summary: Facility Evaluation

raw_content:
Narrative:
On the date above a pre licensing visit was conducted at Sample House by Licensing Program analyst (LPA) Les Inouye. Sample House is currently operating Group Home facility transitioning to a Short Term Residential Treatment Program (STRTP) facility. I was met by Administrator Jennifer Fish and Emily Logan. A review of the Physical Plant was conducted including the Indoor Activity Space, Fixtures Furniture Equipment and Supplies and Outdoor Activity Space. Kitchen was clean and non-perishable and perishable items were observed in the kitchen. Bedrooms were observed, 3 single occupancy for a capacity of 3. The house currently preparing to convert to a STRTP and additional furnishings are being stored at the facility. All rooms were appropriately furnished with storage area was observed. All chemicals and cleaning supplies were locked and secured. Smoke Alarms and Carbon Monoxide detectors were observed and operating. Hot water temperature was measured at 119 degrees. Back yard, there is no pool or hot tub, yard consisted of a lawn area with covered patio area. The physical plant review was observed to be clean, safe, and free of hazards. A review of the Program Statement and Plan Of Operation is ongoing by CCL and updates will reviewed. At this time, it is recommended that the facility be licensed as an STRTP.

met_with: Jennifer Fish


state: CA

facility_name: 2ND HOME INC-SAMPLE

summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPAs) Lisa Slusher travelled to the facility listed above to conduct a prelicensing inspection. Facility Inspection conducted. 1. Facility Grounds are free of hazard. 2. Adequate indoor and outdoor activity space and materials observed. 3. Chemicals appropriately locked. 4. Locked and centrally stored medications observed. Observed medication logs and discussed procedures for psychotropic medications. 5. First aid kit complete with appropriate manual observed. 6. Adequate storage space observed. 7. Individual beds in good repair observed. 8. The house has 3 bedrooms, double occupancy, all are located on a single floorr, all are equipped with required furnishings. 9. Adequate food storage space observed. Supply of two days of perishable foods and a week of nonperishable foods observed upon inspection. 10. Weekly menu posted and accessible to clients. 11. Dining room equipped with large table and chairs accommodating of all clients. 12.Facility has two full restrooms in the house for client use, both are operable. 13. Appropriate forms posted in view of facility clients. 14. No firearms or weapons are allowed in the facility. The following items were discussed and reviewed by LPA during Inspection 1. LIC Reviewed to ensure appropriate staffing ratios, including Administrator, Social Work personnel, and Direct Care staff. The facility does not utilize Peer Partners at this time. Facility will submit an updated LIC 500 to LPA. 2. Administrator Emily Logan is present on-site a minimum of 20 hours per week. 3.Personnel Records reviewed on this date. 4. Facility has current Mental Health Program Approval, Expiring in October 2023.

report_type: Facility Evaluation

visit_type: Annual

met_with: Jennifer Fish, Emily Logan


summary: Facility Evaluation

raw_content:
Narrative:
On this date, an unannounced annual inspection follow-up is conducted on this date. Client (5) and staff interviews conducted. There are no deficiencies to be cited on this date.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On this date, a post licensing inspection is completed by LPA (Licensing Program Analyst) Lisa Slusher. Prior to this date, an updated license was provided to the licensee. The license is no longer provisional as the provider has full MHPA and accreditation through CARF. Received updated staff schedule which verifies appropriate client/staff ratios. An annual continuation inspection is also completed on this date with interviews documented on that inspection. Staff and client files reviewed prior to this date.

met_with: Emily Logan


facility_name: SECOND HOME, INC. - SAN JOSE

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On this date, Licensing Program Analyst (LPA) Lourey Bartolome contacted Second Home Inc. - San Jose and met with Jennifer Fish to discuss the findings on this investigation. Licensing Program Analyst conducted the investigation that included review of documentation and interviews. Based on the information obtained, the above mentioned allegation could not be proven with a preponderance of the evidence. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violations did or did not occur, therefore the allegation is deemed unsubstantiated. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Melanie Krage LICENSING EVALUATOR NAME: Lourey Bartolome 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

report_type: Complaint Investigation

complaint_status: unsubstantiated


raw_content:
Investigation Findings:
13On this date, Licensing Program Analyst (LPA) Lourey Bartolome contacted Second Home Inc. - San Jose and met with Jennifer Fish to discuss the findings on this investigation. Licensing Program Analyst conducted the investigation that included review of documentation and interviews. Based on the information obtained, the above mentioned allegations could not be proven with a preponderance of the evidence. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed unsubstantiated. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Melanie Krage LICENSING EVALUATOR NAME: Lourey Bartolome 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


raw_content:
Investigation Findings:
13On this date, Licensing Program Analyst (LPA) Leslie Inouye conducted a complaint inspection for the Short Term Residential Therapeutic Program (STRTP) for the purpose of delivering the findings for the above care and supervision complaint allegation. LPA met with Alison Tolladay. During the course of investigating the allegation, LPA conducted interviews with staff members and the children in placement, conducted a record review and obtained information. The information revealed inconsistencies in the reporting of the event, the persons involved and the time in which the event occured. Supervision during the allegation was appropriate. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the above allegation occurred, therefore the above allegation is unsubstantiated UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Les Inouye 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: Alison Tolladay


summary: Facility Evaluation

raw_content:
Narrative:
On November 1, 2021, Licensing Program Analyst (LPA) Les Inouye conducted an annual inspection of the facility indicated above. Met at the agency by House Manager Emily Logan and Administrator Jennifer Fish. An inspection of the physical plant was conducted. LPA observed adequate food supply, appropriately maintained yard, adequate bedding, storage space, activity space, hot water that measured 110 degrees and lamps, toiletries and a facility that is safe, sanitary and in good repair. Staff files and were inspected on this date. In addition, client files and medication logs were inspected on this date. At 10: Entrance interview and physical plant inspection. At 11: AM, Client file review was conducted. At 2: PM, Staff files review was conducted. The exit interview was conducted at 4: PM and a copy of this report given to Lindsay Quiring. It is requested that the licensee submit the following updated forms to CCL: LIC 308, 309, 500. In addition, client files and medication logs were inspected on this date.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Reyna Martinez on April 25, 2024 at 10: AM. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2). During the inspection, LPA met with Andres Lopez-Solorio, Administrator and inspected the facility inside and out. LPA reviewed 3 child's records and 2 staff personnel files on site at the facility. LPA reviewed 3 child's psychotropic medications and medication records. LPA interviewed 2 staff on site to discuss the facilities policies and procedures of operation. LPA interviewed no children currently psychotropic medication as they were in school at this time. LPA will attempt interview with children at a later time. LPA provided a copy of the licensing report to Administrator, Andres Lopez-Solorio. No deficiencies are being cited at this time. LPA conducted exit interview with Andres Lopez-Solorio, Administrator.

met_with: Andres Lopez-Solorio


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Lisa Slusher travelled to the facility listed above to conduct an Annual Inspection. Met at the facility by Facility Manager with one client present. Facility manager Andres Lopez-Solario arrived a short time later, and Executive Director Jennifer Fish also met with this LPA. Mental Health Program Approval through Fresno County expiring in April 21,2025 . The facility is accredited through CARF and their accreditation through 9/2026 . 1. Facility Grounds are well kept, with ample activity features and space 2. Adequate indoor activity space and items observed. 3. Cleaning solutions stored in locked cabinets. 4. Locked and centrally stored medications observed. Licensee has made provisions for contraceptives to be held in individually locked containers by clients. Observed medication logs and discussed procedures for psychotropic medications. 5. First aid kit complete with appropriate manual observed. 6. Adequate storage space observed. 7. Individual beds in good repair observed. 8. The house has 4 bedrooms, a mixture of single and double occupancy all located on one single level. Bedrooms are accommodating of all required furnishings. 9. Adequate food storage space observed. Supply of two days of perishable foods and a week of nonperishable foods observed upon inspection. 10. Weekly menu posted and accessible to clients. 11.Dining room equipped with large table and chairs accommodating of all clients. 12.Facility has two full restrooms in the house for client use, both are operable 13. Facility has no animals or firearms personnel files reviewed, 3 client records reviewed. LPA requests the following updated forms/items: LIC 308, Designation of facility responsibility; LIC 309, Administrative Organization; LIC 400, Affadavit regarding client cash resources; LIC 500, personnel report; LIC 610, Emergency Disaster plan; LIC 9020, client roster; current lease agreement/control of property


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Briana Placencia on May 14, 2025 at 9: AM. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2). During the inspection, LPA met with Andres Lopez-Solorio, Administrator and inspected the facility inside and out. LPA reviewed 2 child's records and 2 staff personnel files on site at the facility. LPA reviewed 2 child's psychotropic medications and medication records. LPA interviewed 2 staff on site to discuss the facilities policies and procedures and plan of operation. LPA was unable to conduct any interviews as the children currently on psychotropic medication are at school, they will be interviewed at a later time. LPA provided a copy of this licensing report to Andres Lopez-Solorio, Administrator. No deficiencies are being cited at this time. LPA conducted exit interview with Andres Lopez-Solorio, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Les Inouye conducted an unannounced Case Management inspection to the Short Term Residential Therapeutic Program (STRTP) and met with Jennifer Fish. . Based on information received by phone call and Initial Incident Reporting by Jennifer Fish it has been determined the STRTP failed to provide appropriate supervision in compliance with 87065.2 (a)(2). Based on the LPA's observations, interviews and records review which were conducted, there is a preponderance of evidence to substantiate a violation of regulation based on Title 22, Division 6, Chapter 1 and are being cited on the attached LIC 809D A copy of the report and Appeal Rights was provided to the FFA.


summary: Facility Evaluation

raw_content:
Narrative:
FN Licensing Program Analyst (LPA) Les Inouye conducted an unannounced Case Management inspection to STRTP San Jose and met with Emily Logan. Based on documentation provided it has been determined 2nd Home Inc., San Jose has failed to provide client with proper assistance withe prescription medication and missed a dose.


facility_name: SECOND HOME, INC. - TENAYA HOUSE

raw_content:
Investigation Findings:
13On this date, Licensing Program Analyst (LPA) Leslie Inouye conducted a complaint inspection for the Short Term Residential Therapeutic Program (STRTP) for the purpose of delivering the findings for the above complaint allegation. LPA met with Heiddy Arr. During the course of investigating the allegation, LPA conducted interviews with staff members and the clients, conducted a record review and obtained information. The information revealed inconsistencies. Clients are aware that staff are positioned to supervise during sleeping hours. It is unclear if the inappropriate touching occured in which there would have been a breakdown in supervision. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the above allegation occurred, therefore the above allegation is unsubstantiated UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Les Inouye 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: Chris Kertzman


raw_content:
Investigation Findings:
13On this date, Licensing Program Analyst (LPA) Leslie Inouye conducted a complaint inspection for the Short Term Residential Therapeutic Program (STRTP) for the purpose of delivering the findings for the above complaint allegation. LPA met with Teresa Rubio . During the course of investigating the allegation, LPA conducted interviews with staff members and clients, conducted a record review and obtained information. The information revealed that there was physical contact between clients but supervision could not have prevented all alledged contact. Staff members did not witness all interactions and appropriate discipline was taken on observed/verifiable incidents. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the above allegation occurred, therefore the above allegation is unsubstantiated UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lidia Tinoco LICENSING EVALUATOR NAME: Les Inouye 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: Teresa Rubio


summary: Facility Evaluation

raw_content:
Narrative:
On 07/27/2021, an unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Tamara Melikian at 9;15AM. During the inspection, LPA met with Program Director Jennifer Fish and Administrator Teresa Rubio and inspected the facility inside and out. LPA reviewed four children's records and reviewed two staff personnel records for the facility. LPA interviewed two staff at 9:30AM. One child refused to be interviewed on this date. The three other children on psychotropic medication were interviewed at 10:00AM. A medication count was conducted at 10:30AM. LPA conducted exit interview with Jennifer Fish, Program Director at 11:30AM. There are no deficiencies to be cited on this date.


summary: Facility Evaluation

raw_content:
Narrative:
On November 18, 2021, Licensing Program Analyst (LPA) Les Inouye conducted an annual inspection of the facility indicated above. Met at the agency by House Manager Teresa Rubio. An inspection of the physical plant was conducted. LPA observed adequate food supply, appropriately maintained yard, adequate bedding, storage space, activity space, hot water that measured 118 degrees. The back yard was inspected and was free of hazards. Back yard storage was secured. The swimming pool was properly fenced and the gate is self closing and latching. Staff files and training logs were inspected on this date. In addition, client files including client cash logs and medication logs were inspected on this date. At 9: Entrance interview and physical plant inspection. At 11: AM, Staff file review was conducted. At 1: PM, Client files review was conducted. The exit interview was conducted at 4: PM and a copy of this report given to Teresa Rubio . Deficiency was observed and documentation is on the LIC809-D.


summary: Facility Evaluation

raw_content:
Narrative:
On 07/06/2022, Licensing Program Analyst (LPA) Vanessa Galvan traveled to 2nd Home INC., Tenaya Facility in Fresno, CA. An unannounced SB Psychotropic Medication Inspection was conducted by LPA Galvan at 10:00AM. During the inspection, LPA met with Teresa Rubio, Administrator and inspected the facility inside and out. Three clients, 2 staff, and 1 administrator were present in the facility. LPA reviewed three children's records for the facility at 10:10PM. LPA reviewed two staff and medication training records for the facility at 12:00PM. LPA interviewed two clients and one client refused at 1:00PM. A medication count was conducted with Facility Administrator at 1:40PM. LPA interviewed one staff and administrator at 2:15PM. There were no deficiencies cited on this date. LPA conducted exit interview with Teresa Rubio, Facility Administrator. LPA provided a copy of the summary report and LIC 811 to Teresa Rubio, Facility Administrator upon completion.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Tamara Melikian on November 29, 2023 at 12:50PM. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2). During the inspection, LPA Melikian met with Program Director Jennifer Fish and House Manager Teresa Rubio and inspected the facility inside and out. LPA reviewed 1 child's record and 2 staff personnel files on site at the facility. LPA reviewed 1 child's psychotropic medications and medication records at the facility. LPA interviewed 2 staff on site to discuss the facilities policies and procedures of operation. LPA interviewed 1 child on site. LPA provided a copy of the licensing report to Program Director, Jennifer Fish. There are no deficiencies to be cited on this date. LPA conducted exit interview with Jennifer Fish, Program Director.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Reyna Martinez and Briana Placencia on December 2, 2024 at 10: AM. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2). During the inspection, LPAs met with Teresa Rubio, Administrator and inspected the facility inside and out. LPAs reviewed 1 child's records and 2 staff personnel files on site at the facility. LPAs reviewed 1 child's psychotropic medications and medication records. LPAs interviewed 2 staff on site to discuss the facilities policies and procedures of operation. LPAs interviewed no children currently psychotropic medication as they were in school at this time. LPAs will attempt interview with children at a later time. LPAs provided a copy of the licensing report to Administrator, Teresa Rubio. No deficiencies are being cited at this time. LPA conducted exit interview with Teresa Rubio, Administrator.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On January 22, 2025, Licensing Program Analysts (LPAs) Olivia Medrano, Miriam Flores, and Sonia Sanchez conducted an unannounced Annual inspection at 2nd Home - Tenaya STRTP located in Fresno, CA. LPAs met with Director Jennifer Fish. The facility is accredited through CARF with accreditation through September 2026, and they are approved through Fresno County Department of Behavioral Health through April 21, 2025. 9:00 - 9:30 am - A physical plant inspection was completed and included the following checks. Adequate indoor and outdoor activity space and materials observed. The facility is maintained at 70 degrees. All facility smoke detectors are in appropriate working order, fire extinguisher is properly charged and was serviced in March 18, 2024. All required forms are posted. There are non-functioning cameras in shared living areas. Medications are locked and centrally stored. Individual beds were observed. STRTP was approved on November 1, 2018. Last disaster drill was completed on December 25, 2024. According to the facility manager, there are no firearms or weapons in the facility. The facility has a fenced swimming pool with a self-latching gate. 9:30 - 11:30 am LPAs reviewed three client files and five staff files. 11:30- 12:00 pm LPAs interviewed one staff. 12:30 - 3:30 pm - LPAs interviewed two staff and three clients. LPAs discussed medication logs, needs and services plan with updates, buildings, and grounds and transportation for clients. Three Type B citations were cited during this inspection. ILS 87095.65(e) Emergency Intervention Training, ILS 87065.1(e)(1) Training Requirements, and Safeguards for Cash Resources ILS 80026(h). A copy of this report was left with the Director and a copy of appeal rights.

Deficiencies:
80026(h): Safeguards for Cash Resources, Personal Property, and Valuables

(h) Each licensee shall maintain accurate records of accounts of cash resources, personal property, and valuables entrusted to his/her care, including, but not limited to the following


facility_name: 4 KIDS 2 KIDS-SAFE HOUSE (STRTP)

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Facility provided multiple Special Incident Reports (SIR) and Law Enforcement (LE) Contact Reports detailing how staff was present and attempted to prevent clients from drinking alcohol and not running way. On 04/28/2021, Client#1 (C1), Client#2 (C2), Client#3 (C3), Client#4 (C4) began to drink alcohol that was contraband from previous runway incident by C4. The clients barricaded themselves in the room and threatening staff. Law Enforcement was contacted and additional staff to help to calm the clients. On 04/29/2021, the clients decided to runway and staff follow till they lost track of them. Results from the Department's investigation, consisting of interviews with related parties, inspections, and review of records. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has decided that the allegations of Neglect and Lack of Supervision are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There were no deficiencies observed or cited at this time. Exit interview was conducted with S1 and a copy of this report was left at the facility.

Investigation Findings:
13On July 20, 2022, at 10:00am, Licensing Program Analyst (LPA) Nancy O'Connell conducted an unannounced inspection to Kids Kids- Safe House Short Term Residential Therapeutic Program (STRTP) for the purpose of concluding the investigation on the above allegations and to deliver the findings. LPA O'Connell, met with Staff#1 (S1) and together discussed the investigation details. During the investigation process, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted inspection and conducted interviews. In addition, LPA Rosas interviewed witnesses and pertinent parties related to the investigation. Individuals mention in this complaint are identify on the Confidential Names List (LIC811) dated June 20, 2022. Based on the confidential interviews conducted during the investigation process, record review, statements obtained, LPA Rosas determined the Neglect and Lack of Supervision allegations happen but there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the findings are unsubstantiated. Report continues on LIC-9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 31-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, VENTURA BLVD., STE. WOODLAND HILLS, CA FACILITY NAME: KIDS KIDS-SAFE HOUSE (STRTP)FACILITY NUMBER: VISIT DATE: 07/20/2022

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

met_with: Marylou Escoto, S1


raw_content:
Narrative:
LPA Rosas and AGPA Barnes-Woodard, conducted interviews that provided conflicting information on who in the facility used EPI pen. LPA Rosas received documentation from facility that noted client allergies for Client#1 (C1), Client#2 (C2), Client#3 (C3), Client#4 (C4), and Client#5 (C5). It was identify that C5 had EPI pen. Interviews with pertinent parties did not provide additional information regarding who used an EPI pen or had allergies. It was unclear what medical information was not available for the clients in placement. Results from the Department's investigation, consisting of interviews with related parties, inspections, and review of records. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has decided that the allegations of Personal Rights and Medication are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There were no deficiencies observed or cited at this time. Exit interview was conducted with S1 and a copy of this report was left at the facility.

Investigation Findings:
13On July 20, 2022, at 10:00am, Licensing Program Analyst (LPA) Nancy O'Connell conducted an unannounced inspection to Kids Kids- Safe House Short Term Residential Therapeutic Program (STRTP) for the purpose of concluding the investigation on the above allegation and to deliver the findings. LPA O'Connell, met with Staff#1 (S1) and together discussed the investigation details. During the investigation process, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted inspection and conducted interviews. In addition, LPA Rosas interviewed witnesses and pertinent parties related to the investigation. Individuals mention in this complaint are identify on the Confidential Names List (LIC811) dated June 20, 2022. Based on the confidential interviews conducted during the investigation process, record review, statements obtained, LPA Rosas determined the Medication allegation may had happen but there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the findings are unsubstantiated. Report continues on LIC-9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 31-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, VENTURA BLVD., STE. WOODLAND HILLS, CA FACILITY NAME: KIDS KIDS-SAFE HOUSE (STRTP)FACILITY NUMBER: VISIT DATE: 07/20/2022

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


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13On 12/14/22 at 10:30am, Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation and deliver the finding. LPA spoke with Marylou Escoto and together, discussed the investigative finding. On 8/2/22, the department received a complaint alledging that a minor engaged in inappropriate contact with another minor. During the investigative process, LPA O'Connell conducted confidential interviews with all relevant parties and collected information on the above allegation. After reviewing all the statements and the information obtained, the above allegation is supported, as the confidential interviews confirmed that C2 has demonstrated a history of inappropriate behaviors that necessitate the provision of additional supervision to ensure the safety of C2 and other residents in care. Further record reviews show that the placing agency authorized the provision of one to one supervision for C2 on 6/6/22, and was backdated to 5/23/22 due to the licensee confirming that one to one services had already begun in order to "ensure the safety of the client and assist with her stabilization." Further confidential interviews, and record reviews revealed that C2 has not been assigned a one to one staff on a consistent basis, and in alignment with the authorization from the placing agency, thereby leading to opportunities for the minor to engage in aggressive and inappropriate behaviors with other residents. Based on LPAs observations, record reviews and interviews which were conducted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Based on California Code of Regulations, and Interim licensing Standards (ILS), a deficiency is being cited at this time. See 9099D for details. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 31-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, VENTURA BLVD., STE. WOODLAND HILLS, CA FACILITY NAME: KIDS KIDS-SAFE HOUSE (STRTP)FACILITY NUMBER: 425802125

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

met_with: Marylou Escoto, Administrator (FA)

complaint_status: SUBSTANTIATED


raw_content:
Investigation Findings:
13On 12/14/22, Licensing Program Analyst (LPA) Nancy O'Connell conducted an unannounced inspection in order to deliver findings related to a complaint investigation. LPA spoke with FM to discuss the findings. During the investigative process by Licensing program Analyst, all relevant parties have been accounted for. Supporting evidence includes: conflicting interviews with house residents and staff related to witnessing any instances of residents being locked in a bedroom. Further, based on observation by LPA, bedroom doors do not have the ability to be locked, and only the bathroom accessible to residents can be locked from within. Additionally, interviews conducted regarding staff hitting a resident revealed that during an escalated incident, the alledged victim was physically redirected in accordance with approved restraint/redirection techniques. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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

met_with: Marylou Escoto, Facility Administrator (FA)


raw_content:
Investigation Findings:
13On April 4, 2023 at 9:10am, Licensing Program Analyst (LPA) Nancy O'Connell made unannounced inspection to the above-listed facility for the purpose of conducting an initial investigation on the above allegation. LPA O'Connell met with the Facility Manager who provided access to the facility. On 3/30/23, the Department received a complaint alleging there was an uncleared adult working within the facility. Due to receiving a recent complaint regarding the same allegation, the allegation is found to be substantiated based on evidence obtained previously. Based on LPA observations, interviews, and record reviews, the preponderance of evidence standard has been met regarding this allegation, therefore the above allegation is found to be SUBSTANTIATED. There will not be a deficiency cited at this time as a deficiency has been delivered previously during related complaint (dated 3/16/23). An exit interview was conducted and a copy of this report will be emailed to the FM. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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

met_with: Mary Andrade, Facility Manager (FM)


raw_content:
Investigation Findings:
13On June 28,2023 at1:00pm, Licensing Program Analyst (LPA) Nancy O'Connell made unannounced inspection to the above-listed facility for the purpose of concluding the investigation on the above allegations and deliver the findings. LPA O'Connell met with Marylou Escoto and discussed the investigative findings. On 3/16/23, the Department received a complaint alleging staff are not trained. During the investigative process, LPA O'Connell conducted confidential interviews with all relevant parties and collected information on the above allegations. After reviewing all the statements and the information obtained, the above allegation is supported, as the confidential interviews confirmed that primary residential counselors, responsible for the direct care of clients, are not afforded with necessary training to manage symptoms/behaviors presented by target population that the program serves. Further confidential interviews revealed that staff have not been provided with comprehensive and completed ProAct training, which is used for the purpose of de-escalation, redirection, and conceptualization of trauma based behaviors. This training and training of a similar nature provide staff with the tools to administer trauma-informed care, and support client/staff safety. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division & Chapter number), are being cited on the attached LIC 9099D. Exit Interview conducted, and a copy of this report was left at the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 31-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, VENTURA BLVD., STE. WOODLAND HILLS, CA FACILITY NAME: KIDS KIDS-SAFE HOUSE (STRTP)FACILITY NUMBER: 425802125

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

met_with: Marylou Escoto, Facility Administrator, (FA)


raw_content:
Investigation Findings:
13On June 28,2023 at 1:00pm Licensing Program Analyst (LPA) Nancy O'Connell made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation and deliver the findings. LPA spoke with Marylou Escoto and together, discussed the investigative findings. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. Supporting evidence includes: conflicting interviews which describe minimal or ineffectual attempts by staff to disengage client physical altercations. Further, interviews and record reviews reveal that the facility is staffed at the required ratios, but the needs of clients may fluctuate at times, causing delays in response times by staff members. 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, therefore the allegations are unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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

met_with: Marylou Escoto, FAcility Administrator (FA)


raw_content:
Investigation Findings:
13On 9/6/23 at 9:30am Licensing Program Analyst (LPA) Nancy O'Connell and LPA Jhane Haynes made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegations and deliver the finding. LPA spoke with HOS and together, discussed the investigative finding. During the investigative process by Licensing program Analyst (LPA), Nancy O'Connell, all relevant parties have been accounted for. Supporting evidence includes: conflicting interviews with house residents and staff attesting to the occurrence of the identified allegations. Further, evidence reflects that the facility maintains appropriate medication administration procedures and policies. Lastly, statements to corroborate the occurrence of inappropriate communication with residents could not be obtained. 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, therefore the allegation is unsubstantiated. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Nancy O'Connell LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

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

met_with: Christina Menghrajani, Head of Service (HOS)


facility_name: 7 ALPHA

summary: Facility Evaluation

raw_content:
Narrative:
On January 28 2025 at 11: AM Licensing Program Analyst (LPA) Rosslyn Gray arrived at ALPHA Short Term Residential Therapeutic Program (STRTP); located LAContempo Ave. Palmdale CA 93550 for the purpose of conducting Pre-Licensing inspection. A health and risk assessment were conducted. LPA met with the (S1) who granted access to the facility. The facility is seeking a license to provide care and supervision for four (4) male clients ages 12-17, ambulatory only. Currently there are no children in placement. LPA-Gray observed the follow during the inspection: The (STRTP) Overview: This is a 1 story 3 bedroom house located in a residential neighborhood. There is a two (2) car garage entrance from the outside and inside exit through the laundry area. The driveway has parking space for (2) vehicles. There a vehicle utilized to transport the clients. Description of the vehicle is 6 passenger Toyota Sienna Insured by Philadelphia Indemnity Insurance August 21, 2025, inspected to be operating in good condition. The facility large trash cans are located on the right-hand side of the facility. LPA observed a hard wired interconnected combined smoke and carbon monoxide detector; tested to be operable. There office /therapy room, living room, kitchen, and dining room. LPA observed two (2) Fire Extinguishers located in the kitchen mounted and one in the garage. LPA observed a working telephone at the entrance and in the staff office. Clients will be permitted can use the telephone unless restricted by authorized representatives. All posting requirements were met,(i.e food menu posted in the kitchen and dinning area); regulations, personal rights (posted at the entrance of the kitchen); facility sketch The LIC 610C Emergency Disaster Plan for Children's Residential Facilities are laminated posted on the wall at the entrance dining area. LIC- Page 1 of Garage: This is a two car garage used for storage room. The indoor, exit door is adjacent to the Laundry room. The garage door will remain lock to and security. There are several large white storage bins, cleaning, supplies, clothing, art supplies. Chemicals are stored in the locked cabinets. Laundry Room: Located adjacent exit door that leads to the garage. It is equipped with a white Whirlpool washer and dryer unit. The laundry detergent, chemical and cleaning supplies are stored in a locked cabinets in the garage. Inside/Outdoor Area: LPA observed all windows, screens, and blinds from the inside and outside of the facility were observed to be in good condition. The passageways and porches are unobstructed. The backyard activity space is free of hazard materials and debris. Patio furniture is equipped with a table four (4) chairs. The main air conditioning/central heating unit electrical utilities, gas operated Hot Water Heater and shut-off valves are located on the right side of the house. Therapy Room/Staff Office#1: located to the right of the entrance, to the left down the hallway through double door entry, accessible to staff only. This office is to serve as private setting for therapeutic services and for conducting private interviews. The Licensee will ensure include office furniture, locked file cabinets to store the medication logs, medical devices, medication boxes and a small refrigerator that is utilized to store the clients prescribed medications. Bathroom #2 is located in Therapy Room/Staff Office# It is equipped with a bathtub two(2) sinks, a toilet, and a shower, observed to be in good condition. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. There is sliding glass door that lead to the backyard. Living Room: The Living Room is fully furnished with two (2) sofas, a ceiling fan, two(2) ends, coffee table, 55' television securely mounted on the wall and recess lighting ceiling fan. There is a fireplace that is inoperable. There is sliding glass door that lead to the backyard. Kitchen: The kitchen was observed to be clean and organized. LPA observed ample perishable and nonperishable food items. It is equipped with a four (4) burners gas stove with a oven, two (2) sided sink, a dishwasher, a refrigerator with bottom freezer and a Fire Extinguisher mounted on the wall. Kitchen cleaning supplies, liquids, hand soup, disinfectants and sharp knives are locked in a cabinet inaccessible in the staff office. LIC- Page 2 of Dining Area: The dining area consists of for (4) chairs and a large table, bookshelf/cabinet to store supplies. There are two (2) separate kitchen counter chairs and a Fire Extinguishers mounted on the wall; and a recess lighting ceiling fan. Bathroom #1 is a full sized, locate on the left of the hallway, equipped with a bathtub, shower, (1) toilet, one (1) sink, a storage cabinet inquire with towels and hygiene products, observed to be in good condition. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. The First Aid Kit is also located is this room. It was observed to be equipped with the required items inside (age-appropriate, scissors, tweezers, thermometer, and gauzes, antiseptic, and First Aid Manual Guide. Bedroom #1 is located to the left of the entrance. It is currently unoccupied and equipped for two (2) clients. It is currently unoccupied. It is equipped with two (2) twin bed, comfortable mattress, clean linen, blankets and pillows. There are one (1) sliding door closet and 1 six drawer dresser and 1 drawer night with a lamp. There is adequate lighting, two(2) windows with screens, vertical blinds, observed to be in good condition. Bedroom #2 is located to right of entrance. It is currently unoccupied and equipped for two (2) clients. It is equipped with two (2)twin sized bed, comfortable mattress, clean linen, blankets and pillows. There dresser drawers for each client, adequate lighting, a ceiling fan, window screens, vertical blinds, observed to be in good condition. The staff will accompany clients to local recreational facilities in the facility vehicle. Clients are accorded dignity in personal relationships with staff and others. The facility will operate within license conditions and limitations including capacity limitations. The Administrator ensured the facility will have the written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. LIC- Page 3 of The administrator will provide the Personnel Report (LIC 500) and confirmed that the staff ratio presents for the four (4) clients in placement. The administrator ensured that all will have required criminal record clearance. DOJ, FBI and Child Abuse Response that will meet qualification. LPA advised the Licensee to complete a LIC 200 to reduce to capacity to Children ages 12-17. The Licensee will ensure to complete the LIC 200 prior to Licensure. There were no deficiencies cited at this time. LPA concluded the Pre-License Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Administrator Luqman Watkins 01/28/ LIC- Page 4 of 4

visit_type: Prelicensing

met_with: Administrator Luqman Yusef Watkins


summary: Facility Evaluation

raw_content:
Narrative:
On February 24 2025 at 10: AM Licensing Program Analyst (LPA) Rosslyn Gray arrived at ALPHA Short Term Residential Therapeutic Program (STRTP);located LAContempo Ave. Palmdale CA 93550 for the purpose of conducting was held at the Children's Residential Regional Office in El Segundo. In attendance for the Component III was the Administrator Luqman Yusef Watkins and Licensing Program Analyst (LPA), Rosslyn Gray. The purposes of this Component III meeting were to discuss the Child's and Personnel Records, to be documented, retained, maintained, available and posted at the facility for inspections.LPA-Gray discussed the gender population and specific problems and issues of operating a STRTP, such as, reporting requirements, personnel requirements, supervision, intake issues, compatibility, removal/discharge, complaint procedures, transportation, health services, food, allergies, hygiene, gender hygiene products, visitation, personal property, searches, community sensitivity, Electronic Files to store records, ensure the client ratio is based on staff to behavior that may include increasing staff to provide proper supervision, staff training that also include administer of medication and who will be responsible for administering medication. LPA discussed who will ensure the Technicians are aware of the clients triggers and the reason for their placement, and need to provide a Grievance Box for the clients to report anonymous issues and concerns. LPA discussed the procedure of notification when an unusual incident occurs, and documenting on the ITrack Special Incident Reports: that include details of who what when where and how. LPA informed the Administrator obtain information from the placement agency of the process to link with the ITrack Special Incident Reports. LPA discussed prudent parenting and if the client is resistant to care and or are forced, how will the facility get the clients to buy in. The applicant discussed a plan to utilize peers and role models who are compliant and following the examples of how to follow rules and successfully run their individual program. LPA informed applicant that the capacity of 6 will changed to reflect a capacity of 4 as soon as possible. LPA will ensure that all revisions to the program statement and program operation have been reviewed and approved prior to issuing the Provisional License the Licensee. A copy of this report was provided to Administrator Luqman Yusef Watkins.


summary: Facility Evaluation

raw_content:
Narrative:
June 30, 2025 at 11: AM Licensing Program Analyst (LPA) Rosslyn Gray arrived at ALPHA Short Term Residential Therapeutic Program (STRTP); located LAContempo Ave. Palmdale CA 93550 for the purpose of conducting unannounced Post Licensing inspection. Upon arrival no-one was available upon. LPA made several attempts to contact the Administrator Luqman Yusef Watkins, left a voice message, text message and business card on the front door. On this day the Administrator responded and requested to be reschedule for the inspection to be conducted on a another day. July 2, 2025 at 11: AM Licensing Program Analyst (LPA) Rosslyn Gray arrived at ALPHA Short Term Residential Therapeutic Program (STRTP); located LAContempo Ave. Palmdale CA 93550 for the purpose of conducting unannounced Post Licensing inspection. A health and risk assessment were conducted. LPA met with the House Manager Octavia Askew who granted access to the facility. The facility is seeking a license to provide care and supervision for four (4) male clients ages 12-17, ambulatory only. Currently there are no children in placement. LPA-Gray observed the follow during the inspection: The (STRTP) Overview: This is a 1 story 3 bedroom house located in a residential neighborhood. There is a two (2) car garage entrance from the outside and inside exit through the laundry area. The driveway has parking space for (2) vehicles. There is a vehicle utilized to transport the clients. Description of the vehicle is 6 passenger Toyota Sienna Insured by Philadelphia Indemnity Insurance August 21, 2025, inspected to be operating in good condition. The facility large trash cans are located on the right-hand side of the facility. LIC- Page 1 of LPA observed a hard wired interconnected combined smoke and carbon monoxide detector; tested to be operable. There office /therapy room, living room, kitchen, and dining room. LPA observed two (2) Fire Extinguishers located in the kitchen mounted and one in the garage. LPA observed a working telephone at the entrance and in the staff office. Clients will be permitted can use the telephone unless restricted by authorized representatives. All posting requirements were met,(i.e food menu posted in the kitchen and dinning area); regulations, personal rights (posted at the entrance of the kitchen); facility sketch The LIC 610C Emergency Disaster Plan for Children's Residential Facilities are laminated posted on the wall at the entrance dining area. Garage: This is a two car garage used for storage room. The indoor, exit door is adjacent to the Laundry room. The garage door will remain lock to and security. There are several large white storage bins, cleaning, supplies, clothing, art supplies. Chemicals are stored in the locked cabinets. Laundry Room: Located adjacent exit door that leads to the garage. It is equipped with a white Whirlpool washer and dryer unit. The laundry detergent, chemical and cleaning supplies are stored in a locked cabinets in the garage. Inside/Outdoor Area: LPA observed all windows, screens, and blinds from the inside and outside of the facility were observed to be in good condition. The passageways and porches are unobstructed. The backyard activity space is free of hazard materials and debris. Patio furniture is equipped with a table four (4) chairs. The main air conditioning/central heating unit electrical utilities, gas operated Hot Water Heater and shut-off valves are located on the right side of the house. Therapy Room/Staff Office#1: located to the right of the entrance, to the left down the hallway through double door entry, accessible to staff only. This office is to serve as private setting for therapeutic services and for conducting private interviews. It is equipped office furniture, locked file cabinets to store the medication logs, medical devices, medication boxes and a small refrigerator that is utilized to store the clients prescribed medications. Bathroom #2 is located in Therapy Room/Staff Office# It is equipped with a bathtub two(2) sinks, a toilet, and a shower, observed to be in good condition. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. There is sliding glass door that lead to the backyard. LIC- Page 2 of Living Room: The Living Room is fully furnished with two (2) sofas, a ceiling fan, two(2) ends, coffee table, 55' television securely mounted on the wall and recess lighting ceiling fan. There is a fireplace that is inoperable. There is sliding glass door that lead to the backyard. Kitchen: The kitchen was observed to be clean and organized. LPA observed ample perishable and nonperishable food items. It is equipped with a four (4) burners gas stove with a oven, two (2) sided sink, a dishwasher, a refrigerator with bottom freezer and a Fire Extinguisher mounted on the wall. Kitchen cleaning supplies, liquids, hand soup, disinfectants and sharp knives are locked in a cabinet inaccessible in the staff office. Dining Area: The dining area consists of for (4) chairs and a large table, bookshelf/cabinet to store supplies. There are two (2) separate kitchen counter chairs and a Fire Extinguishers mounted on the wall; and a recess lighting ceiling fan. Bathroom #1 is a full sized, locate on the left of the hallway, equipped with a bathtub, shower, (1) toilet, one (1) sink, a storage cabinet inquire with towels and hygiene products, observed to be in good condition. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. The First Aid Kit is also located is this room. It was observed to be equipped with the required items inside (age-appropriate, scissors, tweezers, thermometer, and gauzes, antiseptic, and First Aid Manual Guide. Bedroom #1 is located to the left of the entrance. It is currently unoccupied and equipped for two (2) clients. It is currently unoccupied. It is equipped with two (2) twin bed, comfortable mattress, clean linen, blankets and pillows. There are one (1) sliding door closet and 1 six drawer dresser and 1 drawer night with a lamp. There is adequate lighting, two(2) windows with screens, vertical blinds, observed to be in good condition. LIC- Page 3 of Bedroom #2 is located to right of entrance. It is currently unoccupied and equipped for two (2) clients. It is equipped with two (2)twin sized bed, comfortable mattress, clean linen, blankets and pillows. There dresser drawers for each client, adequate lighting, a ceiling fan, window screens, vertical blinds, observed to be in good condition. The staff will accompany clients to local recreational facilities in the facility vehicle. Clients are accorded dignity in personal relationships with staff and others. The facility will operate within license conditions and limitations including capacity limitations. The Administrator ensured the facility will have the written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. The administrator will provide the Personnel Report (LIC 500) and confirmed that the staff ratio presents for the four (4) clients in placement. The administrator ensured that all will have required criminal record clearance. DOJ, FBI and Child Abuse Response that will meet qualification. The Licensee previously completed the LIC 200 to reduce the capacity to Children ages 12-17. There were no deficiencies cited at this time. LPA concluded the Post Licensing Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the House Manager Octavia Askew 07/02/2025. LIC- Page 4 of 4

met_with: House Manager Octavia Askew


summary: Facility Evaluation

raw_content:
Narrative:
On 3/12/2026, at 9:00 am, Licensing Program Analyst (LPA) Nestor Gomez arrived at the above facility, for the purpose of conducting an Annual Inspection. LPA Gomez met with Direct Support Personnel (S1) Velda Eddington who granted access to the facility. During the time of inspection, LPA Nestor conducted an inspection of the following areas: Kitchen: equipped with a four (4) burners gas stove with a oven, two (2) sided sink, a dishwasher, a refrigerator with bottom freezer and a fire extinguisher mounted on the wall. The pantry and refrigerator contained ample food for children in care that included both perishable and non-perishable foods. All appliances are in working order. The trash can in the kitchen was equipped with a lid. LPA observed that the open food products and Tupperware were not labeled or dated. Living Room: Equipped with two (2) sofas, a ceiling fan, two (2) end tables, coffee table, 55' television securely mounted on the wall and recess lighting ceiling fan. There is a fireplace that is inoperable. There is sliding glass door that leads to the backyard. Dining area: Equipped with (4) chairs and a table that seats four (4). There are two (2) separate kitchen counter chairs and a Fire Extinguishers mounted on the wall, and a ceiling fan. Continue on 809-C (Page 1) Bedroom #1: located to the left of the entrance. This bedroom is currently occupied by C1. The bedroom is equipped with two (2) twin beds, closet space, one (1) chair, two (2) lamps, one (1) nightstand, and one (1) six drawer dresser. There is adequate lighting, two (2) windows with screens, vertical blinds, observed to be in good condition. Bedroom #2: located to the right of the entrance. This bedroom is currently occupied by C2. The bedroom is equipped with two (2) twin sized beds, one (1) six drawer dresser, one (1) nightstand, two (2) lamps, and closet space. Bathroom #1: located on the left in the hallway. This bathroom is equipped with a storage cabinet stocked with towels, sink, toilet and bathtub/shower. LPA measured the water temperature in Bathroom #1 at 132 degrees Fahrenheit, which does not meet licensing regulations. Bathroom #2: located adjacent to the Therapy room/staff office. This bathroom is equipped with a bathtub, two (2) sinks, a toilet, and a shower, observed to be in good condition. There is also a sliding glass door that leads to the backyard. Garage: This is a two (2) car garage that is used for storage. The indoor exit door is adjacent to the laundry room. The garage door will remain locked. There are several large white storage bins, cleaning, supplies, office supplies, first aid, some hygiene items, and art supplies. Chemicals are stored in locked cabinets. therapeutic services and for conducting private interviews. There is a closer adjacent to this room that stores the client/staff files, client cash resources, medication, and other stored items. Laundry Room: Located adjacent to the exit door that leads to the garage. It is equipped with a Maytag washer and dryer unit. The laundry detergent, chemical and cleaning supplies are stored in a locked cabinets in the garage. Continue on 809-C (Page 2) Backyard: The backyard activity space is free of hazard materials and debris. Patio furniture is equipped with a table four (4) chairs. The main air conditioning/central heating unit electrical utilities, gas operated hot water Heater and shut-off valves are located on the right side of the house. Additional Observations: The cleaning supplies are stored in the garage. Sharps are stored in the garage. There are one (1) fire extinguishers located in the dining room. LPA observed the carbon monoxide/smoke detectors to be in working order when tested by the licensee. LPA observed all required posting. Kitchen cleaning supplies, liquids, hand soup, disinfectants and sharp knives are locked in a cabinet inaccessible in the garage. At the time of the inspection there was only one (1) six drawer dresser in each room and S2 stated that the clients would share the drawer space. LPA observed a total of ten (10) cameras on the facility property. Licensee was informed that the cameras must not be used until approved by the Department. There is a signal system in place on all the facility exits and windows. LPA observed the landline to be placed in the living room area. Vehicles: LPA Nestor inspected one (1) facility vehicle in total. Dodge Grand Caravan (White) with current registration. Insured by Redwood Fire and Casualty Insurance Company that expires on 06/20/2026. Vehicles are in good condition with no issues. Staff Interview: LPA Nestor conducted two (2) staff interviews with S2 and S1. Client Interview: LPA Nestor conducted two (2) client interviews with C1 and C2. LPA Nestor will return to complete the inspection. There were no deficiencies observed or cited at this time. A copy of this report was reviewed and provided to the facility administrator (FA). End of Inspection (Page 3)

met_with: Direct Support Professional (S1) Velda Eddington


summary: Facility Evaluation

raw_content:
Narrative:
On 3/13/26, at 9:00 am, Licensing Program Analyst (LPA) Nestor Gomez arrived at the above-mentioned facility for the purpose of verifying the completion of the required corrections related to the physical plant deficiencies identified during the annual inspection conducted on 3/13/2026. LPA Gomez met with Facility Administrator (FA), Luqman Watkins, who granted access to the facility. LPA Gomez conducted a walk through of the facility and reviewed relevant documentation to confirm compliance. The following deficiencies were identified and cited on 3/13/26: • Citation: CCR 8008(e)(1) Fixtures, Furniture, Equipment and Supplies Requirement: (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). Original Finding: LPA measured the water temperature in Bathroom #1 at 132 degrees Fahrenheit. Correction Verified on 3/13/2026. • Citation: Food Service 80076(a)(1) Requirement: All food shall be safe and of the quality and in the quantity necessary to meet the needs of the clients. Continue on 809-C (Page 1) .... All food shall be selected, stored, prepared and served in a safe and healthful manner. Original Finding: Licensee did not properly store and date food items in the refrigerator. Correction Verified on3/13/2026. • Citation: CCR 80071(a)(1) Register of Clients Requirement: (1) The licensee shall maintain in the facility a register of all clients. The register shall be immediately available to, and copied for, licensing staff upon request, and must contain current information on the following: Original Finding: Licensee did not have a register of clients with the necessary information, and it was not immediately available to the LPA. Correction Verified on 3/13/26. LPA Gomez conducted a walkthrough of the physical plant and confirmed that the facility completed all required corrections associated with the above citations. End of Inspection (Page 2)


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 3/13/26 , at 9:00 am, Licensing Program Analyst (LPA) Nestor Gomez returned to the above-mentioned facility to continue the annual inspection that was started on 3/12/26. LPA Gomez met with Facility Administrator (FA), Luqman Watkins, who granted access to the facility. The following was observed during the Inspection: Staff Records Review: LPA reviewed two (2) staff records for the S4 and S1. LPA Gomez attempted to review the files for FA and S2, but the files were not maintained or present at the facility. Clients Records Review: LPA reviewed two (2) client records for C1 and C2. There were three (3) deficiencies observed and cited at this time. See 809-D. Exit interview was conducted with the Facility Administrator and a copy of this report was emailed to the Facility Administrator.

Deficiencies:
80066(a): Personnel Records (a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information


summary: Facility Evaluation

raw_content:
Narrative:
On December 10, 2024, 10: AM, Component II of the application process for ALPHA FOUNDATION FOR COMMUNITY WELLNESS. This meeting was held at the El Segundo Children's Residential Program Regional Office. Attending Component II were the following individual: Executive Director/Administrator Luqman Watkins and Licensing Program Analyst (LPA), Rosslyn Gray. The facility is currently located Lakeview Dr. Palmdale CA 93551. The Applicant informed LPA of the plan to relocate due to replacement of the septic sewage system. LPA informed Applicant of the requirement to submit a new application and facility sketch. The purposes of this Component II meeting were to review the incomplete application, review revisions to the Program Statement and Plan of Operations, and to resolve any outstanding concerns that may have existed. The following incomplete application forms were discussed at the meeting: Section A-P A. Vision, Mission, Purpose, Goals, and Philosophies B: Administrative Organization C: Facility Sketch D. Staff Plan E. Policies Regarding Child Abuse/Neglect Reporting F. Admission Policies and Procedures G. Admission Determination Procedures H. Intake Policies and Procedures I. Admission Agreement J. Removal or Transfer Policies and Procedures K. Rate Setting and Refunds L. Handling Money, Personal Property, and/or Valuables M. Consultants and Community Resources N. Trauma-Informed Intervention and De-Escalation Techniques O. Conflict of Interest Mitigation Plan P. Continuous Quality Improvement (CQI) Initial Section 1-23 1. Population to Be Served 2. Emergency Response Services 3. Transportation Arrangements 4. Core Services and Supports 5. Culturally Relevant Interventions, Practices, Services, & Supports 6. Trauma Informed Interventions and Treatment Practices 7. Development and Modification of Needs and Services Plans 8. Planned Activities 9. Services During Placement and Post Permanency 10. Plan for Participation in Child and Family Team 11. Identification of Home Based Care 12. Participation of Family Members in Treatment & Outreach to Family 13. Complaints and Grievances 14. Participation and Assistance in Initiatives to Improve the Child Welfare System 15. Family Visitation 16. Personal Rights 17. House Rules 18. Positive Discipline Policies 19. Storage of Medication 20. Documentation of Accreditation 21. Mental Health Program Approval 22. Nursing Services 23. Food and Nutritional Plan/Sample Menus/Clothing & Incidentals 24. Emergency Intervention Plan (Runaway Plan) The Pre-Licensing inspection will be scheduled upon completion of the plan to relocate the Short Term Residential Therapeutic Program. A copy of this report will be provided via email to Executive Director/Administrator Luqman Watkins.


facility_name: AARON'S BOYS HOME #1

raw_content:
Investigation Findings:
13On August 24, 2022, at 12: PM., Licensing Program Analyst (LPA), Kuliema Calloway, made an unannounced visit to the above facility for the purpose of concluding complaint findings. LPA met with Steven Lopez, Facility Administrator at Aaron's Boys who granted access. Based on the interviews and documents obtained, prior to the 14-Day notice given by the facility on 6/23/2022, an emergency CFT meeting was not held, and prior written approval was not obtained from the authorized representative of client (C1). [See Confidential Names Form (LIC 811) dated 8/24/2022, for names.] Therefore, the violation of discharge procedures corroborates allegations of wrongful eviction. Based on the review and analysis of all the evidence, the Department has found this complaint to be Substantiated, meaning, the preponderance of the evidence standard has been met. The following deficiency was cited at the time of this inspection. (See Lic 9099-D). A copy of this report and appeal rights were provided to Steven Lopez, at the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Kuliema Calloway LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, This is an official report of an unannounced visit/investigation of a complaint received in our office on 06/27/2022 and conducted by Evaluator Kuliema Calloway COMPLAINT CONTROL NUMBER: 34-CR- FACILITY NAME:AARON'S BOYS HOME #1FACILITY NUMBER: ADMINISTRATOR:STEVEN LOPEZFACILITY TYPE: ADDRESS: CURBARIL STTELEPHONE: (805) 466- CITY:ATASCADEROSTATE: CAZIP CODE: CAPACITY:12CENSUS: DATE: 08/24/ UNANNOUNCEDTIME BEGAN: 12: PM MET WITH:Steven Lopez, Facility AdministratorTIME COMPLETED:01: PM 9Incidents involving minor in care were not reported to their representative. INVESTIGATION FINDINGS: 13On August 24, 2022, at ? Am., Licensing Program Analyst (LPA), Kuliema Calloway, made an unannounced visit to the above facility for the purpose of concluding complaint findings. LPA met with Steven Lopez, Facility Administrator at Aaron's Boys who granted access. Based on the interviews with staff and documents obtained, the investigation revealed there were reports to Ventura County Probation Department from March to June. It is unclear if the reports were provided to all involved parties. Based on review and analyzing all evidence, the LPA has found this complaint to be Unsubstantiated, meaning the allegation may have happened or is valid, but there is not a preponderance of evidence to prove that the alleged violation occurred. There are no deficiencies to be cited for this allegation. A copy of this report and appeal rights were provided to Steven Lopez, at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Kuliema Calloway LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: AARON'S BOYS HOME #1FACILITY NUMBER: 401703381

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

met_with: Steven Lopen, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On June 16, 2021 at 11:45am Licensing Program Analyst (LPA) Enrique Hernandez conducted an announced Annual/required Inspection for the Aaron's Boys Home Short Term Residential Therapeutic Program (STRTP). LPA met with the Facility Administrator, Steven Lopez who granted access to the facility after a few COVID-19 question and checking LPA temperature with a touchless thermometer by the main entrance. LPA and Administrator toured the entire facility, inside and outside of the home. This is a single-story family home with a living room and a fireplace that has been closed off and made inoperable, a therapy room, Administrative office, kitchen, a dining area, six (6) bedrooms, two (2) full bathrooms and one (1) half bath, a "pool" room with billiards table and staff desk with storage for staff and client items, medication room with locked cabinets. The back yard contains a detached trailer with foundations that has two rooms, one is a therapy/Social Work room with couch and two desk chairs and aquarium and the other is a classroom with six (6) desks and Five (5) Computers. Washer/dryer are located adjacent to the kitchen area. The home is clean, safe, sanitary and in good repair. LPA observed the following: Bedroom #1 is vacant, it has two (2) twin size beds, adequate closet and drawer space. Bedroom #2 is occupied by one male client, it has two (2) twin size beds, adequate closet and drawer space. Bedroom #3 is occupied by one male clients, it has two (2) twin size beds, adequate closet and drawer space. Bedroom #4 is occupied by one male client. It has two (2) twin size beds, dresser, closet and night stand. Bedroom #5 is vacant. It has two (2) twin size beds, dresser, closet and night stand. Bedroom #6 is occupied by one male client. It has two (2) twin size beds, dresser, closet and night stand. Page 1 of Kitchen: There is a supply of non-perishable food supply located in the kitchen. There are four working burners on the stove, a large refrigerator and three freezers at the time of this inspection. Knives and sharps objects are stored in a locked pantry adjacent to the kitchen. Knives and sharps objects are stored in a locked pantry adjacent to the kitchen. LPA observed in a locked cabinet the knives in padlocked storage box not accessible to the clients at the facility. Cleaning supplies and tools are stored in a locked cabinet located adjacent to the washer and dryer in the laundry room adjacent to the kitchen. There is a supply of non-perishable food supply located in the kitchen. There are four working burners on the stove, a large refrigerator with plenty amount of food at the time of this inspection. Bathrooms: LPA observed two (2) full bathrooms adjacent to the bedrooms and a half bath adjacent to the kitchen. During the time of the inspection There are two linen and towel closets and additional storage in the bedroom hallways. All smoke detectors and carbon monoxide detectors are operable. All fire extinguishers are observed to be fully charged. All posting requirements are met. Administrator states there are no exterior or interior cameras on the facility property and LPA did not observe any cameras. Administrator states that there are no guns or weapons on the premises. The front yard and backyard are clear of debris. There are no bodies of water on the premises. LPA observed four facility vehicles at the time of inspection. Valid insurance and registration was confirmed by LPA. LPA observed and advised the facility administrator to repair/removed 7 metal poles next to the side yard of the house Bedrooms #4, #6 and #1 and classroom carpet is worn out In the bathroom by room 4 and 5 by the edge of the shower there is no seal/caulking in the tiles Facility administrator stated that they will email pictures when they repair the bathroom, carpet and when they remove the metal poles. Page 2 of A Review of the Facility's Personnel Summary on June 16, Reveals That Staff Have Doj/fbi Criminal Record Clearances and a Child Abuse Background Clearance. PER California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Chapter 7. Version 3.1, there are no deficiencies to be cited at this time. Exit interview was conducted and due to technical difficulties with the printer the copy of this report will be emailed to the facility administrator. Page 3 of 3

met_with: Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On August 24, 2022, at 1:m., Licensing Program Analyst (LPA), Kuliema Calloway, made an unannounced visit to the above facility for the purpose of conducting a Case Management visit. LPA met with Steven Lopez, Facility Administrator at Aaron's Boys who granted access and toured the facility and the outside staff office. LPA observed six (6) bedrooms, three (3 ) bathrooms, 2 kitchens , dining area, living room inside and outside staff office, lounge and classroom area. Outside lounge area. and there were no client's in care. LPA took photos. A copy of this report were provided to Steven Lopez, at the facility.

met_with: Steven Lopez, Facility Manager


facility_name: ABEONA HOUSE

summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Shikya Belfield, made an announced Complaint tele-Inspection with the above facility on 11/3/2021, at 9: AM. LPA Belfield met with Program Administrator Noelle Kinder. The purpose of the inspection is to deliver the findings regarding the above allegation. Based on interviews with two staff, confidential client interviews, an allegation were made against C1 that they inappropriately touched by C2. It was determined that clients are not allowed in each others bedroom and staff conducts checks to make sure clients are not doing so. during this investigation there was not enough evidence to prove that the interaction did or did not happen. Therefore, this allegation is Unsubstantiated. There were no violations of the Interim Licensing Standards during this inspection. An exit interview was conducted and a copy of this report will be sent to Program Administrator Noelle Kinder and Licensee Davina Polonco. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Shikya Belfield LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

Allegations:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 90

met_with: Noelle Kinder


raw_content:
Narrative:
LPA was not able to talk to one of the clients involved because they declined to interview. The allegations that staff is not providing adequate supervision to children has not met the preponderance of doubt, therefore the allegation is unsubstantiated. LPA conducted an exit interview with Kiana Perez, Residential Counselor, at 2:25PM whose signature confirms the receipt of this document.

Investigation Findings:
13On 10/14/2022 at 2:00PM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the above licensed facility. The purpose of this visit was to deliver the findings for the listed allegations. LPA met with Kiana Perez, Residential. At the time of the visit there were three clients and two staff present. During the course of the investigation, LPA Hood conducted four confidential interviews between 9/8/2022 and 10/12/2022. LPA reviewed the submitted incident reports, staff schedule, Needs and Services Plans, and Child Family Team (CFT) Meeting notes. Based on record review and confidential interviews, a client was in another client's room in the early morning. According to record review and interviews, the client was only present in the room for less than five minutes. The night shift staff member conducts room checks every thirty minutes, which is compliant with the facility's program plan. Continued on LIC9099C... UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Selena Hood LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: ABEONA HOUSEFACILITY NUMBER: VISIT DATE: 10/14/2022

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

met_with: Kiana Perez


summary: Complaint Investigation - Unsubstantiated - 1 deficiency - 3 allegations

raw_content:
Narrative:
Based on confidential interviews, review of the internal investigation, and review of the Sheriff's Office's report, one client states that there was an inappropriate relationship between a staff member and a client. The accused staff member denies any inappropriate conduct with any youths in care. The client involved in this allegation declined to interview with LPA Hood or the Sheriff's office. The client has since turned eighteen and left the placement. Based on the conflicting accounts and inability to interview alleged victims, the allegation that staff member had an inappropriate relationship with a client may or may not have happened. This allegation has not met the preponderance of doubt, and therefore the allegation is deemed unsubstantiated. LPA conducted an exit interview with Emma Spillner, Program Manager, at 12:50PM, whose signature confirms the receipt of this document. Based on confidential interviews, review of the internal investigation, and review of the Sheriff's Office's report, four clients stated that the staff member did share marijuana and nicotine vape pens within the facility/facilities - two of the interviewed claimed that this was done specifically within Abeona House. The accused staff member denies sharing the vape pens, but during their interview with Law Enforcement stated that they had not reported all of the times that they found youth using vape pens or after confiscating vape pens. Based on the recorded first-hand accounts, the allegation that staff member shared their vape with clients has met the preponderance of doubt and this allegation is substantiated. LPA delivered a citation for STRTP Interim Licensing Standards Version 4 87065.2(b) Personnel Duties (see LIC9099D). LPA delivered appeal rights and devised a Plan of Correction with Emma Spillner, Program Manager. LPA conducted an exit interview with Emma Spillner, Program Manager, at 12:50PM, whose signature confirms the receipt of this document.

Investigation Findings:
13On 11/3/2022 at 12:00PM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the listed licensed agency. The purpose of this visit was to deliver the findings for the above allegation. LPA met with Anthony Pham, Residential Care Counselor. This complaint involves a staff member that was employed at another faciltity as well, there is crossover in the investigation. During the course of the investigation(s), LPA Hood conducted ten confidential interviews. LPA reviewed notes from an internal investigation, daily logs for all clients, alleged victim's Needs and Services Plan, and incident reports. In conjuction with the Community Care Licensing (CCL) investigation, the Santa Cruz Sheriff's Office conducted their own investigation. LPA Hood reviewed the redacted warrant request that the Sherriff's Office sent to the District Attorney. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Selena Hood 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, N. First Street, Ste. This is an official report of an unannounced visit/investigation of a complaint received in our office on 02/22/2022 and conducted by Evaluator Selena Hood PUBLICCOMPLAINT CONTROL NUMBER: 26-CR- FACILITY NAME:ABEONA HOUSEFACILITY NUMBER: ADMINISTRATOR:EMMA SPILLNERFACILITY TYPE: ADDRESS: VALENCIA ROADTELEPHONE: (831) 425- CITY:APTOSSTATE: CAZIP CODE: CAPACITY:6CENSUS: 6DATE: 11/03/ UNANNOUNCEDTIME BEGAN: 12: PM MET WITH:Anthony PhamTIME COMPLETED:01: PM 9Staff member had inappropriate contact with clients. INVESTIGATION FINDINGS: 13On 11/3/2022 at 12:00PM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the listed licensed agency. The purpose of this visit was to deliver the findings for the above allegation. LPA met with Anthony Pham, Residential Care Counselor. This complaint involves a staff member that was employed at another faciltity as well, there is crossover in the investigation. During the course of the investigation(s), LPA Hood conducted ten confidential interviews. LPA reviewed notes from an internal investigation, daily logs for all clients, alleged victim's Needs and Services Plan, and incident reports. In conjuction with the Community Care Licensing (CCL) investigation, the Santa Cruz Sheriff's Office conducted their own investigation. LPA Hood reviewed the redacted warrant request that the Sherriff's Office sent to the District Attorney. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Selena Hood 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 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: ABEONA HOUSEFACILITY NUMBER: VISIT DATE: 11/03/2022

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion: Based on record review and confidential interviews, staff member allowed for youth to smoke within the facility and shared marijuana and nicotine vape pens with clients in care.

Deficiencies:
87065.2(b): Direct care staff shall...  Supervision, protection, and care of children at all times... duties that may be necessary to ensure the health and safety of children in the facility.

met_with: Anthony Pham

title: Personnel Duties


raw_content:
Narrative:
The allegation that staff did not seek necessary medical attention to minor in care may or may not be true, the allegation has not met the preponderance of a doubt. Therefore the allegation is unsubstantiated. LPA Hood conducted an exit interview with Noelle Kinder, Administrative Coordinator at 12:05PM whose signature confirms the receipt of this document.

Investigation Findings:
13On 2/22/2023 at 11:48AM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the facility. The purpose of this visit was to deliver the findings on the listed allegation. LPA met with Noelle Kinder, Administrative Coordinator. At the time of the visit there were two youth and three staff. During the course of the investigation, LPA Hood conducted four interviews between 1/24/2023 and 2/15/2023. LPA reviewed incident reports, Needs and Service plans, and the facility's Program Statement. Based on confidential interviews and record review, staff conducted an evaluation of the client's physical and emotional state. The client was able to create a safety plan and return to their nightly routine, so staff decided not to seek medical care. Physically, the client did not receive any noticeable injuries and the client did not report any physical pain after the incident. This staff evaluation is pursuant with the facility's Program Statement. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Selena Hood LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: ABEONA HOUSEFACILITY NUMBER: VISIT DATE: 02/22/2023

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


raw_content:
Narrative:
Based on the information listed, the allegation that staff is not providing adequate supervision to youths in care may or may not be true. The allegation has not met the preponderance of doubt and therefore the allegation is unsubstantiated. No deficiencies were cited at this time. LPA conducted an exit interview with Emma Spillner, Program Manager, at 3:30PM whose signature confirms the receipt of the document.

Investigation Findings:
13On 3/21/2023 at 3:25PM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to deliver the findings for the listed allegation. LPA met with Emma Spillner, Program Manager. During the course of the investigation, LPA conducted six confidential interviews between 3/08/2023 and 3/20/2023. LPA reviewed incident reports and the Needs and Services Plans for the clients involved. Based on confidential interviews, the clients had eloped from the facility on 2/27/2023. Based on interviews and record review, staff had observed clients leaving the home through a bedroom window and followed the clients for approximately ten minutes. Staff lost sight of the residents, and immediately contacted law enforcement to report the residents missing. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Selena Hood LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: ABEONA HOUSEFACILITY NUMBER: VISIT DATE: 03/21/2023

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

met_with: Emma Spillner


raw_content:
Investigation Findings:
13On 8/15/24 at 1: PM, Licensing Program Analyst (LPA) Paul Simien conducted an unannounced inspection to the above facility. The purpose of the inspection is to inform the facility representative of the findings for the above listed allegations. LPA Simien met with Emma Spillner, Administrator who assisted with the inspection. Based on confidential interviews and supportive documentation to include but not limit, incident report, client and staff rosters. Multiple attempts were made to contact individuals involved in the allegations and were unsuccessful. Although the allegations above may have happened, there is not enough of the evidence to support that they are true. Therefore, these allegations are Unsubstantiated. An exit interview was conducted and copy of this report was sent to Emma Spillner, Administrator UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Paul Simien LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Emma Spillner, Administrator


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien made an unannounced visit to the above listed facility main office to inform them of the findings for the above listed allegations. LPA met with Emma Spillner, Administrator (ADM) at AM on 4/3/25. Based on confidential interviews conducted it was determined that the allegations listed above are Unsubstantiated. Facility staff would require clients to check in with staff before calling 911. This was to ensure that clients were using 911 appropriately due to some clients using 911 for non-emergencies. LPA couldn't find any evidence of the facility not ensuring clients mental health needs. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. As a result of this visit, there were no title 22 deficiencies observed. Exit interview was conducted and a copy of this report was provided to ADM. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Paul Simien LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1