire at the facility on November 13, 2021. The resident was arrested, and the judge released him. On November 20, 2021, another fire was started with a pile of clothing on the side yard of the facility which borders a neighbor's house. The Police and Fire Department were called. Staff was unaware a client was home. Clients also jump the neighbor's fence all the time and drink alcohol and do drugs. There are numerous occasions where there are no staff watching the minors or the staff are aloof. The investigation included confidential interviews with staff members and clients, and a review of supportive documentation. The minor who allegedly started the fires was unavailable for interview. A tour of the facility was conducted and burn areas were inspected during the unannounced complaint inspections. AGPA received copies of before and after photos of the fence in the backyard. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: CASA DE ESPERANZAFACILITY NUMBER: VISIT DATE: 03/25/2022

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


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Investigation Findings:
13On March 25, 2022 at 11: AM, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted a follow-up complaint inspection to deliver findings on the above allegations. Upon arrival, AGPA was greeted by Marina Herrera, Facility Manager. On November 18, CCL received complaint allegations concerning a child who is being verbally sexually harassed by his peers at his current group home. The child did not provide examples of his concerns and stated that he did not want to talk about it. The child also did not disclose if group home staff are aware his peers were sexually harassing him. The investigation included confidential interviews with staff members and clients, and a review of supportive documentation. The alleged victim declined to be interviewed and there were no witnesses who corroborated the alleged incident. Based on the above, AGPA Woodard has determined the allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to support the allegation of a violation of client's personal rights. An exit interview was conducted, and a copy of this report was left with the facility representative. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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


raw_content:
Investigation Findings:
13On June 21, 2022, at Licensing Program Analyst (LPAs) Enrique Hernandez and Nanacy O' Connell arrived at the facility to deliver the findings of a complaint investigation. LPA Hernandez met with Marina Herrera Facility Manager (FM) and discussed the investigative findings. On July 8, 2021, the Department received a complaint alleging Staff member is having an inappropriate relationship with group home minor(s). During confidential interviews and documentation obtained, there was insufficient evidence to substantiate the allegation, although there were some statements claiming that a client and staff had a relationship, the two denied the allegation. Other confidential interviews denied seeing or hearing anything inappropriate between the client and the staff. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has decided that the allegation is unsubstantiated, but if any additional information is received this complaint can be amended and findings can be changed. Exit interview was conducted and a copy of this report was left with FM UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Enrique M Hernandez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, This is an official report of an unannounced visit/investigation of a complaint received in our office on 07/08/2021 and conducted by Evaluator Enrique M Hernandez COMPLAINT CONTROL NUMBER: 34-CR- FACILITY NAME:CASA DE ESPERANZAFACILITY NUMBER: ADMINISTRATOR:LUPE L. RODRIGUEZFACILITY TYPE: ADDRESS: QUINTA VISTA DRIVETELEPHONE: (805) 496- CITY:THOUSAND OAKSSTATE: CAZIP CODE: CAPACITY:6CENSUS: 5DATE: 06/21/ UNANNOUNCEDTIME BEGAN: 03: PM MET WITH:Facility Manager TIME COMPLETED:05: PM 91) Staff members' conduct were inimical to the care of group home minors. INVESTIGATION FINDINGS: 13On June 21, 2022, at 3:30pm Licensing Program Analyst (LPAs) Enrique Hernandez and Nancy O' Connell arrived at the facility to deliver the findings of a complaint investigation. LPA Hernandez met with Marina Herrera Facility Manager and discussed the investigative findings. On July 8, 2021, the Department received a complaint alleging Staff members' conduct were inimical to the care of group home minors During confidential interviews conducted with all parties involved and information collected, the above allegation is substantiated, as all relevant parties confirmed that a staff member had a verbal altercation with one of the clients. Additionally, LPA Hernandez received a recording of the actual verbal altercation and staff can be heard yelling at the client. Based on the interviews and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. Exit interview was conducted and a copy of this report was left at the facility SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Enrique M Hernandez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: CASA DE ESPERANZAFACILITY NUMBER: 565800460

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

met_with: Facility Manager


raw_content:
Narrative:
support presence of C1's missing gold chain, and facility inventory document that does not list gold chain as reported upon CI'1 admission into the facility. Additionally, LPA observed during inspection that facility staff office is kept locked with no presence of residents in the office. Although C1 and the RP have reported that C1's personal items were missing while in care, there was no evidenced provided by C1 to show that the gold chain existed or that C1 left the belonging in the care of facility staff. Therefore, it must be concluded that an allegation of personal rights violation cannot be substantiated at this time. Per Title 22, There are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was left at the facility.

Investigation Findings:
13On June 21 2022, at 03:45pm, Licensing Program Analyst (LPA) Nancy O'Connell and Enrique Hernandez made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation and deliver the findings. LPA spoke with Marina Herrera and together, discussed the investigative findings. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. Based on the interviews conducted and documents obtained, the above allegation is found to be Unsubstantiated, meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Supporting evidence includes: conflicting interviews with facility staff attesting to policies related to safeguarding, lack of evidence to UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: CASA DE ESPERANZAFACILITY NUMBER: VISIT DATE: 06/21/2022

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

met_with: Marina Herrera, Facility Manager


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Based on the interviews conducted and documents obtained, the above allegation is found to be Unsubstantiated, meaning that the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. There are no deficiencies to be cited at this time. Exit Interview conducted, and a copy of this report was left at the facility with the Facility Manager.

Investigation Findings:
13On 9/21/22, LPA O'Connell delieved a finding for an amended report which supercedes the origional delievered on 6/21/22. Based on evidence related to misuse of facility funds, Community Care Licensing Division has initiated a Solvency Audit to look further into possible financial issues. During the investigative process by Licensing Program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. Supporting evidence includes: review of LIC500, client roster, interviews with the Reporting party, staff, client, and a public service agency. Interviews with facility staff and a resident, report that the facility provides for all basic needs and meets the required licensing standards. Further, an interview with a public service agency confirms that the facility is current on required service payment. Continued on LIC90099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: CASA DE ESPERANZAFACILITY NUMBER: VISIT DATE: 06/21/2022


facility_name: CASA LIL HAWK

summary: Facility Evaluation

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Narrative:
On 8/8/25, Licensing Program Analyst (LPA) Mariah Hawkins met with Applicant Latino Commission on Alcohol & Drug Abuse Services for the scheduled Component II face-to-face meeting. Representing the Applicant were Executive Director Debra Camarillo and Administrator/Director of Residential Services Salvador Blancas. Also in attendance was Rebecca Mathew, Youth/CYF Director of Substance Use Prevention & Treatment Services with the City & County of San Francisco, Department of Public Health. During the meeting, the following topics were discussed. Application Process Overview Goal/Purpose of the Facility Basic Services and Planned Activities Needs and Services Plans Care and Supervision Policies Emergency Intervention Policies Emergency Disaster Procedures Reporting Requirements Background Clearance/Guardian Process At the conclusion of the meeting, LPA discussed that the prelicensing inspection will be scheduled upon receipt of the fire clearance. LPA thanked the Applicant representatives for attending the meeting. A copy of this report was provided to the Applicant representatives.

met_with: Debra Camarillo, Salvador Blancas, Rebecca Mathew