summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with Andrew Hernandez, Senior Director of Program Services, to commence the annual required inspection. The following was observed: Hillsides group home currently provides care for 17 minors under the Office of Refugee Resettlement and 6 minors under Commercial Insurance Beds Program. Hillsides Group Home is set up as follows: There are five (5) cottages (Sierra, Tradewinds, Canyon, Arroyo, and Redwood) located on the main campus. Each cottage has a common living area equipped with adequate seating and a television, dining area with adequate seating for family style dining, three (3) - four (4) bathrooms, a laundry room with storage for extra linens, bedding, and comforters, kitchen, and ten (10) bedrooms. Each bedroom is equipped with one (1) twin-size bed, dresser, desk, adequate lighting, and ample closet space. All beds have clean and adequate bedding. Laundry supplies are kept in the laundry room in a locked storage cabinet. Individual personal hygiene boxes are kept in a cabinet in the laundry room. LPA Jones-Steward toured the cottages and observed the following: Sierra Cottage: This cottage is set up for commercial insurance beds. This cottage has 10 bedrooms and 4 client bathrooms and 1 staff bathroom. All bedrooms have single beds in good condition and adequate storage space. Each bedroom has a working carbon monoxide detector and sprinkler head. There is a laundry room with all cleaning supplies safely stored. All bathroom and kitchen equipment is clean and in good working condition. Floor plan and notice of personal rights are posted. There are no window coverings in one bedroom where curtains present safety concerns for client. LPA advised the director to find a safe alternative to curtains. There are currently 5 clients assigned to this Sierra Cottage. Tradewinds cottage: Tradewinds consists of 10 bedrooms and 3 full bathrooms. Each bedroom has a single twin bed with linens in good condition. The latch on window in bedroom #2 was broken; thus window could not be opened. This were corrected during the inspection. There are no security bars on bedroom windows. All bedrooms have working carbon monoxide detectors and sprinkler valves. There is a fire pull station and a fire extinguisher in the cottage. All three bathrooms have equipment that is clean and in working order. Hot water is at a safe temperature. There are currently no clients in Tradewinds Cottage. Arroyo Cottage: This cottage is set up for unaccompanied minors. This cottage has 10 bedrooms and 4 bathrooms. All bedrooms have single beds in good condition and adequate storage space. Each bedroom has a working smoke detector and carbon monoxide detector. All windows are operational. There is a fire extinguisher in the cottage There is a laundry room with all cleaning supplies safely stored. All bathroom are in good repair. The right rear burner on the gas powered kitchen stove does not ignite. Floor plan and notice of personal rights are posted. There are currently 8 male clients assigned to this cottage. Canyon Cottage: This cottage is set up for unaccompanied minors. This cottage has 10 bedrooms and 4 bathrooms. . All bedrooms have single beds in good condition and adequate storage space. Each bedroom has a working smoke detector and carbon monoxide detector. There is a fire extinguisher in the cottage There is a laundry room with all cleaning supplies safely stored. All bathroom and kitchen equipment is clean and in good working condition. Floor plan and notice of personal rights are posted. There are currently 9 female clients assigned to this cottage. Redwood Cottage: This cottage is set up for commercial insurance beds. This cottage has 10 bedrooms and 3 client bathrooms and 1 staff bathroom. There is currently one client assigned to this cottage. All bedrooms have single beds in good condition and adequate storage space. Each bedroom has a working carbon monoxide detector and sprinkler head. There is a laundry room with all cleaning supplies safely stored. All bathroom and kitchen equipment is clean and in good working condition. Floor plan and notice of personal rights are posted. There were no deficiencies cited on this date.

met_with: Andrew Hernandez, Director


state: CA

facility_name: HILLSIDES GROUP HOME

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward visited the facility to continue the annual inspection. LPA reviewed 6 staff files and performed two staff interviews. All staff files were complete. There were no deficiencies cited. Client file reviews and interviews will be conducted at a future date.

report_type: Facility Evaluation

visit_type: Case Management


facility_name: HIQMA RESIDENTIAL HOME GRV

summary: Facility Evaluation

raw_content:
Narrative:
On March 5, 2025, at 10am, Licensing Program Analyst (LPA) Cynthia Robinson and Licensing Program Manager (LPM) Cheraki Davis met with HIQMA Residential Home GRV Applicant Adedapo Ajibade to complete Component II of the Group Home (GH) application process, the face-to-face interview. The Applicant attended Component I, the GH orientation, on October 23, 2024. Ade Salau were also in attendance. The purpose of the meeting was to review the GH application process with the applicant, review incomplete licensing (LIC) application forms, and resolve any questions or concerns to ensure that the applicant understands the process and can provide the services outlined in the Program Statement (PS) and Plan of Operation (POO) submitted. LPA verified that the Applicant had applicable clearances and was associated with the GH. During the meeting, LPA reviewed the LIC application forms and the LIC Notification of Incomplete Application, sent to the Applicant on February 12, 2025. During the meeting, LPA received updated LIC forms that were incomplete or missing. LPA informed the Applicant that the PS and POO would require revisions and they have been provided to the Applicant. The LPA discussed the written plans and policies with the Applicant, including the discipline policy, to ensure it aligned with personal rights, trauma-informed emergency interventions, planned activities, administrative organization, staff job descriptions, and the training requirements and qualifications for the Administrator, Facility Manager, and Direct Care Staff. LPA reminded the Applicant of the staff and client ratios and reviewed the regulations outlined in the GH Interim Licensing Standards 84065.5. Regarding the qualifications for the Administrator, the Applicant currently holds an Administrator certificate that is set to expire on April 13, 2025. Applicant verified that they have renewed the certificate prior to expiration and will send the updated certificate once received. (Continued on LIC 809C...) The Applicant does meet the qualifications for Administrator specified in 84064 by holding a bachelor's degree. LPA requested documentation of bachelor's degree from Applicant. Applicant meets work experience and having administration experience. The LPA also discussed alternative financing options with the Applicant to cover the three- month operating cost and informed the Applicant that the funds must be verifiable. LPA and LPM concluded the interview by discussing the next steps in the application process and requesting additional documentation. The Applicant was also provided with Foster Bill of Rights for Youth pamphlet, Employee Rights pamphlet, and Caregiver Training information. The following documents were requested from the Applicant due by March 26, 2025: A Documents LIC Monthly Operating Statement - To be used to provide an estimated operating budget. The number of clients must correspond with the requested capacity of five and all estimated costs shall be reasonable. LIC Balance Sheet Additional Documents Requested Updated Lease Agreement A copy of this report was emailed to the Applicant Adedapo Ajibade for signature. The original copy of the signed report will be placed in the facility file.

met_with: Applicant Adedapo Ajibade


summary: Facility Evaluation

raw_content:
Narrative:
On August 5, 2025, at 9: AM, Licensing Program Analyst (LPA) Cynthia Robinson conducted an announced pre-licensing inspection at Hiqma Residential Home Grv. The applicant Adedapo Ajibade submitted a Group Home (GH) application with a capacity of five clients. Presently there are no clients in care at the proposed new location. The pre-licensing inspection was conducted with the assistance of Applicants, Adedapo Ajibade and Ademola Salau. The facility is a one-story home with four bedrooms and two bathrooms, and a two-car garage. The facility has a living room and dining room in the kitchen area with a large dining room table. There are three combination smoke detectors and carbon monoxide devices located throughout the home and in working order. There is one sliding door exit in the dining room/living room leading to the backyard. There are no pools of bodies of water present. There is a landline telephone that is in working order that will be available to clients located in the living room. There were no observable hazards or obstructions by the walkways and entries/exits. The backyard has a detached covered patio with electrical connected for lights and fans. The backyard also has a built-in gas fireplace with a television available for entertainment alongside an outside dining table and chairs. The central ac unit is in the backyard behind the house located on the left side of the house right along the built-in fireplace. There is a large storage unit located on the right side of the house that is planned to be used as a storage unit with possible plans to have it renovated as staff space at a unknown future date and all plans will be submitted to Licensing if there are any changes. The large storage unit currently holds storage shelves and there are two entryways into the storage unit which both have locks to be made inaccessible to clients. (Continued On LIC 809C...) The Applicant has a working fire extinguisher located by the sliding door leading to the backyard. The garage will be made inaccessible to clients and store extra storage items and cleaning supplies. There are two cameras on the outside premise of the home, one is located at the front door and the second is located on the garage for a view of the driveway. The Applicants has sufficient dishes, cups and silverware for client use and the gas stove is in working order. There are three stools off the kitchen island for more available seating. The sharp knives are locked in the kitchen pantry closet. LPA observed games and puzzles for clients. There is one bedroom located off the kitchen area (bedroom #1) that will be used for two clients with an attached full bathroom (bathroom #1) and closet that will be available for client use. There are three bedrooms located off the main hallway (bedroom #2, bedroom #3 and bedroom #4) and one full bathroom located off the main hallway (bathroom #2 ). The bedrooms will be arranged so that no more than two clients are in a room, and there will be one client per bed. Bedroom #2 will be utilized as a staff office and a confidential area for clients to have a private space if needed. Bedroom #2 or the staff office currently has one small desk for a computer and an office chair with plans to purchase more staff office supplies and another office desk for staff to utilize. There is a laundry room located right outside bedroom #4. Applicants plan to purchase a cabinet to house locked cleaning and laundry detergent supplies. All bedrooms observed the individual beds to be in good repair, equipped with good springs, clean mattresses and pillows. There is an adequate closet and dresser space for clients. The bathrooms were observed to be in clean and working order. LPA tested the water, and it read at 106.8 degrees Fahrenheit in the kitchen and 113 degrees Fahrenheit in the bathrooms. The Applicants were advised that the hot water should measure within 105 degrees Fahrenheit and 120 degrees Fahrenheit. The facility has one facility vehicle, a Toyota Sienna that was observed to be in good working condition. (Continued on LIC 809C...) The following deficiencies were observed: There were no client folders available to house client records. During the visit applicant Adedapo went to purchase file folders to house the client records. The following discussions were had: The applicant is to ensure that all incoming staff will be associated with facility prior to accepting and working with clients and the facility to be in compliance with staffing to client ratio. The applicant is to provide another working station in the staff office for maximum efficiency and client confidential area. The facility will only accept ambulatory and minor clients. The facility will accept clients from Inland Regional Center once vendorized and will look into County requirements as well. After a final review, the facility will be submitted for licensure. Pre-Licensing inspection was completed, and a copy of this report was given to the Applicant, Adedapo Ajibade.

visit_type: Prelicensing

met_with: Applicant, Adedapo Ajibade


summary: Facility Evaluation

raw_content:
Narrative:
On December 19, 2025, at 8:40am, Licensing Program Analyst (LPA), Cynthia Robinson arrived unannounced at the above facility for the purpose of conducting post-licensing inspection. LPA were greeted by facility licensee, Adedapo Ajibade. The Group Home (GH) is approved capacity of five and has the fire clearance for the approved capacity. There are currently no clients in care at this moment. The facility is a one-story home with four bedrooms and two bathrooms, and a two-car garage. The facility has a living room and dining room in the kitchen area with a large dining room table. There are three combination smoke detectors and carbon monoxide devices located throughout the home and in working order. There is one sliding door exit in the dining room/living room leading to the backyard. There are no pools of bodies of water present. There is a landline telephone that is in working order that will be available to clients located in the living room. There were no observable hazards or obstructions by the walkways and entries/exits. Three of the bedrooms are going to be utilized for clients and one bedroom will be utilized as the staff office. The bedrooms will be arranged so that no more than two clients are in a room, and there will be one client per bed. Medication is centrally stored in a locked box located in the pantry. Knives are kept in a locked box located in the pantry made inaccessible to clients. LPA did not review staff or client files, as there are currently no clients present at the facility. However, LPA advised the Administrator regarding the required staff background check process and staff-to-client ratio requirements. (Continued on LIC 809C...) LPA reminded the Administrator that all facility staff must have a completed and cleared background check prior to having any contact with children in care. Per Licensee statement they are in the process of hiring qualified staff. The facility has one van that seats seven, which is presently available for transportation for clients and is in good working condition. Based on today's inspection for post licensing, there were no deficiencies found. Exit interview conducted and a copy of this report was provided to the facility Licensee, Adedapo Ajibade.

met_with: Adedapo Ajibade, Licensee


facility_name: HIS KINGDOM FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Reagan Cohen conducted the Component II - Face to Face Interview with Chuwang R. Pam, Applicant. Application and program statement was reviewed and discussed with applicant. The applicant will oversee a group home for clients with special health care needs, His kingdom Family Home. The following documents were received and verified by LPA: 1. LPA verified the orientation certificate for Component I. 2. LPA made a copy of Licensee's ID for the records. 3. LPA reviewed criminal record clearance for applicant, and saw that it was incomplete. Applicant will complete for and contact guardian to confirm clearance. 4. LPA reviewed application and informed applicant to update the capacity from 6 to 5 and to make sure the age and gender of clients served matches on both the application and program statement. In addition applicant will also: Update the Board of Directors Statement. Make sure there is no conflict of interest between the administrator, board member and landlord. Update the lease agreement. Update all forms to state the facilities proper name 'His Kingdom Family Home.' Obtain a surety bond and update LIC 401 and 401a to reflect the proper amounts. Update LIC 500 to have a Facility Manager and get a new fire clearance with the proper capacity of 5. Update facility sketch LIC 9099 to only have 5 beds that matches the capacity. Complete the LIC C the emergency disaster plan. Update LIC 9106 by not taking clients who are dependants or wards/delinquents, change staff ratio to 1:2 and 1:3, add staff education qualifications, and sign. 5. LPA reviewed the Program Statement which was out of compliance with Group Home with Special Health Care Needs Regulations and General Licensing Requirements. Applicant will refer to application instructions to revise and adhere to the requirements. LPA reviewed application and Program Statement and returned to applicant for revision. Applicant will make the following changes to the program statement: Remove all references to: minor parents, child care, TILP's ILP's, fostor care, and things unrelated to a Group Home Facility. Add a land line or designated phone for the facility. Update the capacity from 6 to 5. Remove references to His Kingdom providing mental and healthcare services, those services are to be provided by the client medical professional physician. Will have the Psychiatric Mobil Team (PET) responsible for psychiatric hospitalization of youth. Add attachment or remove mention of attachments where applicable. Add more personal rights for the clients, including but not limited to: education, telephone, and mail rights. Explain birth the accepted forms of discipline and prohibited forms of discipline. Will add confidential/anonymous capabilities to the grievance procedures. Add abuse reporting procedures for staff. Include copies of the updated lease agreement and Board of Directors Statement. Applicant will submit updated and revised application, Program Design, and LIC 200 by 05/20/2025. LPA scheduled a Pre-Licensing visit for for 05/20/2025 at 10AM. Exit interview completed.

met_with: Chuwang R. Pam


summary: Facility Evaluation

raw_content:
Narrative:
On 5/20/25, Licensing Program Analyst (LPA) Reagan Cohen arrived at the above facility, for the purpose of conducting a Pre- licensing inspection for a Group Home Special Healthcare Needs License. LPA met with applicant, Chuwang Pam and landlord Dr. William Chima who granted access into the home. The applicant and LPA toured the facility both inside and out. Currently residing in the home is Dr. Chima who will be moving out before licence is granted. Applicant is requesting to be licensed for 5 clients ages 7-13 ambulatory only. The home was inspected and the following was observed: This is a two-story house, with a front yard, backyard, and a garage in the back. There are working duel smoke/carbon monoxide detector in every bedroom. They are synched throughout the house. Living Room: There is adequate lighting and a ceiling fan. There is a TV and a coffee table. There is a L shaped sofa, and two chairs. There are cabinets for storage. The living room leads to the kitchen, upstairs, and a hallway to the bedrooms. Bedroom #1: For clients. There are two twin beds. There is adequate lighting and a ceiling fan. There is a door that leads to the kitchen. There is adequate closet storage space and two small bedside dressers. Storage space is filled with extra linens. There are two windows in working order. There are anti-burglar bars on the windows that need to be fixed and made able to open from the inside. Applicant will make the necessary changes. Bathroom #1: is located off of the hallway adjacent to bedroom #1 and #2. It is clear of all cleaning solutions with a working toilet, sink, and shower. There are extra towels in the bathroom. Water temp was measured to be 105 degree F. Bedroom #2: For clients. There is twin bed. There is adequate lighting and a ceiling fan. There is adequate closet storage space and one small bedside dresser. Storage space is filled with extra linens. There are two windows in working order. There are anti-burglar bars on the windows that need to be fixed and made able to open from the inside. Applicant will make the necessary changes. Kitchen/Dinning Room: Is equipped with an operable 4 burner stove, refrigerator/freezer, and small kitchen counter appliances. Applicant will assign locked cabinet for sharps and client medication to be inaccessible to clients in care. Below the sink will be a locked cabinet for cleaning solutions. There are two dinning tables with adequate seating. There is a TV and a fan. Applicant will stock fridge and freezer with and adequate amount of perishable and non-perishable food. Applicant will place in the kitchen a first aid kit was checked to be complete with scissors, tweezers, thermometer, and gauzes, antiseptic. Applicant will also obtain a fire Extinguisher to be fully charged and available in the kitchen. The kitchen leads to bathroom #3, the backyard and the den. Den: There is a den with couches, sofas, and chairs. There is adequate lighting, a ceiling fan, and coffee tables. Applicant will turn the den into an activity/game/hangout room. Applicant will clear out the small bar area in the room. Bathroom #3: This is a half bathroom with a working sink and toilet. There is also a washer and dryer set in the bathroom. Applicant will make this bathroom a staff only bathroom. Up Stairs: Bedroom #3: For clients. There are two twin beds. There is adequate lighting and a ceiling fan. There is adequate closet storage space and two small bedside dressers. Storage space is filled with extra linens. There are two windows in working order. Bathroom #2: is located upstairs adjacent to bedroom #3. It is clear of all cleaning solutions with a working toilet, two sinks, and a shower. There is a fan. There are extra towels in the bathroom. Water temp was measured to be 105 degree F. Master Bedroom: There is a master bedroom upstairs. It will be converted to an office. It will be locked and made inaccessible to clients. Applicant will have an are to store client and staff files and all other facility paperwork. Office Space: There is a landing area off the stairs that is currently being as an office. There are two computers and two desks. Out Side: Front Yard: There is a front yard with adequate space for clients to run around and hang out. Backyard: There is a back yard has a fountain. There is some outdoor seating. The backyard leads to the side yard and garage. There is a side path that leads to the front yard. There is some excess debris and furniture that applicant will remove. Garage: The garage will be used as excess storage and will remain locked and be made inaccessible to clients. Side Yard: There is a side yard next to the garage and backyard. There is a gate and it can be made locked and inaccessible. Applicant is thinking of making it an outdoor exercise and recreation area. There is some excess storage and debris that needs to be cleared out first. Applicant will keep the area locked and inaccessible until it is cleaned out. LPA will follow up with applicant for Component III orientation. LPA will also return to check all the changes that applicant agreed to. LPA will also be checking the facility vehicle and insurance. Applicant will also provide a facility telephone. Exit Interview was conducted and a copy of this report was given to the applicant.

met_with: Dr.William Chima


summary: Facility Evaluation

raw_content:
Narrative:
On 8/28/25, Licensing Program Analyst (LPA) Reagan Cohen arrived at the above facility, for the purpose of conducting a Pre-licensing continuation inspection for a Group Home Special Healthcare Needs License. LPA met with applicant, Chuwang Pam and landlord Dr. William Chima who granted access into the home. The applicant and LPA toured the facility both inside and out. Applicant is requesting to be licensed for 5 clients ages 7-13 ambulatory only. LPA continued the CARE tools checklist. LPA observed 2 complete first aid kit's. LPA observed cleaning chemicals and solutions made locked and inaccessible separate from food storage. LPA observed the bedroom windows to open and the window bars to release and be in working order. LPA observed a fully charged fire extinguisher. LPA inspected the facility vehicle and found it to be in working order. LPA observed the vehicle insurance. Applicant will post sample menu, sample activity schedule, disaster plan, and clients rights. Applicant will create a space for medication that is inaccessible to clients. Applicant will ensure there is an adequate supply of non-perishable food. Applicant will replace the window screen in bedroom #1. Applicant will add a tweezer and thermometer to the first aid kit. Applicant will remove kitchen appliances from the back yard. Applicant will remover bar materials from the den. Applicant will create and post the grievance procedures and box. Applicant will send paperwork to LPA ensuring that the landlord is not on the board of directors. LPA will return on 9/11 to ensure the changes and fixes are made. Exit interview complete. A copy of this report was given to the applicant.

met_with: Chuwang Pam


summary: Facility Evaluation

raw_content:
Narrative:
On 9/11/25, Licensing Program Analyst (LPA) Reagan Cohen arrived at the above facility, for the purpose of conducting a Pre-licensing continuation inspection for a Group Home Special Healthcare Needs License. LPA met with applicant, Chuwang Pam and landlord Dr. William Chima who granted access into the home. The applicant and LPA toured the facility both inside and out. Applicant is requesting to be licensed for 5 clients ages 7-13 ambulatory only. LPA continued the CARE tools checklist. LPA observed public posting of the sample menu, activity schedule, and disaster plan. Applicant informed LPA that client meds will be made inaccessible in the locked closet. LPA observed an adequate amount of non-perishable food in the pantry. LPA observed tweezers and a thermometer in the first aid kit. LPA observed the window screen to be in repair and working order in bed room #1. LPA observed the outdoor and indoor areas to be free of debris and safe for clients. LPA will return to the facility to ensure that a complaint/grievance box is created and available for clients. LPA will return to ensure that clients rights are posted. LPA will return on 9/18 to ensure the changes and fixes are made. Exit interview complete. A copy of this report was given to the applicant.

met_with: Dr.William Chima & Chuwang Pam Applicant


facility_name: HOLIDAY HOUSE

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

raw_content:
Narrative:
The investigation revealed that the facility staff left a cup of tea unattended causing a non-verbal client 1st and 2nd degree burns from attempting to drink the tea that was severely hot. Facilty staff placed the tea on the coffee table located in the living room and proceeded with his normal work duties. The facilty administrator stated that the client tends to eat and drink other people's stuff and staff have redirected him many times. Interviews with staff revealed that client was in his room getting ready for bed and may have stepped out of his room to walk around the house and might have seen the cup and drank it when no one was looking. Client is non-verbal. Staff stated that no one heard the client scream or make noises from the injury. Staff stated that there was no observation from the night staff of any possible injuries to client because client might have gone to his room after the incident and went to sleep. Staff stated that visual checks are done during the day and night and the client's lights were off. The facility administrator stated that a morning staff observed redness on clients face when he woke up and contacted him to report the injuries. The facility administrator reported that he immediately took client to urgent care where it was determined client had first degree burns to the middle of upper chest, second degree burns to the bottom lip, chin and right side of his cheek. Therefore, the facility administrator interviewed night staff and terminated that a staff was at fault of leaving his hot tea cup unattended causing negligence on his part. In addition, another night staff that was working the night shift the day of the incident and was unaware as to how the client sustained the injuries because he was attending to the other clients. The facility client was non-verbal and had a history of exhibiting inappropriate behaviors. Based on the information gathered, the preponderance of evidence to prove the allegation was met, therefore the allegation is substantiated per California Code of Regulations Title 22 - refer to LIC9099-D for deficiencies and a civil penalty of $150 will be assessed in conjunction with the confirmed deficiency. A copy of this report, Confidential Names Form, LIC 9099-D for deficiency and Appeal Rights were provided to the facility representative.

Investigation Findings:
13On February 15, 2023, at 10: AM, Licensing Program Analyst (LPA) Claudia Portillo conducted a follow-up inspection to deliver the findings of a complaint investigation concerning the allegation above. LPA Portillo discussed the findings with the facility representative named above. During the course of the investigation, LPA Portillo interviewed facility personnel on 2/13/23 (see Confidential Names Form dated February 15, 2023). LPA Portillo also reviewed documents including medical records, staff training, facility correction action plans, client records and facility incident reports. It was alleged that youth in care sustained injuries due to staff's lack of supervision. (CONTINUED) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Claudia Portillo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HOLIDAY HOUSEFACILITY NUMBER: 197805600

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

Deficiencies:
80078(a): 1
2
3
4
5
6
7

report_type: Complaint Investigation

met_with: Ricardo Montes

complaint_status: SUBSTANTIATED

title:
Responsibility for providing care and supervision. The licensee shall provide care and supervision as necessary to meet the client's needs.

This requirement is not met as evidence by

description:
1
2
3
4
5
6
7


summary: Facility Evaluation

raw_content:
Narrative:
On April 25, 2022 at 8: AM Licensing Program Analyst (LPA) Noubar Yerkatyan conducted an unannounced inspection at the above facility for the purpose of conducting an annual/required inspection. LPA met with facility Administrator, Ricardo Montes. LPA and Administrator toured the facility. LPA obtained and reviewed the following updated documentation: LIC Personnel and Client Roster LIC C Emergency Disaster Plan Board of Directors report and Program Statement Employee Grievance Policy/ Grievance Procedures Crisis Prevention Intervention Training's Emergency Preparedness: Disaster and Mass Casualties Drills Emergency Evacuation Routes Facility Monthly Activities Calendar Emergency Intervention Plan Complaint Procedures The facility was in full compliance with 7 applicable areas of the Compliance and Regulatory Enforcement (CARE) tools for Children's Residential Licenses. Annual compliance review consisted of the following domains: Physical plant, operations, disaster preparedness plan, emergency intervention, staffing, and client records. Community Care Licensing (CCL) focuses its efforts on three priority areas: prevention, compliance, and enforcement. One fire extinguisher throughout the facility is fully charged and last serviced on 07/13/2021. The facility has a working telephone that is accessible to clients and staff. All passageways and grounds were free of any obstructions. The medications, cleaning solutions, and knives were locked inside the cabinets in the kitchen inaccessible to the clients. There was perishable foods enough for 3 days and non-perishable foods enough for client's consumption for more than a week. Each bedroom has one twin bed/extra long with clean sheets and linens. There were drawers and closet space in each bedroom for client use. The hot water temperature was tested and was in working order. At the time of this inspection the facility was observed to be clean, safe, and in good repair. Administrator is on site at least 20 hours a week. The facility has a central administrative file under their main facility: Hope House facility. The facility has a Volkswagen van used to transport clients. The vehicle has an active insurance policy. The facility maintains an equipment/vehicle safety log in the headquarters office that is monitored by the Maintenance Supervisor. The vehicle is serviced every quarter or as needed. For this review, one (1) San Andreas Regional Center client was selected for the sample to assess the level of care and services they receive. Additionally, LPA reviewed two (2) staff files for compliance with Title Regulations and Interim Licensing Requirements. LPA also conducted interviews with two staff members and one client. Client was unable to be interviewed due to a speech delay. An exit interview was conducted. LPA provided the facility representative above a signed copy the LIC 809 and LIC 811 reports. There were no deficiencies cited at the time of this inspection.

visit_type: Annual

met_with: Ricardo Montes, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On April 24, 2023 at 9: AM Licensing Program Analyst (LPA) Ashley Ruacho and Licensing Program Manager (LPM) Tira Logan-Shanks conducted an unannounced inspection at the above facility for the purpose of conducting an annual/required inspection. LPA met with facility Administrator, Ricardo Montes. LPA and Administrator toured the facility. LPA obtained and reviewed the following updated documentation: · LIC Personnel and Client Roster · LIC C Emergency Disaster Plan · Board of Directors report and Program Statement · Employee Grievance Policy/ Grievance Procedures · Crisis Prevention Intervention Training's · Emergency Preparedness: Disaster and Mass Casualties Drills · Emergency Evacuation Routes · Facility Monthly Activities Calendar · Emergency Intervention Plan · Complaint Procedures The facility was in full compliance with 7 applicable areas of the Compliance and Regulatory Enforcement (CARE) tools for Children's Residential Licenses. Annual compliance review consisted of the following domains: Physical plant, operations, disaster preparedness plan, emergency intervention, staffing, and client records. Community Care Licensing (CCL) focuses its efforts on three priority areas: prevention, compliance, and enforcement. One fire extinguisher throughout the facility is fully charged and last serviced on 02/02/2023. The facility has a working telephone that is accessible to clients and staff. All passageways and grounds were free of any obstructions. The medications, cleaning solutions, and knives were locked inside the cabinets in the kitchen inaccessible to the clients. There was perishable foods enough for 3 days and non-perishable foods enough for client's consumption for more than a week. Each bedroom has one twin bed/extra long with clean sheets and linens. There were drawers and closet space in each bedroom for client use. The hot water temperature was tested and was in working order. At the time of this inspection the facility was observed to be clean, safe, and in good repair. Administrator is on site at least 20 hours a week. The facility has a central administrative file under their main facility: Hope House facility. The facility has a Volkswagen van used to transport clients. The vehicle has an active insurance policy. The facility maintains an equipment/vehicle safety log in the headquarters office that is monitored by the Maintenance Supervisor. The vehicle is serviced every quarter or as needed. For this review, three (3) San Gabriel Pomona Regional Center clients were selected for the sample to assess the level of care and services they receive. Additionally, LPA reviewed three (3) staff files for compliance with Title Regulations and Interim Licensing Requirements. LPA conducted interviews with two staff members. All clients are non-verbal therefore clients were unable to be interviewed due to a speech delay. An exit interview was conducted. LPA provided the facility administrator a signed copy the LIC 809 and LIC 811 reports. There were no deficiencies cited at the time of this inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On April 24th, 2024, at 10: AM Licensing Program Analyst (LPA) Ashley Ruacho conducted an unannounced inspection at the above facility for the purpose of conducting an annual/required inspection. LPA met with facility Administrator, Ricardo Montes. LPA and Administrator toured the facility. LPA obtained and reviewed the following updated documentation: · LIC Personnel and Client Roster · LIC C Emergency Disaster Plan · Board of Directors report and Program Statement · Employee Grievance Policy/ Grievance Procedures · Crisis Prevention Intervention Training's · Emergency Preparedness: Disaster and Mass Casualties Drills · Emergency Evacuation Routes · Facility Monthly Activities Calendar · Emergency Intervention Plan · Complaint Procedures The facility was in full compliance with 7 applicable areas of the Compliance and Regulatory Enforcement (CARE) tools for Children's Residential Licenses. Annual compliance review consisted of the following domains: Physical plant, operations, disaster preparedness plan, emergency intervention, staffing, and client records. Community Care Licensing (CCL) focuses its efforts on three priority areas: prevention, compliance, and enforcement. There is one fire extinguisher throughout the facility, and it is fully charged. The facility has a working telephone that is accessible to clients and staff. All passageways and grounds were free of any obstructions. The medications, cleaning solutions, and knives were locked inside the cabinets in the kitchen inaccessible to the clients. There were perishable foods enough for 3 days and non-perishable foods enough for client's consumption for more than a week. Each bedroom has one twin bed with clean sheets and linens. There were drawers and closet space in each bedroom for client use. The hot water temperature was tested and was in working order. At the time of this inspection the facility was observed to be clean, safe, and in good repair. Administrator is on site at least 20 hours a week. The facility has a central administrative file under their main facility: Hope House facility. The facility has a Volkswagen van used to transport clients. The vehicle has an active insurance policy. The facility maintains an equipment/vehicle safety log in the headquarters office that is monitored by the Maintenance Supervisor. The vehicle is serviced every quarter or as needed. For this review, three (3) San Gabriel Pomona Regional Center clients were selected for the sample to assess the level of care and services they receive. Additionally, LPA reviewed four (4) staff files for compliance with Title Regulations and Interim Licensing Requirements (See confidential name list dated April 24th, 2024). LPA conducted interviews with one staff member. All files were complete and contained all necessary documentation at the time of this inspection. LPA was unable to conduct interviews with clients due to the clients being at their work program. There were no deficiencies cited at the time of this inspection. An exit interview was conducted. LPA provided the facility administrator a signed copy the LIC 809 and LIC 811 reports.

met_with: Ricardo Montes- Administrator


facility_name: HOPE FOR YOUTH INC. BAIN HOUSE

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Complaint Specialist C.K. Kinney(CS) traveled to Hope for Youth-Bain House and met with Clinard Fletcher to deliver findings of investigation. Investigator Lomeli and CS conducted investigation that included review of documentation, and confidential interviews. Inconsistencies in the information obtained prevented a preponderance of the evidence to show allegations occurred as reported. Although the allegations may or may not be valid a preponderance of the evidence was not obtained so the allegations are deemed unsubstantiated. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Charles Kinney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, E SHAW AVE This is an official report of an unannounced visit/investigation of a complaint received in our office on 09/27/2022 and conducted by Evaluator Charles Kinney PUBLICCOMPLAINT CONTROL NUMBER: 24-CR- FACILITY NAME:HOPE FOR YOUTH INC. Bain Housefacility Number: Administrator:fletcher, Clinardfacility Type: Address: N. BAIN AVENUETELEPHONE: (559) 681- CITY:FRESNOSTATE: CAZIP CODE: CAPACITY:4CENSUS: 4DATE: 01/26/ UNANNOUNCEDTIME BEGAN: 09: AM MET WITH:Clinard FletcherTIME COMPLETED:10: AM 9Minor sustained unexplained injuries while in care. INVESTIGATION FINDINGS: 13Complaint Specialist C.K. Kinney(CS) traveled to Hope for Youth-Bain House and met with Clinard Fletcher to deliver findings of investigation. Investigator Lomeli and CS conducted investigation that included review of documentation, and confidential interviews. Based on information that was obtained Investigator Lomeli found a preponderance of the evidence that this allegation occurred. Allegation is Substantiated. This facility is being cited for violation of Title Division Chapter Article Section 80078(a) Responsibility for Providing Care and Supervision. Copy of this report, the deficiency citation and Appeal Rights left at the facility at conclusion of inspection SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Charles Kinney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, E SHAW AVE FACILITY NAME: HOPE FOR YOUTH INC. BAIN HOUSEFACILITY NUMBER: 107206866

met_with: Clinard Fletcher

complaint_status: unsubstantiated


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Reyna Martinez conducted a complaint inspection and met with Kevin Thomas. The purpose of the inspection was to deliver the findings for the above complaint allegation. During the investigation, LPA conducted interviews and reviewed supporting documents provided by the agency. Based on the information obtained during the investigation a preponderance of the evidence that the allegation occurred as reported could not be found. Although the allegation may or may not have happened, or is valid, there is not a preponderance of the evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated at this time. An exit interview was conducted, and a copy of this report and appeal rights were provided at the end of the inspection. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Reyna Martinez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

met_with: Kevin Thomas


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Reyna Martinez conducted a complaint inspection and met with Nikita Graves. The purpose of the inspection was to deliver the findings for the above complaint allegations. The Department has investigated the complaint alleging Staff engaged in physical altercation with youth; Staff grabbed youth by the neck which caused youth to sustain injuries. LPA conducted confidential interviews and obtained documentation.There were inconsistencies in the confidential interviews. Although the allegations may have happened or is valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Reyna Martinez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

met_with: Nikita Graves


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13On May 29, 2025 at 12:30pm, Licensing Program Analyst (LPA), Melissa Renovato conducted an unannounced visit to Hope For Youth Bain House facility in Fresno, CA in order to deliver the findings of the above allegations and met Administrator, Katrina Mason. On March 17, 2025, the above allegations were referred to Community Care Licensing for investigation. The investigation included an inspection of the Facility, confidential interviews, and review of records. Based on the investigation conducted the department found that there was conflicting information regarding these issues. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the allegations occurred. Therefore, the allegations are Unsubstantiated at this time. A copy of this report was provided at the conclusion of the inspection along with appeal rights. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Melissa Renovato LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Katrina Mason, Administrator


raw_content:
Investigation Findings:
13On November 6, 2025, Licensing Program Analyst (LPA), Melissa Renovato conducted an unannounced visit to the Hope for Youth Bain House Group Home in Fresno, CA in order to deliver the findings of the above allegation and met Katrina Mason, House Manager. On September 25, 2025, the above allegation was referred to Community Care Licensing for investigation. The investigation included an inspection of the Facility, confidential interviews, and review of records. Based on the investigation conducted the department found that there was conflicting information regarding these issues. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the allegations occurred. Therefore, the allegations are Unsubstantiated at this time. A copy of this report was provided at the conclusion of the inspection along with appeal rights. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Melissa Renovato LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Katrina Mason, House Manager


summary: Facility Evaluation

raw_content:
Narrative:
On June 23, 2021, Licensing Program Analysts (LPAs) Tamara Melikian and Eduardo Barragan conducted an unannounced annual required inspection at the facility. LPAs were met at the facility by Porscha White, House Manager. An inspection of the facility was conducted and the following was observed: Client files were inspected on this date. Staff files were at the corporate office and will be inspected at a later date. The facility was inspected indoors and outdoors. Hot water temperature measured at 109 degrees. Observed adequate supply of perishables and non-perishables. Observed adequate supply of furnishings, linen and storage space for clients. Cleaning chemicals inaccessible to clients. Medications centrally stored and locked. There are no pets at the facility. Per the Administrator, there are no weapons at the facility. There are no bodies of water at the facility. There has been one deficiency in the prior 12 months. No deficiencies were noted on todays visit. LPA's left a copy of this report at the facility. The visit was then concluded.

met_with: Porscha White


summary: Facility Evaluation

raw_content:
Narrative:
On 07/21/2021, Licensing Program Analyst (LPA) Tamara Melikian conducted an unannounced case management inspection to review staff files at the corporate office located at W Richert in Fresno, CA. Met at the corporate office by Administrator Clinard Fletcher and Program Manager Vernell Watts. Staff files inspected. A review of staff records on 07/21/2021 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. There are no deficiencies to be cited on this date.

met_with: Clinard Fletcher, Vernell Watts


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Corina Carrillo conducted a case management inspection April 13, 2022 at 9:30AM, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 9 out of Direct Care Staff and 4 out of 4 youth files were reviewed. 2 out of Direct Care Staff and 1 out of 4 youth were interviewed. (See the Confidential Names List, LIC 811, April 13, 2022.) The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, youth case plans, quarterly assessments, and crisis intervention plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Carrillo observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Clinard Fletcher.


facility_name: HOPE HARBOR

summary: Facility Evaluation

raw_content:
Narrative:
On March 10, 2022 at 8:40 am, Licensing Program Analyst (LPA) Darlene Almaraz-Oseguera met with Licensee, Donna Giddings and Brandon Towns to conduct a Post-Licensing inspection of the facility. There are two clients in care at this time, and no clients were present during this inspection. The facility was inspected inside and out. The home is a two story residence. Upstairs is the House Parents area that consists of two bedrooms, and one bathroom. Downstairs there are four bedrooms with adjoining bathrooms, and two additional bathrooms, which makes a total of five bathrooms downstairs. There is one recreational room, one movie room, and a large dinning area. The kitchen which is also downstairs has a dinning area off to one side. The facility will be operating with the capacity of 6. The bedrooms are set up as follows: Bedroom # Vacant and has one queen bed, all required linen, mattress in good condition. Bedroom # Vacant and has two twin beds, all required linen, mattresses in good condition. Bedroom # Occupied by one resident and has two twin beds, all required linen, mattresses in good condition. Bedroom # Occupied by one resident and has two twin beds, all required linen, mattresses in good condition. All bedrooms contained adequate shelf and closet space for resident's belongings. The staff office contained office supplies, and emergency and disaster plan that was posted. Licensee stated that residents files along with the staff files and are stored in the staff closet.. Medications and the first aid kit are double locked in the staff closet located in bedroom #1 which is vacant. Medication logs will be kept with the medications. The bathrooms were clean and in good repair. Water temperature of one of the client bathrooms of the main house of the property was measured at 112.1 degrees. Continued on 809-C The property contains a large backyard which is fenced by a block wall. There are three exits to the backyard; one door off of the garage, one sliding door off the movie room, and another sliding door off the recreation room that opens to a large patio. All hazardous items were made inaccessible to areas where residents do not have access. Cleansers/chemicals were stored in a locked cabinet in the laundry room. Sharp knives were inaccessible and stored in a locked drawer in the kitchen. The facility's smoke/carbon monoxide detectors in the hallways, bedrooms, kitchen, and recreation room were checked and were operable. There were no guns or weapons in the facility as stated by Licensee. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Disaster Plan, and current menu. LPA observed a sufficient supply of 7-day non-perishable food for six residents and a sufficient supply of 2-day perishable food. There was a variety of snacks available for residents as well. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There were no deficiencies cited based on the inspection this date. Facility Provisional License to be issued. An exit interview was conducted and a copy of this report was reviewed and emailed to Licensee, Donna Giddings.

met_with: Brandon Towns


summary: Facility Evaluation

raw_content:
Narrative:
On February 22, 2023, at 12: PM, Licensing Program Analyst (LPA) Eduardo Barragan conducted an unannounced Required Annual inspection of the facility. LPA met with Brandon Towns, Home Coordinator. The home is a two story residence. Upstairs is the House Parents area that consists of two bedrooms, and one bathroom. Downstairs there are three bedrooms all with adjoining bathrooms, and one additional bathroom, which makes a total of four bathrooms downstairs. There is one respite/office, one recreational room, one movie room, and a large dinning area. The kitchen which is also downstairs has a dinning area off to one side. The facility is currently operating with the capacity of 3 but with a capacity of 6. The bedrooms are set up as follows: Bedroom #1 will be occupied by two residents; two twin beds, all required linen, mattresses in good condition. Bedroom #2 will be occupied by two residents; two twin beds, all required linen, mattresses in good condition. Bedroom #3 will be occupied by two residents; two twin beds, all required linen, mattresses in good condition. All bedrooms contained adequate shelf and closet space for resident's belongings. Medications and the first aid kit are locked in the staff office located at the beginning of the hallway when going toward the resident's bedrooms. Medication logs will be kept with the medications. However, C2 did not have a MAR sheet filled out for his medication that specified the date of the prescription, number of refills prescribed, time of each dose taken, and etc. The bathrooms were clean and in good repair. The hot water temperature's in the bathrooms property measured at 111 degrees. All hazardous items have been properly made inaccessible to areas where children will have access. Cleansers/chemicals are locked and stored in the locked cabinet beneath the kitchen sink. Sharp knives are inaccessible and stored in a locked cabinet beneath the kitchen sink. LPA also observed a minimum 7-day non-perishable and a 2-day perishable supply of food. Proper storage of all food was noted. The hot water temperature in the kitchen sink was tested and was measured at 113 degrees which is within regulatory requirements.The exterior of facility was also inspected and observed to be clean well maintained. Emergency exits were free from obstruction. There were 10 cameras located inside of the home and 11 cameras located surrounding the home. There are no guns or weapons as stated by the Licensee. All required forms are posted including the Facility License, Grievance Procedures, Visitation Policies, Personal Rights, and the Emergency Disaster Plan was also posted. A review of staff files indicates that staff files contained all required documentation per Title Regulations. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. LPA reviewed three client files, and all files did have the necessary documents required per regulations. Based on the facility inspection and file reviews, there is one deficiency found at this time. Please refer to LIC809-D. A copy of this report was discussed with Brandon Towns, Home Coordinator. A copy of this report and appeal rights were emailed to Brandon Towns, Home Coordinator, immediately prior to LPA leaving the facility.

met_with: Brandon Towns, Home Coordinator


summary: Facility Evaluation

raw_content:
Narrative:
On May , 2025, at 9: AM, Licensing Program Analyst (LPA) Stefanie Mutialu made an unannounced visit for the for the purpose of conducting an annual inspection of the facility. LPA met with Residential Manager, Brandon Towns. The Facility is licensed to serve six (6) ambulatory children ages 12-17 years old. The current census is four (4) children. The facility is a two story six-bedroom, six-bathroom home. A physical plant inspection was completed with Residential Manager, Brandon Towns and included the following checks: four client bedrooms, one respite parent bedroom/office, two staff bedrooms, three client bathrooms, one respite parent bathroom, two staff bathrooms, kitchen, pantry, laundry room, living room/dining room, game/activity room, theater room, and gym in the garage. Staff living area is on the second floor. The backyard has a garden, two shaded areas with patio furniture, and a grass area for sports and recreation. All required forms are posted including Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster, the Emergency Disaster Plan was also posted. LPA observed one ring camera at the facility in the front of the home, ten exterior cameras around the home, and eleven interior cameras that are not facing restrooms or bedrooms. ***Continued on page 2*** Facility grounds are clean and free of debris. There is adequate indoor and outdoor activity space. All facility carbon monoxide detectors were tested and observed to be in working order; fire extinguishers are properly charged and fire clearance is on file. Licensee maintains an adequate supply of perishable and non-perishable foods to prepare the items on the posted menu. LPA observed a minimum seven-day non-perishable and two-day perishable supply of food. Individual beds were observed with clean linens, pillows, comforters, and mattress in good repair. All three bedrooms contain two twin beds. The facility has three client bathrooms. The water temperature was tested in one bathroom the appropriate range of 105 degrees to 120 degrees. All client files are stored and maintained on a secure internet database and in locked office in a locked cabinet. LPA reviewed four of four client (C1-C4) files to ensure clients had all required documents per Title 22. Clients do not have prescribed medication. LPA reviewed two of two staff (S1-S2) files to ensure staff had all required documents per Title 22 regulations. Staff records are stored in a secured location at other facility. Per a review of Guardian, all staff have a criminal record clearance. LPA conducted two staff interviews. No deficiencies cited Due to time constraints LPA will return on another day to conduct client interviews. Per facility staff, no firearms or weapons are allowed in the facility. The licensing fee payments are current. An exit interview was conducted, and a copy of this report, confidential names (LIC811), and appeal rights were discussed and provided to Residential Manager, Brandon Towns. A copy of this report will be placed in the facility file.

met_with: Residential Manager, Brandon Towns


summary: Facility Evaluation

raw_content:
Narrative:
On May 8, 2025, at 3: PM, Licensing Program Analyst (LPA), Stefanie Mutialu attempted to continue unannounced annual inspection, which was started on May 7 ,2025. No one was present at the facility and LPA observed facility van was not in the driveway. LPA continued to wait for clients to arrive home after school and conduct two client interviews. At 4: PM client had not arrived. LPA will return another day to conduct two client interviews.


summary: Facility Evaluation

raw_content:
Narrative:
On May 20, 2025, at 4: PM, Licensing Program Analyst (LPA), Stefanie Mutialu continued the unannounced annual inspection, which was started on May 07 ,2025. LPA met with Residential Manager, Brandon Towns. LPA conducted to client (C1-C2)interviews . No deficiencies cited. An exit interview was conducted, and a copy of this report, LIC811 (confidential names), and appeal rights were discussed and provided to Residential Manager, Brandon Towns. A copy of this report will be placed in the facility file.


facility_name: HOPE HOUSE

raw_content:
Narrative:
The Department received a complaint alleging Ref. #1 (Confidential Names form LIC 811 dated 3/10/22) sustained multiple injuries in care, was inappropriately restrained by staff and was not allowed to make a phone call. Staff denied the allegations. The investigation revealed Ref. #1 was unable to obtain a laptop that was in a secure location. Ref. #1 then walked to his room, walked out and obtained a phone to make a call. Staff told Ref. #1 he needed to ask for permission to use the phone. Ref. #1 immediately escalated in self injurious, aggressive behavior and was ushered to a nearby room to stabilize. Staff reported Ref. #1 bit himself on the wrist, spit at staff, cursed at staff and lunged at a staff's legs. As a result of Ref. #1 presenting with behaviors, staff reported using a Two Person Hold to guide Ref. #1 down to a mat and while he was on the floor used Three to Five Second Holds up to four times within a ten to fifteen-minute time frame. After the incident a body check was conducted and Ref. #1 was observed with redness and marks on his neck, stomach and back. A red mark on Ref. #1 neck, staff suggested, could have been obtained from a two-way radio device that was clipped to his collar. The marks on Ref. #1 back, staff suggested, could have been obtained from a police belt worn by Ref. #1 and his body's movement while on the floor. Statements obtained by staff regarding the use of restraint were consistent. Staff reported utilizing holds as they were trained, to ensure the safety of the resident and staff. Statements obtained from confidential interviews conducted revealed insufficient facts related to the reported incident. Statements obtained from interviews conducted with placing agency workers revealed there were no concerns related to the incident or the allegations reported to the Department. Based on information obtained through interviews conducted and records review, the allegations are Unsubstantiated. Although the allegations may have happened or are valid the preponderance of evidence standard was not met. Exit interview conducted and a copy of this report and Confidential Names form LIC 811 dated 3/10/22 were provided to the above-mentioned facility representative. No deficiencies were cited.

Investigation Findings:
An unannounced follow up complaint inspection was conducted by Licensing Program Analyst (LPA) Christopher Larios on 3/10/22 at 3: PM. During the inspection LPA Larios met with Facility Manager Jonathan Lopez in person and Administrator Dorothy Gonzalez via facetime. The purpose of the inspection was to deliver findings for the above-mentioned complaint allegations. During the course of the investigation LPA Larios conducted interviews with two placing agency social workers on 2/28/22, one resident on 3/2/22, one staff on 3/2/22, one case worker on 3/7/22, three staff on 3/7/22 and one staff on 3/8/22. Additionally, a record review was conducted on 12/22/21 and copies of a resident's behavior documents, service plans, progress notes, incident reports and identification data were obtained. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Christopher Larios LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HOPE HOUSEFACILITY NUMBER: VISIT DATE: 03/10/2022

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

met_with: Jonathan Lopez


raw_content:
Narrative:
Continue from page 1 . . . It was alleged that Facility staff inappropriately handled resident in care. The facility staff denied the allegation and stated that the child was not put on a restraint or was handle inappropriately. The staff stated that there was an argument between two clients over a wireless speaker and staff separated the clients to different areas and went to check on the client but the client became aggressive toward the staff. The staff indicated that the client tried to bite and hit the staff but the staff talked to him to calm down and blocked the client's moves. The staff indicated that the client came down while the staff was there. The confidential interview revealed conflicting and inconsistent statements. There were statements indicated that a client was pushed, chocked and handle in a rough matter by the facility staff while other statements indicated that the child was not handle inappropriately by the facility staff. There were no witnesses to support the allegation. Information obtained indicated that the client has self harming behaviors. The placement social worker indicated having no concerns with the care and supervision in the facility. There was no corroborating information obtained through interviews to confirm the allegation. Based on the information obtained though interviews and records review the allegation is found unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the allegation occurred, therefore, the above allegation is Unsubstantiated. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited. An exit interview was conducted, and a signed copy of this report was left with above staff.

Investigation Findings:
13On March 11, 2022, Licensing Program Analyst (LPA) Heriberto Perez conducted a follow-up complaint inspection to the above facility and met with Dorothy Gonzalez, Administrator. The purpose of the visit was to deliver the finding for the above complaint allegation. During the course of investigating the allegation, LPA Perez interviewed with one client and one staff on December 02, 2021, LPA Humberto Flores interviewed one client on December 02, 2021, LPA Perez interviewed one staff and County Social Worker via telephone on January 18, 2022, LPA Perez interviewed two staff via telephone on January 20, 2022 (see Confidential Names LIC 811 dated March 11, 2022). LPA analyzed pertinent documents such as Individual Program Plan (IPP), Individual Service Plan Prioritized Objective List, Special Incidents Reports, Law Enforcement Investigation Report, Regional Center Investigation Report and County Investigation Report . It was alleged that Facility staff inappropriately handled resident in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Heriberto Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HOPE HOUSEFACILITY NUMBER: VISIT DATE: 03/11/2022

met_with: Dorothy Gonzalez, Administrator


raw_content:
Narrative:
On 11/30/23 the Department received a complaint alleging client in care sustained multiple unexplained injuries and staff did not seek medical attention for client. It was further alleged that client had injuries to client's back and ankle. The facility did not seek medical attention and failed to report the injuries. Based on the information gathered during confidential interviews, relevant parties denied the allegations indicating client during Thanksgiving week injured self while playing and having behaviors. The client was playing at the park and on a slide when the client scratched client's back. The client was rubbing a scab on client's ankle which caused the scab to reopen. Staff indicated client tends to hit self and likes to pick at client's scabs. Client also does not like to wear shoes due to the shoes bothering client. Staff indicated client when injured is provided first aid by the health staff on site and was taken to the doctor on 11/29/23. Staff indicated a note of the injury was sent to the school in client's backpack. Others interviewed indicated clients tend to hit self and indicated they have not observed anything concerning. LPA reviewed medical visit form dated 11/29/23 which indicated client was seen for a follow up visit for intentional self-harm by other specified means. Client has an abrasion on his ankle and back. The ankle abrasion seems to be due to rubbing against the surface and the back as well. Client was prescribed Neosporin to the ankle and to the back. LPA reviewed an incident report dated 11/27/23 which indicated client sustained injuries due to self-harm. Client was treated for client's injuries and incident was reported. LPA reviewed a police report which indicated on 11/30/23 the officer arrived at the facility and observed client had a cut on his left ankle and a healing abrasion that was scabbed on his back. The officer did not observe any other apparent injuries. The officer saw client's shoes and noted that the shoe looked to potentially have a hard rim around the ankle portion, however the inner portion looked softer than the outer material. Facility staff advised that client suffers from Autism, harms himself periodically and is aggressive towards others. Facility staff provided incident reports of previous injuries. Based on the interviews and records reviewed the allegations is/are found unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the allegations. Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On March 18, 2024, at 10: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegations. LPA Cabral met with the facility assistant administrator Jonathan Lopez. During the investigation, LPA Cabral interviewed two facility staff (AD, S1) and attempted to interview one client (C1) on 12/7/23. LPA interview one staff (S3) on 12/12/23 (see Confidential Names Form LIC 811 dated March 18, 2024). LPA Cabral interviewed others on 12/7/23. LPA reviewed incident reports, police reports, progress notes, behavior charts, body charts, health logs, event reports, medical visit forms and client's behavior plan. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: HOPE HOUSEFACILITY NUMBER: VISIT DATE: 03/18/2024

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

met_with: Jonathan Lopez, Assistant Administrator


summary: Facility Evaluation

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Narrative:
On August 11, 2022 at 08: AM Licensing Program Analyst (LPA) Noubar Yerkatyan conducted an unannounced inspection at the above facility for the purpose of conducting an annual/required inspection. LPA met with facility Administrator, Dorothy Gonzalez. LPA and Administrator toured the facility. LPA obtained and reviewed the following updated documentation: · LIC Personnel and Client Roster · LIC C Emergency Disaster Plan · Board of Directors report and Program Statement · Employee Grievance Policy/ Grievance Procedures · Crisis Prevention Intervention Training's · Emergency Preparedness: Disaster and Mass Casualties Drills · Emergency Evacuation Routes · Facility Monthly Activities Calendar · Emergency Intervention Plan · Complaint Procedures The facility was in full compliance with 7 applicable areas of the Compliance and Regulatory Enforcement (CARE) tools for Children's Residential Licenses. Annual compliance review consisted of the following domains: Physical plant, operations, disaster preparedness plan, emergency intervention, staffing, and client records. Community Care Licensing (CCL) focuses its efforts on three priority areas: prevention, compliance, and enforcement. There are 5 fire extinguishers throughout the facility, all fully charged and all last serviced on 02/07/2022. The facility has a working telephone that is accessible to clients and staff. All passageways and grounds were free of any obstructions. The medications and cleaning solutions were locked inside the cabinets in separate storage rooms. There was perishable foods enough for 3 days and non-perishable foods enough for client's consumption for more than a week. Each bedroom has two twin beds with clean sheets and linens. There were drawers and closet space in each bedroom for client use. The hot water temperature was tested and was in working order. At the time of this inspection the facility was observed to be clean, safe, and in good repair. Administrator is on site at least 25 hours a week and on-call 24/7. Facility currently has two (2) administrator trainees both working 40 hours per week in addition to the 25 hours. The facility has a central administrative file under this main facility: Hope House facility. The facility has a Honda Odyssey mini-van used to transport clients. The vehicle has an active insurance policy. The facility maintains an equipment/vehicle safety log in the headquarters office that is monitored by the Maintenance Supervisor. The vehicle is serviced every quarter or as needed. For this review, one (1) DCFS/North Los Angeles Regional Center client, and one (1) DCFS/Frank D. Lanterman Regional Center client was selected for the sample to assess the level of care and services they receive. Additionally, LPA reviewed three (3) staff files for compliance with Title Regulations and Interim Licensing Requirements. LPA also conducted interviews with two staff members and attempted with one client. Clients in the facility were unable to be interviewed due to a speech delay. An exit interview was conducted. LPA provided the facility representative above a signed copy the LIC 809 and LIC 811 reports. There were no deficiencies cited at the time of this inspection. LPA issued an technical advisory, copy left with staff.


summary: Facility Evaluation

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Narrative:
On 12/21/ Licensing Program Analysts (LPAs) Dawn Mahecha and Joe Martinez made an unannounced visit to the Hope house group home for the purpose of a case management- incident inspection. LPAs met with Administrator and discussed the following reported incident. Child sustained bruising on left arm: Administrator stated the following- Staff did not observe bruise on child. Staff documented that child reported bruise was obtained at school but then child stated to school staff that bruise was obtained at home. Child had 1 to 1 outside Respit care with an outside contracted agency through Department of children and family services and Regional center. Documents received and reviewed by LPAs identified child having self injurious behavior and documented bug bites on arms. LPAs were unable to meet with child as child was discharged from home. Administrator stated agency was unable to do any follow up with child since child was discharged from home. Information and documents received indicate no incidents occurring where staff interacted with child in manner causing child to have bruising. Based on information received it is unclear as to how or where child obtained bruise. Although the incident may have happened there is not a preponderance of evidence to indicate incident did or did not happen. Exit interview completed, no deficiencies cited and a copy of this report was emailed to Administrator.


summary: Facility Evaluation

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Narrative:
On March 7th at 08: AM Licensing Program Analysts (LPA's) Ashley Ruacho and Noubar Yerkatyan conducted an unannounced inspection at the above facility for the purpose of conducting an annual/required inspection. LPAs met with facility Administrator, Dorothy Gonzalez and Administrator trainee Jonathan Lopez. LPA's and Administrator toured the facility. LPAs obtained and reviewed the following updated documentation: · LIC Personnel and Client Roster · LIC C Emergency Disaster Plan · Board of Directors report · Employee Grievance Policy/ Grievance Procedures · Crisis Prevention Intervention Training's · Emergency Preparedness: Disaster and Mass Casualties Drills · Emergency Evacuation Routes · Facility Monthly Activities Calendar · Emergency Intervention Plan · Complaint Procedures The facility was in full compliance with 7 applicable areas of the Compliance and Regulatory Enforcement (CARE) tools for Children's Residential Licenses. Annual compliance review consisted of the following domains: Physical plant, operations, disaster preparedness plan, emergency intervention, staffing, and client records. Community Care Licensing (CCL) focuses its efforts on three priority areas: prevention, compliance, and enforcement. There are 5 fire extinguishers throughout the facility, all fully charged and all last serviced on 02/13/2023. The facility has a working telephone that is accessible to clients and staff. All passageways and grounds were free of any obstructions. The medications and cleaning solutions were locked inside the cabinets in separate storage rooms. There is perishable food enough for 3 days and non-perishable foods enough for client's consumption for more than a week. 8 bedrooms in total with one that was unoccupied and two had single twin beds, all bedrooms had clean sheets and linens. There were drawers and closet space in each bedroom for client use. The hot water temperature was tested and was in working order. At the time of this inspection the facility was observed to be clean, safe, and in good repair. Administrator is on site at least 25 hours a week and on-call 24/7. Facility currently has one (1) administrator trainee working 40 hours per week. The facility has a central administrative file under this main facility: Hope House facility. The facility has two Honda Odyssey mini-van's and one 10 passenger van used to transport clients. The vehicle's have active insurance policies. The facility maintains an equipment/vehicle safety log in the headquarters office that is monitored by the Maintenance Supervisor. The vehicle is serviced every quarter or as needed. For this review, one (1) DCFS San Gabriel/Pomona Regional Center, two (2) San Gabriel/Pomona Regional Center client were selected for the sample to assess the level of care and services they receive. Additionally, LPA reviewed two (2) staff files for compliance with Title Regulations and Interim Licensing Requirements. LPA also conducted interviews with three staff members and no clients were present at the time of the inspection. Clients in the facility were unable to be interviewed due to being at school and non-verbal. An exit interview was conducted. LPA provided the facility representative above a signed copy the LIC 809 and LIC 811 reports. There were no deficiencies cited at the time of this inspection.

met_with: Dorothy Gonzalez-Administrator, Jonathan Lopez Admin. Trainee


summary: Facility Evaluation

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Narrative:
On March 21st, 2024, at 10: AM Licensing Program Analysts (LPA) Ashley Ruacho conducted an unannounced inspection at the above facility for the purpose of conducting an annual/required inspection. LPA met with facility Administrator, Dorothy Gonzalez and Administrator trainee Jonathan Lopez. LPA and Administrator toured the facility. LPA obtained and reviewed the following updated documentation: · LIC Personnel and Client Roster · LIC C Emergency Disaster Plan · Board of Directors report · Employee Grievance Policy/ Grievance Procedures · Crisis Prevention Intervention Training's · Emergency Preparedness: Disaster and Mass Casualties Drills · Emergency Evacuation Routes · Facility Monthly Activities Calendar · Emergency Intervention Plan · Complaint Procedures The facility was in full compliance with 7 applicable areas of the Compliance and Regulatory Enforcement (CARE) tools for Children's Residential Licenses. Annual compliance review consisted of the following domains: Physical plant, operations, disaster preparedness plan, emergency intervention, staffing, and client records. Community Care Licensing (CCL) focuses its efforts on three priority areas: prevention, compliance, and enforcement. There are 5 fire extinguishers throughout the facility, all fully charged and all last serviced on 02/01/2024. The facility has a working telephone that is accessible to clients and staff. All passageways and grounds were free of any obstructions. The medications and cleaning solutions were locked inside the cabinets in separate storage rooms. There is perishable food enough for 3 days and non-perishable foods enough for client's consumption for more than a week. 8 bedrooms in total, four had single twin beds, all bedrooms had clean sheets and linens. There were drawers and closet space in each bedroom for client use. The hot water temperature was tested, measured at 116 degrees, and was in working order. At the time of this inspection the facility was observed to be clean, safe, and in good repair. The administrator is on site at least 25 hours a week and on-call 24/7. The facility currently has one (1) administrator trainee working 40 hours per week. The facility has a central administrative file under this main facility: Hope House facility. The facility has two Honda Odyssey mini-vans and one 10 passenger van used to transport clients. The vehicles have active insurance policies and current registration. The facility maintains an equipment/vehicle safety log in the headquarters office that is monitored by the Maintenance Supervisor. The vehicles are serviced every quarter or as needed. For this review, one (1) DCFS- Palmdale/San Gabriel/Pomona Regional Center, three (3) San Gabriel/Pomona Regional Center, and two (2) Central Valley Regional Center clients were selected for the sample to assess the level of care and services they receive. Additionally, LPA reviewed five (5) staff files for compliance with Title Regulations and Interim Licensing Requirements. LPA also conducted interviews with three (3) staff members and no clients were present at the time of the inspection. Clients in the facility were unable to be interviewed due to being at school and non-verbal. An exit interview was conducted. LPA provided the facility representative above a signed copy of the LIC 809 and LIC 811 reports. There were no deficiencies cited at the time of this inspection.


summary: Facility Evaluation

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Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Pamela Silva and Timika Martin on 07/10/24 at 9: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs met with Jonathan Lopez, Administrator, and inspected the facility inside and out. LPAs reviewed two (2) of child's records and three (3) of staff personnel files on site at the facility. LPAs reviewed two (2) of child's psychotropic medications and medication records. LPAs interviewed two (2) of staff on site to discuss the facility's policies and procedures of operation. LPA was unable to interview children currently prescribed psychotropic medication due to being non-verbal. No deficiencies are being cited at this time. LPAs conducted exit interview and provided a copy of this report to the Administrator, Jonathan Lopez.


facility_name: HOUSE OF SULAIMAN, THE

summary: Complaint Investigation - Substantiated - 1 allegation

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Narrative:
hospital. Based on LPA's observations, interviews which were conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 & Chapter 5, Regulation 84072(d) Personal Rights are being cited on the attached LIC 9099D. Exit interview conducted and a copy of this report and a copy of the appeal rights were left at the facility with Frederick Elkins, DSP.

Investigation Findings:
13Licensing Program Analyst (LPA) Jean Stidman conducted an unannounced inspection to the facility on 10/19/23 at 3:30pm to deliver complaint allegation findings. LPA met with Frederick Elkins, DSP and discussed the above allegation. During the investigation of staff abandoned minor at hospital, LPA toured the facility with John Tarawali, Administrator on 7/17/23. On this inspection, LPA inspected the facility inside and out, reviewed one client file and obtained documentation for the complaint investigation of Client Face Sheet, Identification and Emergency Information, case notes for June and July 2023, Admission Agreement and Attachment A, Functional Behavior Assessment, Health and Education Passport, Child and Family Team Meeting Notes, Individual Program Plan and 30-day notice. On 7/28/ LPA obtained documentation for the complaint investigation of 30-day notice rescinded. LPA conducted four interviews on 7/1/23 and 7/28/23. The facility staff admitted to refusing to pick up the minor from the SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Jean Stidman LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: HOUSE OF SULAIMAN, THEFACILITY NUMBER: VISIT DATE: 10/19/2023

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

met_with: Frederick Elkins, DSP


raw_content:
Narrative:
facility. Based upon records reviewed the facility has between one to three staff for three clients. Based on LPA's observations, interviews which were conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegations are found to be unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. No title 22 regulations were cited during today's inspection. Exit interview conducted and a copy of this report and a copy of the appeal rights were left at the facility with Frederick Elkins, DSP.

Investigation Findings:
13Licensing Program Analyst (LPA) Jean Stidman conducted an unannounced inspection to the facility on 10/19/23 at 4:00pm to deliver complaint allegation findings. LPA met with Frederick Elkins, DSP and discussed the above allegatios. During the investigation of staff does not provide adequate supervision to minor in care, staff does not treat minor with respect and staff smoke marijuana on the premises in the presence of minor, LPA toured the facility with John Tarawali, Administrator, on 8/1/23. On this inspection, LPA inspected the facility inside and out, reviewed three client files and obtained documentation for the complaint investigation of the client Face Sheet, Identification and Emergency Information, Admission Agreement and Individual Program Plan. LPA obtained documentation of staff timesheets and work schedules for July 2023, LIC500, personnel record and background clearance. LPA conducted six interviews on 8/1/23 and 10/3/23. Six out of six confidential interviews reported the staff provide adequate supervision, the staff treat the clients with respect, and that staff do not smoke at the UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Jean Stidman LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: HOUSE OF SULAIMAN, THEFACILITY NUMBER: VISIT DATE: 10/19/2023

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


raw_content:
Narrative:
The department has conducted a complaint investigation regarding the allegations: Staff physically abuse minor in care. Staff do not prevent minor from being bullied while in care. During the investigation, six interviews were conducted, which revealed that there was conflicting information on whether or not staff physically abused a minor and if staff did not prevent a minor from being bullied while in care. S1, S2, and S3 don't see the minor's actions as bullying, they see it more of teasing and sibling squabble, and they step in to separate them when it gets to far. While FC1 wouldn't go into detail on whether they and the other minors in facility engage in arguments or bullying, FC3 stated he doesn't argue or fight with other minors in the facility, and FC2 says he bullies FC3 with FC1 but it just with name calling and there isn't punching or kicking as that what FC2 describes as bullying. In regard to staff physically abusing minor in care. FC3, S1, S2 and S3 all denied that the staff physically harm anyone in the home and LPA did not observe evidence of minors being abused either in the records or on her visits. While FC1 and FC2 wouldn't confirm nor deny it. Based on LPA interviews conducted, and records reviewed, the allegation may have happened or is valid, but there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the above allegations are found to be UNSUBSTANTIATED. An exit interview was conducted with, and a copy of this report was provided to John Tarawali Administrator.

Investigation Findings:
13On August 6,2024 at 10: AM LPA Kayla Green arrived at the Agency to deliver allegation findings. LPA Kayla Green met with John Tarawali Administrator and discussed the above allegations. Licensing Program Analyst (LPA) Kayla Green conducted an unannounced inspection to the facility on 05/07/24 at 10:35am to deliver complaint allegation findings. LPA met with John Tarawali , administrator and discussed the above allegations. During the course of the investigation, the following documents were gathered and reviewed: Documentation of staff timesheets and work schedules for April 2024, LIC500, personnel record and background clearance. Confidential interviews were conducted with 6 individuals, and attempted with 1 individual, during the period of 5/7/2024 to 7/11/2024. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dara Campos LICENSING EVALUATOR NAME: Kayla Green LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: HOUSE OF SULAIMAN, THEFACILITY NUMBER: VISIT DATE: 08/06/2024

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

met_with: John Tarawali Administrator