summary: Facility Evaluation

raw_content:
Narrative:
On March 11, 2026, an informal conference was held with A Safe Space Small Family Home (SFH) at the Riverside Children's Residential Program Office to discuss current Community Care Licensing (CCL) concerns. Present at the meeting were LaCresha Cook (Regional Manager), Jennifer Smith, Licensing Program Manager (LPM), Licensing Program Analysts (LPAs) Rachel Vanegas and Carissa Aviles, and A Safe Space SFH Licensee - Candice Caldwell. Present via teleconference were Fresno County Social Worker De'Ywanna Jones and Fresno County Social Worker Supervisor Jabari James. The following concerns were addressed: · Oversight · Accountability · Care and Supervision · Inspection Authority · Misrepresentation of information provided to CCL · Client records · Staff records · Personal Rights · Reporting requirements · Medication Concerns Licensing Program Manager (LPM) Smith discussed oversight, accountability, care and supervision, inspection authority, misrepresentation of documents and the importance of providing the Department with accurate information that is true and correct at all times. **Continued on the next page** Licensee was reminded that the client's needs must be met and operational needs of the facility must be addressed on a continuous basis. LPM Smith advised that the Licensee must be active and functioning in her role in order to ensure accountability for the general supervision of the licensed facility and ensure established policies concerning its operational needs are implemented daily. LPM Smith requested clarity to the Licensee's role in the SFH. Licensee stated that she is the Licensee. LPM Smith requested clarity as to who Summer is. Licensee stated that Summer is considered Human Resources (HR) and helps the Licensee with staffing such as staff hires and payroll. Licensee further stated that Summer has an assistant named Krystal. LPM Smith asked the Licensee if Summer has had any communication or handled any care and supervision matters with social workers regarding the client in care. Licensee denied having knowledge of the information. Licensee stated that Summer is not the owner or a co-licensee of the SFH. Licensee stated that Summer has been to the SFH three times to meet with the Licensee since becoming licensed. Licensee stated that Summer doesn't do anything involving client in care. LPM Smith requested information regarding staff role for Myeshesia. Licensee stated that Myeshesia is a Lead Staff but is often referred to as a manager by other staff in the home. Licensee stated that there is nothing documented in writing that Myeshesia is a manager and that Summer is HR. LPM Smith asked if Myeshesia has ever been designated any administrative roles by the Licensee. Licensee stated, no. LPM Smith and RM Cook further explained the meaning of inspection authority and the importance of the Licensee granting access to the entire SFH upon Licensing arrival, including access to staff and clients for confidential interviews and records review. LPM Smith asked Licensee about locked bedrooms in the home not being opened due to staff not having keys. Licensee denied having knowledge of the information. Licensee provided insight to personal appointments that have required the Licensee to be away from the SFH about 4-6 days in the month of February 2026. LPM Smith asked the Licensee who covers for the Licensee in the home during Licensee's absence. Licensee stated Myeshesia. LPM Smith and RM Cook further clarified that the Licensee is required to notify Licensing whenever absent from the SFH and another staff will be delegated administrative responsibilities. LPM Smith clarified the contact email on file for the SFH. Licensee stated that Licensee has never used asafespacesfh@gmail.com. Licensee stated that Summer and Krystal are the ones that have access to and utilize the aforementioned email address. LPM Smith showed the Licensee the LIC 200 form that was submitted with her initial application. LPM Smith and RM Cook advised Licensee to update a LIC 200 with the updated email address. Licensee responded that she would update the LIC 200 form with the correct email address. **Continued on the next page** LPM Smith discussed the importance of maintaining and monitoring eligible clearance for all staff. LPM Smith discussed accountability and lack of response or communication with Licensing and facility staff during attempted visits to the SFH on 02/23/26 and 02/27/26. Licensee stated that she was participating in training that did not allow access to the telephone. RM Cook reiterated the importance and severity of ensuring that communication is maintained with Licensing. RM Cook further expressed the magnitude of non-compliance and the importance of immediately bringing her facility back into compliance. LPM Smith inquired about facility staff not being compliant regarding Licensing completing client and staff interviews. Licensee denied having knowledge of the information. Fresno County Representatives provided the following information: - Summer was involved with pre-placement planning for their client in care - Licensee was previously present in weekly CFT meetings - Myeshesia has taken over the role of the Licensee in the SFH due to reported conflict between the client in care and the Licensee as per decision of Summer in November 2025 - Additional staff besides the Licensee residing in the SFH - Licensee has no longer participated in recent CFT meetings for their client in care since December 2025 - Summer is involved with weekly CFT meetings to provide strategies and tactics in working with the client in care - Special incident reporting concerns have been discussed due to lack of reporting to social workers - Concerns regarding staff not being able to reach the Licensee, Myeshesia, or Summer Licensee stated that Myeshesia was there to support the Licensee, not replace her. Licensee acknowledged that at the start of placement for client in care, incident reports were not being submitted. Licensee denied having knowledge of the other information discussed. LPM Smith asked the Licensee if there were any "live in staff" in the home. Licensee denied having knowledge of the information. Licensee was adamant that she is the only adult living in the home. LPM Smith discussed concerns regarding personal rights for the client in care such as the client being bribed to maintain in placement. Licensee denied having knowledge of the information. LPM Smith requested protocol for reporting unauthorized absence for client in care. Licensee stated that the staff are not allowed to prevent that client from leaving, but did confirm that she was not reporting all absences to Licensing or the placement agency. **Continued on the next page** LPM Smith requested the following plan of correction: - Copies of LIC 500 licensing forms from August 1, 2025 - March 11, 2026. - A signed declaration that Licensee is residing in the SFH seven days a week. - LIC Designation of Facility Responsibility - Copy of current lease agreement - Above documents to be submitted to Riverside North Regional Office (RNRO) by close of business on 03/13/26. Additionally, LPM Smith requested the following be submitted to Riverside North Regional Office (RNRO) by close of business on 03/24/26: - A plan of action detailing how the Licensee is actively functioning in the Licensee's role to ensure accountability for operational needs of the SFH. - All staff records for staff that have worked for the facility since 9/27/24, including the Licensee's file and training documentation are delivered to the RNRO - Client records for clients placed in the facility since 3/1/25 are delivered to the RNRO - All Special Incident Reports for clients placed in the facility since 3/1/25. - Copy of staff time sheets from August 1, 2025 - March 11, 2026. - LIC Application to update Licensee's email address An exit interview was conducted and a copy of this report and appeal rights were reviewed and provided to Licensee Candice Caldwell.

met_with: Licensee - Candice Caldwell


state: CA

facility_name: A SAFE SPACE SFH

summary: Facility Evaluation

raw_content:
Narrative:
On March 16, 2026, at 02:30PM, Licensing Program Analysts (LPAs) Rachel Vanegas and Carissa Aviles arrived at A Safe Space Small Family Home (SFH) for the purpose of conducting a Case Management visit to follow-up on requested documents that the Licensee did not provide the Department as agreed. On March 11, 2026, an informal conference was held with A Safe Space SFH at the Riverside North Children's Residential Program Regional Office (RNRO) to discuss Community Care Licensing (CCL) concerns. During the office conference, Licensee agreed to submit the following documents by close of business on March 13, 2026: Copies of LIC 500 licensing forms from August 1, 2025 - March 11, 2026, a signed declaration that Licensee is residing in the SFH seven days a week, LIC Designation of Facility Responsibility, and a copy of current lease agreement. LPA Vanegas spoke to Licensee via phone who authorized Peer Manager, Richard Michael Lopez, to sign and receive this report. Based on observations, the SFH is being cited for California Code of Regulations (CCR) Section 80063(a) Accountability for not submitting the requested documents: - Copies of LIC 500 licensing forms from August 1, 2025 - March 11, 2026 - A signed declaration that Licensee is residing in the SFH seven days a week - LIC Designation of Facility Responsibility - A copy of current lease agreement An exit interview was conducted and a copy of this report and appeal rights were reviewed via phone with the Licensee - Candice Caldwell and provided to Peer Manager - Richard Michael Lopez.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Peer Manager - Richard Michael Lopez


summary: Facility Evaluation

raw_content:
Narrative:
On March 23, 2026, at 12pm, Licensing Program Analyst's (LPAs) Rachel Vanegas and Carrisa Aviles arrived at A Safe Space Small Family Home (SFH) to conduct a Case Management inspection for the purpose of following up on the Plan of Correction (POC) issued on March 16, 2026. LPA Vanegas spoke to Licensee via phone who authorized Direct Support Professional II - Shaundre Byrd, to sign and receive this report. On March 16, 2026, LPAs conducted a case management inspection to follow-up on requested documents that the Licensee did not provide to the Department by March 13, 2026, as agreed upon at the Informal Office Conference held on March 11, 2026. On March 16, 2026, a deficiency was issued to provide the following POC by due date of March 17, 2026: copies of LIC 500 licensing forms from August 1, 2025 - March 11, 2026, a signed declaration that Licensee is residing in the SFH seven days a week, LIC Designation of Facility Responsibility, and a copy of current lease agreement. On March 17, 2026, the Licensee submitted an updated lease agreement, a document titled "Declaration of Licensee Residency", LIC 500's for August 2025, September 2025, October 2025, November 2025, and December 2025, and LIC 308. LPA contacted the Licensee via email to notify the Licensee that the POC was incomplete and not being accepted due to the LIC 308 having an identified person that was not cleared and associated to the SFH, the LIC 500's were incomplete and missing hours worked for staff along with the January 2026, February 2026, and March LIC 500's not being submitted, and the document titled "Declaration of Licensee Residency" needing to be completed on the LIC Declaration form provided to the Licensee on March 11, 2026. **Continued on the next page** LPA followed up with the Licensee via phone on March 17, 2026, to ensure receipt and understanding of the email sent by LPA explaining the POC not being complete and not acceptable. The Licensee confirmed receipt and understanding. On March 18, 2026, the Licensee re-submitted LIC 500s for August 2025, September 2025, October 2025, November 2025, and December 2025 and the LIC 855. The Licensee was informed that the POC remained incomplete due to the following: Hours worked remained incomplete, along with the January 2026, February 2026, and March LIC 500's still not being submitted. The LIC 855 did not include statement that Licensee resides in the SFH seven days per week. On March 19, 2026, the Licensee re-submitted the LIC 500's for August 2025, September 2025, October 2025, November 2025, December 2025, January 2026, February 2026, and March 2026. The Licensee was informed that the dates of employment were not clearly legible on the LIC 500 submitted for December 2025 and needed to be resubmitted. The LIC 855 was revised to include the Licensee resides in the SFH seven days per week. The Licensee re-submitted the LIC 500 for December 2025 as requested but the employment dates remained unreadable. LPA requested that the LIC 500 for December 2025 be submitted again. On March 19, 2026, Licensee submitted completed POC. Based on observation and record reviews, the POC was not cleared until March 19, 2026. As a result of the Licensee's failure to complete the POC by the due date of March 17, 2026, the Licensee is being assessed a civil penalty of $100 per day from March 18, 2026, through March 19, 2026, for a total amount assessed of $200. An exit interview was conducted, and a copy of this report, LIC 421FC, and appeal rights were reviewed and provided to Direct Support Professional II - Shaundre Byrd, whose signature confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On March 23, 2026, Licensing Program Analysts (LPAs) Rachel Vanegas and Carissa Aviles arrived at A Safe Space Small Family Home (SFH) for the purpose of conducting a Case Management Deficiency inspection. On March 16, 2026, LPAs arrived at the SFH for a Case Management. Upon LPAs' arrival to the SFH, LPAs' observed that Staff 1 (S1) was on-boarding Staff 2 (S2). LPAs met with S1 and S2 who also stated that S2 was being on-boarded. During the inspection, LPAs also observed that Client 1 (C1) was present in the SFH. LPA Vanegas spoke with Licensee Candice Caldwell via telephone, and the Licensee stated that she informed the staff that she was not going to make it to the SFH to on-board S2 and dismissed S2 from the SFH. LPA Vanegas informed the Licensee that S2 could not be present in the home or working until the cleared background clearance was obtained. The Licensee then stated that S2 was not a staff, she did not have a copy of his driver's license, and did not know why S2 was at the SFH, maybe he was inquiring about a job. A review of records confirmed that S2's criminal background clearance was started in Guardian on March 13, 2026, including the submission of S2's driver's license, and LIC 508OSS. Based upon observation, record review, and confidential interviews the facility is cited one Type A violation in accordance with California Code of Regulations (CCR) 80019(e)(2) Criminal Record Clearance due to S2 not having a criminal record review pursuant to Health and Safety Code Section 1522 prior to working, residing, or volunteering in the licensed facility. The facility will be issued an immediate civil penalty of $100 ($100 per day for each day the violation occurred). The facility will also be cited an immediate civil penalty of $250 for a repeat violation of CCR 80019(e)(2) within a 12-month period. **Continued on the next page** LPAs conducted a Health and Safety Inspection of the SFH on March 16, 2026 and March 23, 2026. The staff present were not able to grant access to the client bedroom next to the laundry room or to the master bedroom, due to the keys not being accessible. LPA Vanegas spoke to the Licensee on both inspection dates and was informed that the keys should be on the key ring that staff had access too. Also, during the Health and Safety Inspections on March 16, 2026 and March 23, 2026, LPAs observed a hole in the wall of C1's bedroom. Based on observation and interviews, the facility is also being cited two Type B violations in accordance with CCR Section 80044(a) Inspection Authority of the Licensing Agency due to the Licensing Agency not having access to all bedrooms, specifically, one client bedroom located next to the laundry room and the master bedroom and CCR Section 80087(a) Buildings and Grounds due to C1's bedroom having a hole in the wall behind the bedroom door knob handle. An exit interview was conducted, a copy of this report, LIC 809D, LIC421BG, LIC421FC, and appeal rights were reviewed and provided to Direct Support Professional II - Shaundre Byrd.


summary: Facility Evaluation

raw_content:
Narrative:
On April 3, 2026, at 11:00AM, Licensing Program Analyst (LPA) Rachel Vanegas arrived at A Safe Space Small Family Home (SFH) for a Case Management visit for the purpose of following up on the Plane of Corrections (POCs) issued on March 23, 2026. LPA met with Myeshesia Owens - Facility Manager. LPA Vanegas spoke to Licensee via phone who authorized Myeshesia Owens - Facility Manager, to sign and receive this report. The written POC was given to Direct Support Professional II - Shaundre Byrd, and reviewed via phone with the Licensee, Candice Caldwell, on March 23, 2026. The POC due date for the Type A violation of California Code of Regulations (CCR) Criminal Record Clearance Section 80019(e)(2) was March 24, 2026, and the POC due date for the two Type B violations of CCR Buildings and Grounds Section 80087(a) and CCR Inspection Authority Section 80044(a) was March 30, 2026. Based on observation and record reviews, the POCs remain uncleared to date, April 3, 2026. As a result of the Licensee's failure to complete the POCs by the due dates of March 24, 2026, and March 30, 2026, the SFH is being assessed three civil penalties. One Type A repeat violation civil penalty of $100 per day for CCR Section 80019(e)(2) from March 23, 2026, through April 3, 2026, for a total amount assessed of $1,200. One Type B violation of $100 per day for CCR Buildings and Grounds Section 80087(a) from March 31, 2026, through April 3, 2026, for a total amount assessed of $400. One Type B violation of $100 per day for CCR Inspection Authority Section 80044(a) from March 31, 2026, through April 3, 2026, for a total amount assessed of $400. Civil penalties will continue to accrue at $100 per day, per violation, until deficiencies are corrected. An exit interview was conducted, and a copy of this report, LIC 421FC, and appeal rights were reviewed and provided to Myeshesia Owens - Facility Manager, whose signature confirms receipt.

met_with: Myeshesia Owens - Facility Manager


facility_name: ABUNDANCE OF LOVE CARE FACILITY

summary: Facility Evaluation

raw_content:
Narrative:
On October 17, Licensing Program Analyst (LPA) Cynthia Ramos met with Applicant Lisa Johnson for for a Component II of the application process. LPA Ramos went over revisions needed for the application prior to license. The due date is November 17, 2025. LPA Ramos provided applicant with a copy of the LIC 184, Notice of Incomplete Application and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to the Applicant, Lisa Johnson.

met_with: Applicant-Lisa Johnson


summary: Facility Evaluation

raw_content:
Narrative:
On December 22, 2025, Licensing Program Analyst (LPA) Maryjane Perez arrived at Abundance of Love Care Home Small Family Home (SFH) for a pre-licensing inspection for an initial license. LPA met with applicant Lisa Johnson who led a tour of the entire house. The applicant is applying to serve six ambulatory children ages 6 to 17 years old. Currently there are no clients placed in the home. The home is a two-story building with four bedrooms and three bathrooms. The downstairs consisted of an entry way with all required postings such as personal rights, emergency disaster plan, facility sketch, visitation policy, and "See something, say something" poster. The kitchen had a locked cabinet for storing clients medications, and first aid kit with all required elements. There was a locked kitchen sink cabinet that stored cleaning chemicals and another locked cabinet that stored knives/ sharp objects. The refrigerator and pantry were fully stocked with perishables and non-perishable foods. There was a dining table with adequate seating, a living room with a couches and TV, and a locked cabinet for storing clients cash resources, client files, and personnel records. Bathroom #1 was fully functioning with a shower/ bathtub, sink, and toilet. Hot water temperature was measuring 112.8 degrees Fahrenheit. Bedroom #1 was utilized for two clients and had two twin size beds, closet/ dresser space, lighting, a TV and all required bedding. The bedroom was currently vacant. There was a hallway closet for extra storage and had two emergency backpacks. The upstairs had a loft with bored games, gaming consoles, books, toys, and a couch with a TV. Bedroom #2 was the master bedroom for applicant and had a king size bed with bathroom #2 that was fully functioning. There was a locked hallway closet for storing extra cleaning chemicals, extra household items such as hygiene supplies, towels and linens, and laundry detergent. There was bedroom #3 that was utilized for two clients and had two twin size beds, closet/dresser space, all required bedding, a TV, and lighting (currently vacant). Bedroom #4 was utilized for two more clients and had two twin size beds closet/ dresser space, all required bedding, a TV, and lighting also currently vacant. The laundry room was locked at all times and had a washer/ dryer and laundry essentials. Bathroom #3 had a sink, shower/ bathtub, toilet and a trash can with a lid. The backyard where children will have access to play was completely fenced, had a gate with a latch and was free of hazards. There were no pools or other bodies of water and no weapons/firearms as stated by applicant. The garage was locked at all times, and had an extra refrigerator and freezer used for grocery overstock. Bedrooms were arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items have been properly made inaccessible to areas where children will have access. There was a telephone service and all appliances were in working order. Based on this inspection, there are no corrections needed at this time therefore, the home is appropriate for a capacity of six ambulatory clients. The request for licensure will be forwarded to Licensing Program Manager for final approval. Component III orientation was also completed this day of December 22nd, 2025. An exit interview was conducted and a copy of this report and an "Additional Application Revisions" letter was provided to applicant Lisa Johnson.

visit_type: Prelicensing

met_with: Applicant- Lisa Johnson


facility_name: AC HEALTHCARE SERVICES

summary: Facility Evaluation

raw_content:
Narrative:
On 12/12/24 at 11AM, Licensing Program Analyst (LPA) Mariah Hawkins conducted the announced Prelicensing Inspection. LPA met with Applicants Abraham Siwoku and Adedolapo Adebesin. LPA toured the facility site and observed the facility to be clean and well-maintained. The facility is a 2-story house in a residential neighborhood. There is one kitchen and two bathrooms specifically for client use, and all were observed to be in highly sanitary condition. There is a common space for visitation and activities. Hot water measured within the required range. The bedrooms offer two beds each as well as personal storage space. The facility will serve children ages 3 to 17, ambulatory only. The applicants currently have two biological children in their care and agree to notify the licensing agency if there are any changes to the household size. The applicants have submitted a complete application packet and plan of operation. All requested revisions were made. The applicants have relevant work experience and hold valid first aid certificates and have demonstrated understanding of the program's plan of operation. Items to complete prior to licensure: - Applicants will obtain a house phone and provide number to LPA. - Applicants will obtain tweezers for the first aid kit. - Completion of Component III Category-Specific Orientation/Training. This facility will be ready for licensure once the above are completed and Licensing Program Manager Isabel Diego has reviewed and approved the application. An exit interview was conducted, and a copy of this report was provided to Applicants.

met_with: Applicant Abraham Siwoku


summary: Facility Evaluation

raw_content:
Narrative:
On 12/12/24 at 11AM, Licensing Program Analyst (LPA) Mariah Hawkins met with Applicants Abraham Siwoku and Adedolapo Adebesin for the scheduled Component II face-to-face meeting. The purpose of this meeting was to discuss the facility's Plan of Operation and licensing requirements. The following items were discussed: - Title Regulations - Inspection Authority and Licenisng Procedures - Goal/Purpose of the Small Family Home - Care and Supervision Policies - Staff Training - Recordkeeping - Reporting Requirements - Needs and Services Plans - Basic Services and Planned Activities - Visitation Policies - Background Clearance/Guardian Process Applicants demonstrated understanding of the program policies and procedures. An exit interview was conducted, and a copy of this report was provided to Applicants.


summary: Facility Evaluation

raw_content:
Narrative:
On 06/24/25 at 9:30am, Licensing Program Analyst (LPA) Kristin Pierotti conducted a post-licensing inspection. LPA met with Adeolapo Adebesin and Abraham Siwoku and informed of the purpose of the visit. LPA used the CARE Inspection Tool and conducted a tour of the facility site. There are currently no clients in care. LPA observed the facility to be in good condition, clean and well organized. Kitchen and bathrooms are sanitary. The facility currently has no clients in care. The facility has 2 bedrooms for clients which have 2 beds and plenty of storage for client's personal belongings. The rooms and common spaces are nicely decorated and furnished. Medications, sharps, and chemicals are stored where inaccessible to the clients. The facility is ready to accept clients. The Licensee will notify LPA when they admit their first client. LPA observed that both staff are "in process" in Guardian. LPA is offering technical assistance for the Licensee to fill out the LIC508O-O-S and submit to LPA. An exit interview was conducted, appeal rights discussed and a copy of this report and the LIC9102 was left with Abraham Siwoku, Licensee whose signature confirms receipt

met_with: Adeolapo Adebesin, Staff Abraham Siwoku, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On 01/29/2026 at 1: PM, Licensing Program Analyst (LPA) Jasmine Cardeno met with Facility Administrator, Abraham Siwoku, and Facility Staff, Adedolapo Adebesin, to conduct an unannounced inspection to the facility, AC Healthcare Services. LPA discussed with Facility Administrator the purpose of the visit is to provide the new license for the facility, AC Healthcare Services. At 1: PM, LPA printed out the new license and informed Facility Administrator that the facility, AC Healthcare Services is no longer on provisional license. At 1: PM, LPA conducted a walk-through tour of the facility facilitated by Facility Administrator. The facility currently has no clients in care. LPA observed the facility is clean and in good condition. LPA observed the kitchen and living room area to be clean and sanitary. The facility has two designated bedrooms for clients on the lower level of the two-story home. Each bedroom has two beds and plenty of storage for client's personal belongings. The rooms and common spaces are furnished and kept clean. LPA observed cabinets and storage spaces that are to be locked for storage for medications, sharps, and chemicals to make inaccessible to clients. In addition, LPA had a discussion with Facility Administrator and Facility Staff regarding the updates for the AC Healthcare Services with Regional Center. LPA has documented the discussion with Facility Administrator and Facility Staff in a corresponding LIC 812 document that details the facility's correspondence with Regional Center. An exit interview was conducted and a copy of this report along with the License for the facility was given to Facility Administrator, Abraham Siwoku, whose signature confirms receipt.

met_with: Facility Administrator, Abraham Siwoku


facility_name: ADEDAYO FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On January 28th, 2025, Licensing Program Analyst (LPA) Maryjane Perez met with applicants Tolulope and Adedapo Adedayo this date for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the LIC 184, Letter of Application Revision, and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicants Tolulope and Adedapo Adedayo .

met_with: Applicants- TOLULOPE & ADEDAPO ADEDAYO


summary: Facility Evaluation

raw_content:
Narrative:
On March 5, 2025, at 1: PM, Licensing Program Analyst (LPA) Maryjane Perez began a pre-licensing inspection and component III for Adedayo Family Home Small Family Home for an initial license. LPA met with applicants Tolulope and Adedapo who led a tour of the entire home. The facility was toured both inside and out with the applicants. The applicants are applying for 2 ambulatory children ages 0 to 17. Currently there are no children placed in the home. The home is a two story building with 5 bedrooms and 3 bathrooms. The downstairs consisted of an entry way with all required postings such as visitation policy, personal rights, facility sketch, and emergency disaster plan. Bedroom #1 was downstairs and was fully furnished with a queen size bed, dresser and closet space that was currently vacant and will be utilized for a client. There was bathroom #1 that was fully functioning with water temperature reaching 109.8 degrees F. There was a storage closet that was filled with coats and shoes. The kitchen was clean and sanitary with locked knives and sharps stored under the stove. There was a medicine cabinet in the kitchen that was locked and will store client medication. The refrigerator/ pantry were fully stocked with perishable and non-perishable foods. Proper storage of all food was discussed. There was a fire extinguisher up to date and the First Aid kit was accessible with all required items. There was also a dining table and living room space with couch, TV, and a fire place that was properly screened. Telephone land-line service was missing. The upstairs consisted of bedroom #2 that was fully furnished and had a queen size bed that was utilized for applicants biological child. There was bathroom #2 that was fully functioning with two side by side sinks and one locked cabinet storing cleaning supplies/ chemicals. There was also a loft area that was used as a family room with couches and TV. Bedroom #3 was also upstairs and was fully furnished with closet and drawer space and had a queen size bed that was currently vacant and will be used for a client. There was also bedroom #4 which was the master bedroom for applicants that had bathroom #3 and a locked closet that will store clients files in a locked cabinet . Bedroom #5 was a vacant guest room that had a queen size bed and dresser/ closet space. Upstairs also had a laundry room that stored blankets, linen, towels and extra hygiene supplies. The laundry detergent/ essentials were locked in a cabinet. Trash cans for storage of solid waste in bathrooms did not have tight fitting lids. All hazardous items have been properly made inaccessible to areas where children will have access. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. The backyard was observed to be clean and free of hazards. There was no pool or other body of water and there are no guns or weapons as stated by applicants at this time. Based on this inspection of the home, the facility will need the following corrections: (2) lock boxes for cash resources and medication Obtain telephone land line Trash cans need tight fitting lids in bathrooms After corrections are completed, the applicant will notify LPA so that another inspection can be completed. Component III orientation was also completed this day of March 5, Exit interview conducted and a copy of this report was discussed and provided to applicants Tolulope and Adedapo Adedayo.

met_with: Applicants- Tolulope and Adedapo Adedayo


facility_name: ADOM SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On May 8, 2024 at 9: AM, Licensing Program Analyst (LPA) Linda Haynes completed a pre-licensing inspection of Adom Small Family Home. LPA met with Applicant Ben Adom who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients in placement. The home is a two story building with four bedrooms and three bathrooms which are set up as follows: · Bedroom #1 (Applicants) has one bed and two cribs and will sleep the applicant and two infiants. · Bedroom #2 (daughters) has one bed and sleeps the daughter. · Bedroom #3 (sons) has one bed, it sleeps the son. · Bedroom #5 (Client's) has 2 beds, it will sleep two clients. · A great room/living room, kitchen, dining area, three bathrooms, laundry room, two car garage, an office, and the backyard. The Client's bedrooms were arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The four smoke detectors were checked, and they were working properly. There are two carbon monoxide detectors in the home one is located in downstairs in the hallway and one is located upstairs in the hallway. The two carbon monoxide detectors where checked and were working properly. The home's central air conditioning module was located on the side of the house. The home's hot water heater was located in the garage. The appliances were in working order. The client's files will be locked inside a locked file box in the kitchen. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A trash can for storage of solid waste had a tight-fitting lid and was present. The sharp knives are in a locked cabinet in the kitchen. The medications will be located in a locked cabinet in the kitchen. The hot water in bathroom one (master) measured to be 110.8 degrees Fahrenheit, in bathroom two was 114.2 degrees Fahrenheit and in bathroom three 119.1 degrees Fahrenheit. The home's First Aid kit was accessible and is located in a cabinet in the kitchen and contained all required supplies. There was three fire extinguishers present in the home one is located in the kitchen, one is located in the hallway leading to the laundry room and one is located upstairs in the hallway. They were observed to be properly charged and inspected by the fire department. There are no firearms in the home as stated by the applicant. There is no pool or other body of water at the home. The backyard where clients will have access to play is fenced. The following correction needs to be made: Lock needs to be add to the Laundry room door due to cleaning products. At 9: AM a component III was conducted. An exit interview was conducted. Application will be forwarded to the Licensing Program Manager for Licensing.

met_with: Ben Adom


summary: Facility Evaluation

raw_content:
Narrative:
On May 2, 2025 at 09:45AM, Licensing Program Analyst (LPA) Rachel Vanegas arrived to the facility listed above for the purpose of conducting a post-licensing/annual inspection of the facility. LPA met with the Licensees Ben and Abena Adom who led a tour of the facility inside and outside. The home is a two-story residence with four bedrooms and three bathrooms. The current census for children in care is zero. The first story of the facility consists of: One living room, a dining room, a kitchen, family room with recreational games accessible to children in care, a storage closest for extra linen, one restroom, and Bedroom #1. There is a locked laundry room on the first floor with an access door to the attached garage. Children in care do not have access to the laundry room/garage. Bedroom #1 has two single beds that will sleep two clients and is currently vacant. There is adequate space for storage of personal belongings in the closet and drawers. The second story of the facility consists of: Bedroom #2 is the master bedroom and it sleeps the licensees. It has two cribs for two clients that are currently vacant. Bedroom #3 has a single bed that sleeps the licensees daughter. Bedroom #4 has a single bed that sleeps the licensees son. All bedrooms are arranged so that no more than two clients are in a room and there is one client per bed. **** Cleansers/chemicals are locked and stored in the locked laundry room and are inaccessible to children in care. Sharp knives are inaccessible and stored in a locked cabinet in the kitchen. The facility's smoke detectors were checked and operable. The carbon monoxide detectors are located in the hallway on the first floor and the hallway on the second floor, they were both tested and operable. There are no guns or weapons in the facility as stated by the Licensee, Ben Adom. The required postings were observed and accessible to clients including Personal Rights, Emergency Plan, Meal Menus, Visitation policies, etc. The facility outside grounds were also inspected and were observed to be clean and well maintained. Emergency exits were free from obstruction. There is no pool or other body of water located at the facility at the time of this inspection. Based on the facility inspection and current census being zero, LPA did not review any staffing or client files at the time of this inspection and there are no deficiencies cited at this time. LPA informed the Licensee to notify the Department at the time of receiving their first child in care. The Department will return to conduct staff and client file reviews at the facility. LPA provided technical assistance to the Licensee and discussed the importance of conducting biannual drills and documenting biannual disaster drills including the date, type of drill, and participants of the drill, etc. for proper Operations compliance with Disaster and Mass Casualty Planning. An exit interview was conducted and a copy of this report, LIC 9102, and appeal rights were reviewed and provided to the Licensee - Ben Adom.

visit_type: Annual

met_with: Licensee - Ben and Abena Adom


facility_name: AGNES SMALL FAMILY HOME

summary: Facility Evaluation

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Narrative:
On June 7, 2022, Licensing Program Analyst (LPA) Babatunde Aborchie and Licensing Program Manager (LPM) Abdoulaye Traore met with applicant Agnes Ogbatue this date for a Component II. LPA and LPM went over revisions needed for the application prior to licensure. LPA and LPM gave a copy of the LIC 184, Notice of Incomplete Application, and additional correspondence to assist with the revisions needed to the application. Copy of this report was provided to applicant.

met_with: Agnes Ogbatue


summary: Facility Evaluation

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Narrative:
On September 14, 2022 at 11: AM Licensing Program Analyst (LPA) Babatunde Aborchie began a Pre-Licensing inspection for a Small Family Home license. LPA met with applicant Agnes Ogbatue led a tour of the home. The facility was toured both inside and out with the applicant. Applicant is applying for a capacity of 3 ambulatory clients. The home consists of: Downstairs: Bedroom #1, It was furnished with a twin hospital bed. It sleeps one resident under legal guardian of the applicant. There were also a family room, a living room, dining area, a kitchen and one full bath. Upstairs: Bedroom #2, The room consisted of a queen bed and a toddler bed. It will sleep two residents. It is currently used as playroom. Bedroom #3, The master bedroom was furnished with a king-sized bed and two cribs, one vacant. It sleeps applicant, spouse and one foster child. Bedroom #4, The room was furnished with a queen bed. It sleeps applicant's biological daughter age 23 years. Bedroom #5, The room consisted of one full sized bed and a twin bed. It sleeps the applicant's biological son and nephew. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in a medication box in the master bedroom. Cleansers/chemicals were locked and stored in the upper kitchen cabinet. Sharp knives were inaccessible and stored in a box locked in the upper kitchen . There were no guns or weapons as stated by applicant at this time. The hot water temperature was tested and noted to be 120 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items and it was in the kitchen cabinet. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed for small family home will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Applicant/Licensee

met_with: Applicant


summary: Facility Evaluation

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Narrative:
On November 13, 2023 at 10: AM Licensing Program Analyst (LPA) Karen Beal conducted an annual random inspection of Agnes Small Family Home license. LPA met with applicant Agnes Ogbatue led a tour of the home. The facility was toured both inside and out with the licensee. Licensee has 1 child in care. Downstairs: There were also a family/play area room, a living room, laundry, dining area, a kitchen and one full bath. Bedroom #1, It was furnished with a twin hospital bed. It sleeps one resident under legal guardian of the applicant. Upstairs: Bedroom #2, The room consisted of a queen bed and a toddler bed and is used as playroom. Bedroom #3, The master bedroom was furnished with a king-sized bed and two cribs. It sleeps applicant, spouse and one foster child. Bedroom #4, The room was furnished with a queen bed. It sleeps applicant's biological daughter age 23 years. Bedroom #5, The room consisted of one full sized bed and a twin bed. It sleeps the applicant's biological son. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. ***Continued to LIC 9099-C*** Inside the facility the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in a medication box in the master bedroom. Cleansers/chemicals were locked and stored in the upper kitchen cabinet. Sharp knives were inaccessible and stored in a box locked in the upper kitchen . There were no guns or weapons as stated by applicant at this time. The hot water temperature was tested and noted to be 115 degrees. Proper storage of all food, trash cans for storage of solid waste have tight fitting lids First Aid kit were accessible with all required items and it was in the kitchen cabinet. A fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted upstairs on the wall.. The backyard where children will have access to play was completely fenced and free of hazards. The client interview was not conducted due to the child's developmental age. A technical violation issued and licensee for not An exit interview was conducted. A copy of this report was provided to Applicant/Licensee

met_with: Licensee, Agnes Ogbatue


summary: Facility Evaluation

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Narrative:
On June 5, 2025 at 9: AM Licensing Program Analyst (LPA) Maryjane Perez conducted a pre-licensing visit for a change of location at Agnes Small Family Home. LPA met with Licensee Agnes Ogbatue who led a tour of the entire home. The licensee is applying for a capacity of 2 children ages 0 to 17. The home is a one story building with 5 bedrooms and 6 bathrooms. There was an outside entry way that consisted of a play room with bathroom #1 then there was the front door entry way that consisted of a closet storing extra household items, a pool table, formal living room with couches, fire place and television. There was a hallway with locked cabinets storing medications and first aid kits. There was a laundry room that had fire extinguisher #1 and locked cabinets storing cleaning supplies/ laundry detergents. Bathroom #2 was fully functioning with water temperature measuring 137.3 degree's Fahrenheit licensee understands water temperature needs to measure between 105-120 degrees Fahrenheit. Bedroom #1 had a queen size bed, a desk area, a large walk in closet and bathroom #3 that was fully functioning that will be utilized for one client and is currently vacant. The kitchen had locked knives/ sharps in a cabinet, the refrigerator and pantry were fully stocked with 3 days of perishable and 7 days of non-perishable foods. There was a locked liquor refrigerator and a locked cabinet under the sink storing cleaning supplies and a dining room table with adequate seating. There was a family room with couches, television, a screened fire place and a land line telephone. Postings such as visitation policy, personal rights, menu, and emergency disaster plan were posted at this time. There was a movie theater room with adequate seating and a large screen. A hallway with fire extinguisher #2 and cabinets with extra linen and blankets. There was bedroom #2 that was licensees bedroom and had a crib, bathroom #4, and two walk in closets. Bedroom #3 had a queen size bed with a large walk in closet and bathroom #5 that would be utilized for one client- the room is currently vacant. There was fully furnished bedroom #4 for licensees child with a full size bed, closet space, and shared bathroom #6 with bedroom #5. Bedroom #5 had two full size beds fully furnished with a walk in closet and was occupied by licensees two biological children. There was a study that had a desk, computer and closet for storing clients locked cash resources, records, and personnel files. The study also had an exit door leading to the front of the house where the entry way to the play room was. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawers and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. Appliances were in working order. There was two garages both free of hazards. There was several trash cans that needed lids. There were no weapons/firearms as stated by licensee. The backyard was very large and had several fenced off areas that had gates with latches. There was also a built in underground pool that had a fence surrounding it measuring 4 feet 2 inches. Licensee understands that the surrounding pool fence needs to be measuring 5 feet high. Based on this inspection of the home, the facility will need the following corrections: - Trash cans in laundry room and bedrooms to have tight fitting lids - Pool fence to be measuring 5 feet high - Water temperature to be measuring between 105-120 degrees Fahrenheit. After corrections are completed, licensee will notify LPA so that another inspection can be completed. Exit interview conducted and a copy of this report was discussed and provided to licensee Anges Ogbatue.

met_with: Licensee- Agnes Ogbatue


summary: Facility Evaluation

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Narrative:
On June 19, 2025 at 10: AM Licensing Program Analyst (LPA) Maryjane Perez arrived at Agnes Small Family Home (SFH) and met with licensee Agnes who led a tour of the home. The purpose of this visit is to ensure corrections were made from the pre-licensing inspection on June 5, 2025. The licensee is applying for a capacity of 2 children ages 0 to 17. The home is a one story building with 5 bedrooms and 6 bathrooms. There was an outside entry way that consisted of a play room with bathroom #1 then there was the front door entry way that consisted of a closet storing extra household items, a pool table, formal living room with couches, fire place and television. There was a hallway with locked cabinets storing medications and first aid kits with all required elements. There was a laundry room that had fire extinguisher #1 that was operable and locked cabinets storing cleaning supplies/ laundry detergents. Bathroom #2 was fully functioning with water temperature measuring 119.4 degrees Fahrenheit. Bedroom #1 had a queen size bed, a desk area, a large walk in closet and bathroom #3 that was fully functioning that will be utilized for one client and is currently vacant. The kitchen had locked knives/ sharps in a cabinet, the refrigerator and pantry were fully stocked with 3 days of perishable and 7 days of non-perishable foods. There was a locked liquor refrigerator and a locked cabinet under the sink storing cleaning supplies and a dining room table with adequate seating. There was a family room with couches, television, a screened fire place and a land line telephone. Postings such as visitation policy, personal rights, menu, and emergency disaster plan were posted at this time. There was a movie theater room with adequate seating and a large screen. A hallway with fire extinguisher #2 and cabinets with extra linen and blankets. There was bedroom #2 that was licensees bedroom and had a crib, bathroom #4, and two walk in closets. Bedroom #3 had a queen size bed with a large walk in closet and bathroom #5 that would be utilized for one client- the room is currently vacant. There was fully furnished bedroom #4 for licensees child with a full size bed, closet space, and shared bathroom #6 with bedroom #5. Bedroom #5 had two full size beds fully furnished with a walk in closet and was occupied by licensees two biological children. There was a study that had a desk, computer and closet for storing clients locked cash resources, records, and personnel files. The study also had an exit door leading to the front of the house where the entry way to the play room was. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawers and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. Appliances were in working order. There was two garages both free of hazards. All the trash cans in the home had tight fitting lids. There were no weapons/firearms as stated by licensee. The backyard was very large and had several fenced off areas that had gates with latches. During the inspection LPA observed the underground pool to have a mesh fence surrounding it that was measured to be exactly 5 feet high. There was a self close pool gate with a latch and swung away from the pool. The pool also had an operable pump system to keep it clean. Based on this inspection of the home, the following corrections were made: - Trash cans in laundry room and bedrooms had tight fitting lids - Pool fence was measuring exactly 5 feet high - Water temperature now measured between 105-120 degrees Fahrenheit at 119.4 degrees F. Based on this inspection, all corrections were made and the home is appropriate for a capacity of 2 ambulatory clients. The request of license will be forwarded to Licensing Program Manager for final review and approval. An exit interview was conducted and a copy of this report was discussed and provided to licensee Agnes Ogbatue.


facility_name: AGUNENYE RESIDENCE

summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Reagan Cohen and Licensing Program Manager (LPM) Lakescia Smith conducted the Component II - Face to Face Interview with Chizoba Agunenye, Applicant. Application and program statement was reviewed and discussed with Mr. Agunenye. The applicant will oversee a small family home, Agunenye Residence. The following documents were received and verified by LPA and LPM: 1. LPA and LPM verified the orientation certificate for Component I. 2. LPA and LPM made a copy of Licensee's ID for the records. 3. LPA and LPM verified criminal record clearance for applicant. 4. LPA and LPM reviewed the Program Design which was out of compliance with Small Family Home Regulations and General Licensing Requirements. Applicant will refer to application instructions to revise and adhere to Section B Documents: B7-B9. Licensee will provide more details when revising B7: Facility Program Description, including: adding more details for Goals, Purpose, and Program Methods, adding specific community resource examples for Activities, adding the "maintenance of clients cash resources" in Basic Services and specifying anonymity in Registering Complaints. Licensee Licensee will provide more details when revising B8: Rules of Discipline including adding specific discipline tactics and practices for clients (Licensee can also include positive incentive structures) and specific reasons for discharging a client. Licensee will provide more details when revising B9: Admission Policies including, adding a sample admission form, changing the NSP's to be created by the Social Workers, and including a physician medical assessment. Licensee will also add sections that cover "House Rules, Visitations, Program Modifications, and Refund Policies." LPA and LPM reviewed application and Program Design and returned to applicant for revision. Applicant will submit updated Program Design by 3/7/2025. LPA and LPM discussed with applicant which placement agency applicant would be working with to receive clients from. LPA and LPM also discussed Licensing Duties and Responsibilities, specifically Small Family Home Regulations, section 83064. LPA and LPM scheduled a Pre-Licensing visit for Agunenye Residence for 3/7/2025 at 9AM. Exit interview completed.

met_with: Chizoba Agunenye


summary: Facility Evaluation

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Narrative:
On 3/7/25, Licensing Program Analyst (LPA) Reagan Cohen arrived at the above facility, for the purpose of conducting a Pre- licensing inspection for a Small Family Home License. LPA met with applicant, Chizoba Agunenye who granted access into the home. The applicant and LPA toured the facility both inside and out. Currently residing in the home is applicant and Adult 1. Applicant is requesting to be licensed for 1 client ages 3-17 ambulatory only. The home was inspected and the following was observed: This is a one-story house, with a backyard and a garage in the back. Living Room/Dinning Room: There is adequate furniture which is in good condition. The area is is equipped with a sofa, a chair, and a television. There is a fire place in the living room with a cover over it. Windows operational with curtains and screens are operational. Dining area contains a six seated dining set with six straight back chairs. Kitchen: Is equipped with an operable 5 burner stove, refrigerator/freezer, small kitchen counter appliances. The kitchen has adequate supply of perishable and non-perishable food. Applicant had an adequate amount of plate, bowels, cups, and utensils. Applicant will lock up knives in a cabinet and make them inaccessible. Laundry room: In the laundry room. Fire Extinguisher were fully charged and available. The room has a working washer and dryer. Applicant is storing all cleaning solutions in the laundry room. Applicant will lock the cabinet and ensure cleaning solutions are inaccessible. Extra linens and bedding are located in the room. The first aid kit was checked and is complete with scissors, tweezers, thermometer, and gauzes, antiseptic. Bedroom #1: Is for the Applicant and is located off of the laundry room and is equipped with bed, and a closet. Bedroom #2: is located off of the living room and is equipped with 1 full bed, clean bedding, adequate closet space, and has one working window with a screen. Bedroom also has extra blankets and pillows, games, books, a TV, and a bench with extra storage. The closet is storing licensees clothes, Applicant agreed to remove personal belongings and allow only for client storage in the clients room. Bedroom #3: is set up as an office with a desk. There is plenty of closet space with Licensee storing personal items in the closet. Applicant wants to eventually convert it into a bedroom. All rooms are clean, safe, and sanitary. Smoke alarms located in every bedroom were tested during the inspection and they were all in working condition. Bathroom #1: is located adjacent to bedroom #2 and #3. It is clear of all cleaning solutions with a working toilet, sink, and shower. The water temperature is measured at 105 degrees F. Extra towels and hygiene product are located in the room. Bathroom #2: is located in bedroom #1 it will be made inaccessible to clients. Backyard: Outdoor activity space (back yard) free of obstructions. The garage is locked and being used for storage. There is a pool, applicant will ensure proper pool coverage. There is an under the house access in the backyard Applicant will ensure it is made inaccessible and remove debris from the area. The home will utilize Tesla Model Y 2021 and Nissan Altima to transport clients in care. Current automobile insurance is with Mercury Insurance Company. Insurance and registration is current. Applicant will ensure that cleaning solutions located in the laundry room are made inaccessible. Applicant will ensure that the knives in the kitchen will be made inaccessible. Applicant agreed to install a land-line will ensure that a working phone is provided for the clients at all times. Applicant will obtain a pool cover to ensure client safety around the pool. Applicant will change application to a requested capacity of 1. Exit Interview was conducted and a copy of this report was given to the applicant. LPA will follow up with applicant for the next visit to finish up pre-licensing inspection.


summary: Facility Evaluation

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Narrative:
On April 18, 2025, at 1:00pm, Licensing Program Analyst (LPA), Reagan Cohen conducted a Small Family Home (SFH) Component III office meeting with Applicant, Chizoba Agunenye. LPA met with Applicant to discuss forms required to be maintained, available, and posted at the facility for inspections. We discussed child and personnel records that are required to be documented, retained and available for inspection. We also discussed specific requirements, concerns and issues operating a Small Family Home (SFH), such as, reporting requirements, finances, basic services, accountability, personnel requirements, admission agreements, client medical assessment, client records, telephone usage, transportation, health services, food services, responsibility for providing care and supervision, building and grounds, licensing inspections, waivers and exceptions, civil penalties, reasonable and prudent parenting standards, needs and services plan, children's records, personal rights, discipline, and activities. Licensing of facility is pending final approval due to final physical plant inspection pending. A copy of this report was provided to the Applicant, Chizoba Agunenye.


summary: Facility Evaluation

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Narrative:
On 7/29/25 at 2: PM LPA Reagan Cohen arrived at the above facility to continue the Pre-Licensing visit. LPA inspected the pool in the backyard and observed a pool fence compliant with the rules and regulations. The fence is missing a final entry panel. Applicant has ordered the part and will inform LPA when it is installed. LPA observed a land line in the clients bedroom accessible to clients in care. LPA advised applicant that they need to ensure all adults who will live or work at the facility have the appropriate clearance on guardian before having access to the facility. Applicant showed LPA paperwork for all adults giving their forms to Guardian LPA observed cleaning solutions and sharps to be locked and inaccessible. LPA observed the client bedroom to be clear and ready for client to live in. LPA advised applicant to post license, client personal rights, emergency disaster plan, activity schedule, and menu. Exit Interview was conducted and a copy of this report was given to the applicant.


summary: Facility Evaluation

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Narrative:
On 9/4/25 at 3: PM LPA Reagan Cohen arrived at the above facility to continue the Pre-Licensing visit. LPA inspected the pool in the backyard and observed a pool fence compliant with the rules and regulations. LPA observed the posting of the facility menu, activity schedule, clients personal rights, and the facility disaster plan. LPA completed the CARE tools checklist. LPA completed the pre-licensing visit inspection. LPA and applicant discussed next steps in the application. Exit Interview was conducted and a copy of this report was given to the applicant.


facility_name: ALABI SMALL FAMILY HOME

summary: Facility Evaluation

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Narrative:
On October 09, 2024, Licensing Program Analyst (LPA) Rafael Enriquez met with applicant Adedeji Olabode Alabi for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the notification of incomplete application (LIC 184), Letter of Application Revisions, and additional correspondence to assist with the revisions needed to the application. Copy of this report was emailed to applicant and a signed copy will be placed in the facility file.

met_with: Applicant- Adedeji Olabode Alabi


summary: Facility Evaluation

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Narrative:
On November 22, 2024, at 12: PM Licensing Program Analyst (LPA) Maryjane Perez arrived at Alabi Small Family Home to conduct pre-licensing inspection for an initial license. LPA met with applicant Adedeji Alabi who led a tour of the entire home. The applicant is applying for a capacity of three children ages 0 to 17. The home is a two- story building with 4 bedrooms and 3 bathrooms. The downstairs consisted of Kitchen with locked sharps and perishable and non-perishable foods, dining room with table, fully furnished living room, a bathroom with water temperature measuring 114.8 degrees, a bedroom with two twin size beds and adequate storage space for clients that is currently vacant, an office area with closet space and a garage with extra freezer space and is locked at all times. The upstairs consisted of a loft area that is fully furnished with couch, TV and gaming, closet with stocked linen and towels, a master bedroom that will be locked at all times that has a crib for a client, a laundry room, a bathroom that has cleaning supplies and detergent locked away. A bedroom for applicants biological children with a full size bed, and another bedroom for applicants biological children with a full size bed. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawers and closets for children's belongings. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. Appliances were in working order.Trash cans for storage of solid waste need tight fitting lids. LPA observed there to be a land line telephone service, knives and sharp objects were made inaccessible to children. The medication is locked in kitchen cabinets and refrigerator. The Facility Sketch and Emergency Disaster Plan were posted at this time. The backyard was observed to be clean and free of hazards. There is no pool or other body of water. Based on this inspection of the home, the facility will need the following corrections: - Obtain lids for trash cans After corrections are completed, the applicant will notify LPA so that another inspection can be completed. Exit interview conducted and a copy of this report was discussed and provided to applicant Adedeji Alabi.

met_with: Applicant Adedeji Alabi


summary: Facility Evaluation

raw_content:
Narrative:
On December 10, 2025, Licensing Program Analyst (LPA) Joon Choi conducted a post-licensing inspection for Alabi Small Family Home (SFH). LPA met with Licensee Adedeji Alabi (LIC). The facility was toured both inside and out with the licensees. Currently there is one client placed in the facility. The facility is licensed for a capacity to serve 3 minor clients. The residence is a five -bedroom, two-story house with 3 bathrooms and an open loft upstairs. There are three bedrooms upstairs and two bedrooms downstairs. Three bedrooms can be designated for clients (one upstairs and two downstairs) with the client full bathroom being downstairs. The licensee's master bedroom is to be used for an infant client. The facility consists of a living room (common area), a kitchen, dining area, upstairs open loft, garage, and the backyard. Within the facility there is a storage room downstairs by the stairwell and one upstairs that has extra linen. There are three bedrooms and two bathrooms upstairs designated for LIC and their relatives. The downstairs bathroom is for all staff and clients. One downstairs bedroom is arranged for two clients per room with two beds in that room. There is a second bedroom downstairs in case one of the clients in the shared bedroom becomes non-ambulatory. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawers and closet space for children's belongings. Towels and linens were stored in a cabinet by the clients' bedrooms. The smoke detectors and carbon monoxides were checked and were working properly. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where clients would have access. A medications lock box is available and in the kitchen. Sharp objects/knives are locked in a kitchen drawer. There were no guns or weapons as stated by applicant at this time. The hot water temperature was tested and noted to be holding at 115.5 degrees Fahrenheit. There was adequate food storage supply of two days of perishable foods and a week of non-perishable food. The food was all properly stored. Trash cans for storage of solid waste have tight fitting lids. The Facility Sketch and Emergency Disaster Plan were posted in the kitchen dining. There was no pool or other body of water; and the backyard where clients will have access to play was completely fenced and free of hazards. The garage is closed to the clients and had access to the tankless water heater. During the visit, LPAs interviewed two staff. The facility's client was at school at the time of this visit. With the assistance of LIC1, LPA reviewed one client file; there were no deficiencies, but technical advisories were provided. With the assistance of LIC1, LPA reviewed two staff files; there were no deficiencies, but technical advisories were provided With the assistance of LIC1, LPA conducted a health and safety inspection of the facility's physical plant, reviewed the facility's operations, and reviewed client and staff files. Exit interview was conducted and a copy of this report and technical advisories were provided to LIC1.

met_with: Adedeji Alabi, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On February 4, 2026, Licensing Program Analyst (LPA) Joon Choi arrived at Alabi Small Family Home (SFH) pre-licensing inspection for a change of capacity. The home was licensed for a capacity of three ambulatory clients (1 infant aged client could be placed in the licensee's room if needed; otherwise the two downstairs bedrooms could have facilitated at the most, three ambulatory clients ages 5 -17). The licensee is applying for a capacity increase of two ambulatory clients to have a total capacity of five ambulatory only clients. As stated previously, one out of the five clients could be placed in the licensee's room as long as they are of infant age. The licensee has excluded one of the previously available downstairs bedrooms as a possible client(s) room, and instead opened up one of the upstairs bedrooms for client(s) use. The Facility was toured both inside and out with the licensee. The home is a two-story building with five bedrooms and three full bathrooms (one downstairs, two upstairs). During the inspection, LPA observed that downstairs consisted of the kitchen, a living room, a dining area, a full bathroom and two bedrooms. Downstairs bedroom #1, consisted of two twin sized beds which currently sleeps one client. Bedroom #2 is now closed for clients. The upstairs consisted of three bedrooms and two full bathrooms. The master bedroom is for the licensee, a second bedroom is for the licensee's relative, and the third upstairs bedroom will be available for up to two clients. Currently, the facility's sole client is not prescribed any medications. Medication protocol and storage discussed with the licensee. Currently, the licenses a locked medication box that is ready to be used. Sharp knives were inaccessible and stored in a magnet-locked cabinet in the kitchen. The First Aid Kit was in the kitchen cabinet and contained all required items. The garage was inspected and free of hazards. The facility will utilize one primary vehicle for clients.. The water temperature was tested and measured at 115 degrees F. LPA observed a minimum of seven-day non-perishable and a three-day perishable supply of food. There was a variety of snacks available for the client. In addition to the downstairs storage closet, the upstairs had a stand alone laundry room. Continued on the Next Page A trash can was observed to have tight fitting cover. The following required posted items were observed accessible to clients: facility license, facility sketch, and emergency disaster plan. The facility upgraded from one fire extinguisher, to two fire extinguishers (one upstair, one downstairs) The upstairs master bedroom was fully furnished with one king size bed, a full bath; it sleeps the licensee and their relative. The second upstairs bedroom sleeps one other licensee's relative , it was fully furnished with a full size bed. The third upstairs bedroom (intended for clients) was furnished with a queen size bed and full size bed. Due to the limited space caused by the queen size bed/frame in this room, LPA advised the licensee to downgrade to a full size bed/frame to match the other bed, a closet and plenty of storage space was available in this room and it will sleep two clients. The sole downstairs bedroom, is fully furnished with two twin sized bed/frames and it currently sleeps one client. There is plenty of closet and drawer space in this room. All two client bedrooms were arranged to have at the most, one child per bed (two beds in each room). As stated previously, the licensee is willing to sleep one infant aged client in the upstairs master bedroom if need be. No room was commonly used for other purposes other than a bedroom, and no bedroom serves as a passageway to another room. No potential client room as access to the outside, which then prevents these rooms from being used for non-ambulatory clients. There were adequate drawers and closet space for each child's belongings. The smoke and carbon monoxide detectors were checked and working. Cleansers/chemicals were locked and stored in the upstairs master bedroom. The upstairs space includes a laundry room, a storage room and an additional full bathroom to used by the clients. All hazardous items have been made inaccessible to clients. All windows and screens were in good repair. Licensee states there are no weapons or ammunition in this home. Licensee also reported there are no surveillance cameras indoors within the facility. The facility outside grounds were also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. Clients' files and staff files were reviewed and found to comply. Based on today's inspection and observations, there are three Technical Violations being cited at this time. The request for a change of capacity will be provided to licensing program manager for final approval, after licensee has addressed the Technical Violations. An exit interview was conducted, and a copy of this report, appeals rights and technical violations were discussed and provided to Licensee.


facility_name: ALCANTAR SFH

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
C1 was in Las Vegas. Confidential interviews revealed conflicting statements. Some interviews indicated C1 was allowed to go on a community pass and was asked to return at 10:00 pm and once C1 did not return, several staff tried to call C1 and C1 blocked their phone numbers. Conflicting interviews indicated C1 was not allowed to go on walks by themselves and had a curfew to return to the facility at 8:00 pm each night. While other interviews indicated C1 left the facility through their bedroom window and staff were unaware C1 left the facility. Confidential interviews revealed conflicting statements if S1 was at the facility when C1 left the facility. Some interviews indicated S1 was at the facility and other interviews indicated there is a rotating overnight schedule and S1 and S2 were not at the facility when C1 left the facility. Thus, confidential interviews did not corroborate the allegation with a preponderance of evidence. Based on confidential interviews and records reviewed the allegation that the licensee did not ensure adequate supervision was provided to C1, which may have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report, LIC 811, and appeal rights were provided to Jacquelyn Alvarado. A copy of this report will be placed in the facility file.

Investigation Findings:
13On April 16, 2025, at 1:00 pm, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced at the facility and met with Jacquelyn Alvarado, Licensee, to discuss the investigative finding for the allegation noted above. LPA Adaleyci Caballero conducted an inspection of the facility on November 13, 2024 at 1:30 pm and no deficiencies were observed. LPA Linley interviewed one Client (C1), four Staff (S1-4), one Probation Officer (PO), and LPA was unable to interview one Client (C1) and two County Social Workers (CSW1-2), despite multiple attempts to contact them. LPA reviewed the facility documents during the investigation. On November 13, 2024, Community Care Licensing (CCL) received an allegation that the licensee did not ensure adequate supervision was provided to minor in care. It was reported that C1 left the facility on 11/01/2024 for a walk and was picked up by an unknown person and was taken to Las Vegas. It was reported that Law Enforcement made contact with C1 while they were in Las Vegas and notified the facility UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley 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 61-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: ALCANTAR SFHFACILITY NUMBER: VISIT DATE: 04/16/2025

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

report_type: Complaint Investigation

met_with: Jacquelyn Alvarado

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On Monday February 26, Licensing Program Analyst (LPA) Linda Haynes met with Applicant Diana Alvarado VIa Microsoft Teams to complete a Component II Interview. LPA asked Applicant about the finger prints for both Applicant and Applicant's mother who also resides in the home. LPA sent forms to Applicant for transfer of fingerprints. a signed copy of this LIC 809 will be placed in facility file.

met_with: Diana Alvarado


summary: Facility Evaluation

raw_content:
Narrative:
On April 10, 2024 at 9: AM, Licensing Program Analyst (LPA) Linda Haynes completed a pre-licensing inspection of Alcantar Small Family Home. LPA met with Applicant Diana Alvarado who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients in placement at this time. The home is a one story building with three bedrooms and two bathrooms which are set up as follows: · Bedroom #1 (Applicants) has one bed will sleep the applicant. · Bedroom #2 (Client's) has one bed, it will sleep one client. · Bedroom #3 (Client's) has two bed's, it sleeps two client's. · A great room/living room, kitchen, dining area, two bathrooms, laundry room, and the backyard. The Client's bedrooms were arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom. The six smoke detectors were checked, and they were working properly. The carbon monoxide detector is located in the hallway. The carbon monoxide detector was checked and is working properly. The home's central air conditioning module was located on the car port. The home's hot water heater was located in a hot water closet on the outside of the home. The appliances were in working order. The client's files will be locked inside a cabinet in the laundry room. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A trash can for storage of solid waste had a tight-fitting lid and was present. The sharp knives will be in a locked cabinet above the fridge. The medications will be located in a locked cabinet above the fridge. The hot water in bathroom one measured to be 117.1 degrees Fahrenheit and the hot water in bathroom two measured to be 117.1 degrees Fahrenheit. The home's First Aid kit was accessible and is located in the laundry room and contained all required supplies. One fire extinguisher was present in the home it is located in the kitchen by the kitchen cabinets. It was observed to be properly charged and inspected by the fire department. Licensee stated there were no weapons/firearms in the home. There is no pool or other body of water at the home. The backyard where clients will have access to play is not fenced. There are no corrections that need to be made at this time A Component III was completed. An exit interview was conducted. Application will be forwarded to the Licensing Program Manager for Licensing.


summary: Facility Evaluation

raw_content:
Narrative:
On April 22, 2025 at 10:40AM, Licensing Program Analyst (LPA) Rachel Vanegas arrived unannounced at Alcantar Small Family Home (SFH) to conduct an annual/post-licensing inspection of the facility. LPA met with the Licensees, Jacquelyn and Diana Alvarado, who led a tour of the facility which was toured both inside and out. The home is a one story building with three bedrooms and two bathrooms which are set up as follows: Bedroom #1 (Licensee) has two beds and sleeps the Licensee's. Bedroom #2 (Client's) has one bed, it sleeps one client. There is adequate storage for personal belongings in drawers and a closet. Bedroom #3 (Client's) has two beds and will sleep two client's. It is currently vacant. There is adequate storage for personal belongings in drawers and a closet. A great room/living room, kitchen, dining area, two bathrooms, laundry room, and the backyard. The client bedrooms are arranged so that no more than two clients are in one room and sleep one client per bed. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. There are combination smoke detector/carbon monoxide detectors in every bedroom and hallway. The smoke detector/carbon monoxide detectors were tested and are in properly functioning order. Home appliances were observed in proper functioning order. Medications and sharp knives are in a locked cabinet in the kitchen above the refrigerator and are inaccessible to clients in care. There is one fire extinguisher in the home that was observed to be properly charged, it is located the kitchen. **Continued on the next page** The hot water temperature was checked in the kitchen and registered at 113.4 degrees Fahrenheit. Telephone services were in working order at the time of this inspection. LPA observed that there was an adequate two day supply of perishable food and seven day supply of non-perishable food in the kitchen refrigerator and pantry. A trash can for storage of solid waste had a tight-fitting lid and is located in the kitchen. The first aid kit is located in the laundry room and contained all of the required materials. Cleaning chemicals are located in a locked storage cabinet in the laundry room. LPA also observed other required postings upon entry to the home including the facility license, foster youth personal rights, complaint hotline information, emergency numbers, etc. The backyard was observed to be clean and free of hazards. There were recreation games available for use throughout the home and backyard. There is no pool or other body of water at the facility at this time. The Licensee reported that there are no firearms or other weapons on the facility grounds at this time. LPA conducted one client file review for Client 1 (C1) and observed the needed documents in the file including, placement agreements, JV Authorization's, Health Screening, Psychotropic Medication Administration Records, consent to medical treatment authorization forms, etc. One of one client files did not contain a signature from the authorized representative for the Needs and Services Plan (NSP) and the personal rights form. LPA conducted five staff file reviews for Staff 1 (S1), Staff 2 (S2), Staff 3 (S3), Staff 4 (S4), and Staff 5 (S5) and observed that five out of five staff files contained needed documents including CPR/First Aid certificates, Drivers License, Job Duties, Criminal Background Clearance Forms, etc. Three out of five staff files reviewed did not contain signed documentation of good physical health and tuberculosis (TB) screening. Based on observation and record review, the facility is being cited one Type B violation in accordance with California Code of Regulations (CCR) (Title 22) 80065(g)(1) for not having documentation of a health screening and TB examination results on file for S3, S4, and S5. The facility is issued two technical violations in accordance with CCR Section 83070(b)(13) for not having authorized representative signature for the NSP and CCR Section 83068.2(b)(12) for not having authorized representative signature for the Personal Rights Form. An exit interview was conducted and a copy of this report, LIC 811, LIC 9102, and appeal rights were reviewed and provided to the licensee - Diana Alvarado.

met_with: Licensee - Jacquelyn Alvarado Licensee - Diana Alvarado


facility_name: ALEXANDER HOME

summary: Facility Evaluation

raw_content:
Narrative:
On October 8, 2021, Licensing Program Analyst (LPA) Rachel Bruce was met by Manager, Nicole Alexander. The purpose of this inspection is to conduct an unannounced required annual inspection. The facility is licensed for four residents. There are currently zero residents in placement. There is no staff on board at this time as there are no clients. No staff or client files were reviewed/inspected during this visit. The Admistrator file and Facility file are complete. A tour of the facility was conducted and the following was observed: No Medications are stored at this time. Fire extinguisher charged. First Aid kit stocked and available. Smoke alarms in place and operational. Food supply does not apply as there are no residents Adequate Client furnishings. Yard is free of any hazards and there are no bodies of water. There are no weapons in the residence. There is pet dog that is kept outside in a separate dog run in the backyard. There have been zero deficiencies cited at this facility during the last 12 months. Per Title Regulations, no deficiencies were cited during this inspection. A copy of the report was left with the facility representative

met_with: Nicole Alexander, Manager


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst's (LPA's) Reyna Martinez and Lidia Tinoco arrived at the Alexander home for an unannounced required annual inspection. The facility is licensed for four residents. There are currently zero residents in placement. There is no staff on board at this time as there are no clients. No client files were reviewed/inspected during this visit. The Administrator file,1 staff file and Facility file are complete. A tour of the facility was conducted and the following was observed: No Medications are stored at this time. Fire extinguisher charged. First Aid kit stocked and available. Smoke alarms in place and operational. Food supply does not apply as there are no residents Adequate Client furnishings. Yard is free of any hazards and there are no bodies of water. There are no weapons in the residence. There is pet dog that is kept outside in a separate dog run in the backyard. There have been zero deficiencies cited at this facility during the last 12 months. LPA's discussed with staff the intentions of the license. Staff informed us they plan to keep the license and will notify LPA when they intend to start taking clients again. Per Title Regulations, no deficiencies were cited during this inspection. A copy of the report was left with the facility representative.

met_with: Nicole Alexander


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Reyna Martinez arrived at the Alexander home for an unannounced required annual inspection. The facility is licensed for four residents. There are currently zero residents in placement. There is no staff on board at this time as there are no clients. No client files were reviewed/inspected during this visit. The Administrator file, 1 staff file and Facility file are complete. A tour of the facility was conducted and the following was observed: No Medications are stored at this time. Fire extinguisher charged. First Aid kit stocked and available. Smoke alarms in place and operational. Food supply does not apply as there are no residents Adequate Client furnishings. Yard is free of any hazards and there are no bodies of water. There are no weapons in the residence. There is pet dog that is kept outside in a separate dog run in the backyard. There have been zero deficiencies cited at this facility during the last 12 months. LPA discussed with staff the intentions of the license. Staff informed us they plan to keep the license and will notify LPA when they intend to start taking clients again. Per Title Regulations, no deficiencies were cited during this inspection. A copy of the report was left with the facility representative.


facility_name: ALICE NGANGA SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On June 5, 2025 at 11:am Licensing Program Analyst (LPA) Jennifer Baca met with Licensee Alice Nganga for the purpose of conducting a Component 2 meeting. LPA reviewed the revisions submitted by the Licensee that were requested by the LPA. The sections that were reviewed were the following: 1 .Discharge and Removal- 2 .Emergency Intervention Plan- 3. House Rules-Runaway plan- 4. Discipline policies- 5. Control of real property owners letter- 6. Facility Sketch- LPA verified Licensee photo ID. LPA answered other questions from the Licensee and explained the next steps. LPA has registered the licensee for Component 3 scheduled for June 11, 2025. Orientation certificate for Component 2 was signed. licensee will send updates discussed by June 9, 2025. Facility sketch needed to have the number of youths added, and ambulatory status: drivers license log to verify the current drivers license for transportation: youths bedtimes to be adjusted and be age appropriate. A copy of this report was given to the Licensee.

met_with: Alice Nganga Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 09/15/2025 at 10:08 a.m. Licensing Program Analyst (LPA) Elena Gonzalez-Soto arrived at the facility announced for the purpose of a pre-licensing inspection. LPA was greeted by Alice Ngana, Licensee who assisted with the inspection. Physical Plant: LPA observed the facility is a one-story home with four bedrooms a front yard and a backyard. LPA observed posting of personal rights, working carbon monoxide and smoke detectors, first aid kit, fire extinguisher inspected 04/2025, inaccessible cleaning solutions, food menu, hot water temperature of 112F, Fridge Temperature of 46. F, and freezer temperature of 0.6F. Operations: LPA observed posting of personal rights, observed the area for cash storage, and discussed there shall be at least one medical resource available to call at all times and someone who is capable of communicating with emergency personnel in the facility at all times.\ Staffing: LPA reviewed Licensee's personnel record, and observed criminal record clearance, mandated reporter statement and CPR and First Aid Certification. LPA reviewed Staff 1 (S1) personnel record and observed criminal record clearance and mandated reporter statement. S1 did not have on file a CPR and First Aid Certification. Cont. on LIC812-C Client Records: LPA discussed that client records shall remain available to the licensing agency to inspect, audit, and copy upon request. At this time, there are no clients in care, however pending placement of a client into the facility, the licensee is prepared to provide care and has the following maintained at the facility: a locked and secure location for cash resources to be entrusted to Licensee; a secure location and process for locking and maintaining medication in a centrally stored location; and maintaining separate client records for each client to ensure the confidentiality of the records maintained. Licensee stated S1 has a current CPR and First Aid Certificate. LPA instructed Licensee to print out a copy and place it in S1's personnel file. The facility has no swimming pool or bodies of water on the property, and no use of security recording cameras in private areas. LPA conducted two interviews. LPA completed Component Three of the licensing process with the Licensee. An exit interview was conducted and a copy of this report was issued to Alice Ngana, Licensee.

met_with: Alice Ngana, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On 12/22/2025 at 11: AM Licensing Program Analyst (LPA) Elena Gonzalez-Soto arrived unannounced at the above facility for a case management inspection related to an incident report. LPA met with Alice Ngana who assisted with the inspection. LPA reviewed one client file and obtained the following documents: admission agreement, client history, JV220/223, Health and Education Passport, CFT notes, and IEP. LPA conducted an inspection of the facility. LPA obtained a copy of the LIC 500. No citations were issued during today's inspection. Further follow up is needed. An exit interview was conducted and a copy of this report was issued to Alice Nganga, Licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On 01/02/2025 at 9: AM Licensing Program Analyst (LPA), Elena Gonzalez-Soto, arrived unannounced at the above facility to continue a case management inspection related to an incident report dated 12/10/2025. LPA met with Alice Ngana, Licensee who assisted with the inspection. LPA conducted an inspection of the facility. LPA conducted two confidential interviews. The facility is being issued a Technical Violation under the California Code of Regulations, Title 22, Division 6, Chapter 1, Article 06 (Continuing Requirements), Section 80068.2 (Needs and Services Plan). The facility is being issued a citation under the California Code of Regulations, Title 22, Division 6, Chapter 1, Article 06 (Continuing Requirements),Section 80078 (Responsibility for Providing Care and Supervision). An exit interview was conducted, a copy of this report and appeal rights were issued to Alice Ngana, Licensee.

met_with: Alice Nganga, Licensee


facility_name: ALICE SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Ashley Ruacho conducted a Component II - Face to Face Meeting at the Monterey Park Regional Office. The following were present: Alice Wambui, Applicant. LPA discussed their application and program statement and advised them of the following corrections. The following information must be completed and submitted to Licensing: Part A LIC Affidavit Regarding Client Cash Resources - amount that will be handled. LIC Personnel Report - Husband and Mother-in-Law need to be listed. LIC Personnel Report - Date of physical. LIC Health Screening Report- New x-ray required. LIC 508D Criminal Record Statement LIC 610C Emergency Disaster Plan - Section IV has an address missing. Brief letter stating they authorize the relocation of the Small Family Home. LIC Fire Inspection - pending Part B Statement of Purpose - placements foster care or regional centers. Page 40- Week one activities - elaborate on learning to build fires. Page 41 - Plan for child and family interaction- Elaborate on this, what is the plan to incorporate foster youth families. Page 45- #5 states - PRN - what is the meaning. Part B Number 6- explain more about how incident will be corrected. Number 7- Elaborate more or include all natural ones used. Number 9 - Cannot use time out for when staff need a break from child's behavior. Page 53- Placing agency typo No restraints used in Small Family Home (SFH). Page 54- People to notify- 911 typo Part B Emergency information. Sign in and sign out procedures. Immunization requirements The following documents were received from the Applicant during the Face To Face Meeting: - SFH Orientation Certificate The Pre-Licensing inspection was scheduled during today's visit. An exit interview was conducted, and a signed copy of this report was provided to the applicant.

met_with: Alice Wambui, Applicant