raw_content:
Narrative:
***Continued from LIC 9099*** On October 13, 2023, at 3: PM, LPA initiated the investigation at CFLC-Sunset House, reviewed children and staff records and obtained documents from the files. Additionally, LPA conducted a health and safety inspection and interviewed Assistant Administrator Lizeth Ruvalcaba. There were no immediate hazards observed. During investigation, LPA conducted collateral interviews with C1, C2, and C3. C4 was not able to be contacted for an interview. LPA were unable to contact the County Social Workers (CSW). Regarding the allegation that staff did not ensure that children have access to hygiene products, several confidential interviews stated that when the children arrive to the facility, they are given a bag with towels and hygiene products. Another confidential interview stated the children can request toiletries from the staff. Confidential witness stated that children felt that they were getting basic items. Perfume, body oil and nail polish were not being purchased and the facility requested the children to purchase those hygiene items with the children's allowance. Confidential interview stated children keep their toiletries in their bedroom. In regard to staff do not ensure that children are fed adequately, confidential interviews stated that grocery shopping is done weekly. Children can request food items they would like to have. Confidential interview stated that staff do purchase items the children's want to eat food from their culture if they can find it in the market. Another confidential interview stated that when children get their cultural food, it is often wasted due to the children not eating it. Regarding staff not treating minor with dignity or respect allegation, confidential interview stated, "all children are treated with dignity and respect at all times". The children are the ones who are disrespectful". Another confidential interview stated staff do not disrespect children. Children get mad when things are not going their way." LPA received a conflicting information. Concerning staff do not provide towels for children, confidential interview stated that towels are given to children upon their arrival to the facility. The children are given a with supplies in it which includes two sets of towels and towels are replaced when requested by the children. Another confidential interview stated there is ample supply of towels available in the linen cabinet for the children to use. Confidential interview didn't disclose information regarding the allegation. ***Continued from LIC 9099-C*** In regard to staff forcing their religious beliefs onto child, a confidential interview denied talking to them about religion. A confidential interview stated that a staff would say "bless you" if someone sneezed. Children are asked if they attend church when they arrive at the facility just in case, they want to attend religious services. Confidential interview felt being forced to attend religious services. In regard to staff do not ensure that children have identification, a confidential interview stated staff were aware that some children wish to have an identification card. However, confidential reported that staff do not have the birth certificates for the children to obtain identification and staff have requested birth certificates from social workers. Another confidential interview stated the children that have birth certificates did not want to go The Department of Motor Vehicles to obtain an identification card. In regard to staff withholding minor's allowance allegation, a confidential interview stated allowance have never been withheld. Another confidential interview stated staff would hold our allowance if a children wanted to save their allowance for a special purchase. Confidential reports indicated that staff would make children pay for their hygiene needs with their allowances. LPA received a conflicting information. Based on confidential interviews, observations, and file reviews, the allegations that staff do not ensure that children have access to hygiene products; staff do not ensure that children are adequately fed; staff do not treat minors with dignity or respect; staff do not provide towels for children; staff forced religious beliefs onto child; staff do not ensure that children have identification; and staff withheld minor's allowance. 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 at this time. Exit interview was conducted. A copy of this report, LIC 811, and appeal rights were explained and provided to Lizeth Ruvalcaba, Administrator

Investigation Findings:
13On May 10, 2024. at 1: PM, Licensing Program Analyst (LPA) Karen Beal arrived at CFLC- Sunset House and met with Lizeth Ruvalcaba, Administrator. The purpose of this visit was to deliver the investigative finding of the complaint involving the children listed on the Confidential Names (LIC 811). On October 12, 2023, Community Care Licensing (CCL) received a complaint alleging that staff do not ensure that children have access to hygiene products, staff do not ensure that children are adequately fed, staff do not treat minors with dignity or respect, staff do not provide towels for children, staff forced religious beliefs onto child, staff do not ensure that children have identification, and staff withheld minor's allowance. It was specifically alleged that children do not have access to their allowance; children do not have a choice of food being purchased; children are not given the option to get identification; and staff body shame children. ***Continued to LIC-C*** UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Karen Beal LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: CFLC-SUNSET HOUSEFACILITY NUMBER: VISIT DATE: 05/17/2024

met_with: Lizeth Ruvalcaba, Administrator


state: CA

facility_name: CFLC-SUNSET HOUSE

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Regarding the allegation that staff did not adequately monitor a minor's online activities, it was specifically stated that C1 was doing inappropriate things in the shower. A confidential interview denied staff were not monitoring clients' online activities. Staff would communicate with the clients to ensure the online materials were appropriate. Confidential interview reported that staff did not observe C1 using C1's phone in the shower due to privacy. Another confidential interview corroborated that staff were not aware that C1 was using the phone to access online stuff while in the restroom. Confidential interview maintained that staff did not ensure C1 was always supervised adequately. The confidential interview stated staff was not paying attention to C1 in while C1 was in the shower. In regard to the allegation that staff did not pick up C1 from school when requested, it was specifically stated that C1 wanted to go home early from school and C1 began to undress in the school lobby. Confidential interview revealed that C1 wanted to leave school earlier than the closing time but C1 was advised to remain in school until school was over. Another confidential interview believed C1 wanted to go home in the middle of the day. The confidential interview revealed that C1 had no reason to leave school early, however, it was reported that C1 ended up undressing at school due to staff inquiring C1 to stay in school. Additional confidential interview stated C1 wanted to go home and play. LPA was unable to gather additional information. Based on confidential interviews and observations, the allegations that staff did not adequately monitor C1's online activities, and S1 did not pick up C1 from school when requested, may have occurred, however, there was not a preponderance of evidence to support the alleged violations. Therefore, these allegations are unsubstantiated at this time. A copy of this report, LIC 811 and the appeal right was reviewed and provided to STRTP representative.

Investigation Findings:
13On September 16, 2024, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at CFLC-Sunset House, Short Term Therapeutic Residential Program (STRTP) and met with facility manager Aleighna Mejia to deliver investigative findings involving the STRTP. On January 30, 2024, a complaint report was referred to Community Care Licensing (CCL) alleging staff did not adequately monitor a minor's online activities, and staff did not pick up a minor from school when requested. On February 8, 2024, (LPA) Babatunde Aborchie arrived at the STRTP to initiate the investigation and conducted a safety inspection. There were no safety issues observed. During investigation, LPA interviewed Administrator 1 (A1), Staff 1 and 2 (S1 and S2), clients 1, 2 and 3 (C1, C2 and C3). LPA was unable to interview County Social Worker (CSW). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Babatunde Aborchie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: CFLC-SUNSET HOUSEFACILITY NUMBER: VISIT DATE: 09/16/2024

report_type: Complaint Investigation

met_with: Aleighna Mejia

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
In regard to the allegation that staff did not ensure minor is properly fed while in care, confidential interviews stated that clients get three meals a day and snacks in between. Staff cooks breakfast, lunch, and dinner every day. Other confidential interviews stated clients are allowed to eat alternative foods if they do not like the food that has been made for them, they are not forced to eat what was already prepared. A confidential interview maintained that C1 is not allowed to grab food from the kitchen and staff offers C1 spicy Mexican food. LPA received conflicting information. Regarding the allegation that staff left minor unattended at medical appointments, confidential interviews stated that the younger clients have priority of having staff accompany them at medical appointments due to their ages. Other confidential interviews stated C1 is over the age of 18 and was to attend Doctor appointments alone. However, a confidential interview indicated that C1 had to take Uber to go to the pharmacy as staff didn't want to take C1. It was further disclosed that C1 was left behind for doctor appointments on multiple occasions. In regard to the allegation that staff did not address a minor's change in medical condition and staff did not seek timely medical attention for client, confidential interviews stated that C1 goes to the doctors on a regular basis. Other confidential interviews stated that clients must tell staff when they are sick or injured in order for staff to know what is going on. However, confidential interviews indicated that C1 was neglected. Other confidential interviews stated that when clients express concerns or make a complaint, staff will take them to urgent care or the doctor's office and make a report about it. Additional confidential interviews stated that clients always receive care in a timely manner as long as they tell staff about it right away. A confidential interview maintained that C1 sustained injuries due to punching a wall, but C1 was taken to the urgent three weeks later. Lastly, for the allegation that staff did not provide appropriate transportation for a minor, it was specifically reported that C1 had to ask for an uber to pick up medicine from a pharmacy. Confidential interviews stated that clients are never denied transportation to places of such importance. Another confidential interview stated, no client must find their own ride, staff always provides transportation. LPA was unable to verify the information. Based on confidential interviews and a review of pertinent documents, the allegations that staff do not ensure C1 is properly fed while in care, staff left C1 unattended at medical appointments, staff did not address C1's change in medical condition, staff did not seek timely medical attention for C1 and staff did not provide appropriate transportation for C1, may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted. A copy of this report, LIC 811 and appeal rights were explained and given to client services Maria Ramirez.

Investigation Findings:
13On September 20, 2024, at 12: PM, Licensing Program Analysts (LPA) Maryjane Perez conducted an unannounced visit at California Family Life Center (CFLC) - Sunset House Short Term Residential Therapeutic Program (STRTP) and met with Client Services Maria Ramirez to deliver the findings for the above stated allegations. On 5/2/ Community Care Licensing received complaint allegations that staff do not ensure a minor is properly fed while in care; staff left a minor unattended at medical appointments; staff did not address a minor's change in medical condition; staff did not seek timely medical attention; and staff did not provide appropriate transportation for a minor. On May 6, 2024, LPA Karen Beal conducted a health and safety inspection of the facility and no hazards were observed. Lpa K. Beal also obtained pertinent documents and interviewed Assistant Administrator, staff 2 (S2), and client 1 (C1). In addition, LPA M. Perez conduct interviews with foster children 2, 3, and 4 (FC2, FC3, FC4) as well as staff 3 and 4 (S3 and S4) to gather additional information. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: MaryJane Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: CFLC-SUNSET HOUSEFACILITY NUMBER: VISIT DATE: 09/20/2024

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

met_with: Maria Ramirez- Client Services


raw_content:
Narrative:
comments or jokes towards other clients. Additionally, confidential interviews corroborated stating that they have not witnessed any physical inappropriate interactions between clients. Another confidential interview stated that it was reported that C2 gets in C1's bed but the two clients did not share a bedroom. A confidential interview reported that staff will make sure clients are not in each other's beds and conduct room checks frequently. LPA received conflicting information. Based on confidential interviews and a review of pertinent documents, the allegation that staff did not prevent minors in care from engaging in inappropriate interactions may have happened or is valid but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted. A copy of this report, LIC 811 and appeal rights were explained and given to direct care staff II Susie Garcia.

Investigation Findings:
13On May 23rd, Licensing Program Analyst (LPA) Maryjane Perez made an unannounced visit to CFLC- Sunset House Short- Term Residential Therapeutic Program (STRTP) and met with direct care staff II Susie Garcia to deliver the finding for the above stated allegation involving staff and clients as listed on the Confidential Names (LIC 811). On 12/31/2024, Community Care Licensing received complaint allegation that staff did not prevent minors in care from engaging in inappropriate interactions. On 1/08/25, LPA conducted a health and safety inspection where no immediate hazards were observed. Additionally, LPA interviewed staff 1 (S1), staff 2 (S2), staff 3 (S3), staff 4 (S4), staff 5 (S5), staff 6 (S6) client 2 (C2), client 3 (C3), and client 4 (C4). Client 1 (C1) and client 5 (C5) refused to be interviewed. During investigation, confidential interviews reported that a client was on a phone call talking inappropriately about another client in the home and staff had to redirect them. Other confidential interviews stated that staff makes up allegations to get clients in trouble. Other confidential interviews stated that C2 will make sexual UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: MaryJane Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: CFLC-SUNSET HOUSEFACILITY NUMBER: VISIT DATE: 05/23/2025

met_with: Direct Care Staff II- Susie Garcia


summary: Facility Evaluation

raw_content:
Narrative:
On July 16, 2021 10: AM, Licensing Program Analyst (LPA), Anastasia Flores, conducted a collateral interview at this facility. During the time at the facility LPA conducted a safety inspection of the facility and interviewed client #1 (C1), as identified on the Confidential Names form LIC 811, dated 07/16/21, regarding allegations from a prior placement. The allegations are not related to this facility. No other information is needed at this time. Exit interview conducted and a copy of this report was provided to the facility.

report_type: Facility Evaluation

met_with: Lizeth Ruvalcaba


summary: Facility Evaluation

raw_content:
Narrative:
On December 12, 2022 at 1: PM, Licensing Program Analyst (LPA), Val Wilson, arrived at CFLC-Sunset House, Short Term Residential Therapeutic Program, to initiate an annual inspection. The purpose of the inspection is to conduct an annual inspection of the facility. LPA was met at the facility by Program Director, Sheila Stephenson. The facility temporarily closed August 1, 2021, related to Covid and staffing resources. At the time of the inspection, there is no clients or staff in the facility. LPA provided and reviewed with the Program Director the Entrance Checklist and then the Program Director led the tour of the facility at 1: PM. Administrator, Rafaella Aguilar, joined the inspection around 2: PM. No Client files or Staff files were reviewed during time of inspection. Personnel Files are maintained off site at the corporate office in Hemet, Ca. During the time of inspection, there were no clients present in the facility for interviews. The Administrator stated there are no firearms or weapons allowed in the facility. Facility appears to be meeting the terms and conditions of their license. The facility consists of four bedrooms and two bathrooms. Smoothing of patching work repair and painting is needed in all four bedrooms. The facility includes a dining area, kitchen area, living room, laundry room, staff office, and a portable therapist office/visitor room located in the backyard. All bedrooms have individual beds and drawer space for each client with no more than two beds in a room. The facility ensures that there is one client per bed with appropriate clean linens, pillows, comforters, and mattresses in good repair. Facility grounds are clean and free of debris. There is adequate indoor and outdoor activity space. Gym equipment and other activities were observed for client use on the back patio. All facility smoke detectors and carbon monoxide detectors are in appropriate working order. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster. Medications are locked and centrally stored in the medication room next to the front door. Water temperatures were noted between a minimum of 105 and a maximum of 125 degrees F. (Continued) (Continued) Facility has a pool which is appropriately fenced on three sides and secured with a rod iron fence. The enclosure was measured to be 5 feet in height, with a self-latching gate. The wood fencing on the walkway side of the pool that leads to the front door is leaning due to the weight of the greenery on the fencing. Based on the inspection, the facility is being cited in accordance with Title 22, Division 6, Chapter 1 and Interim Licensing Standards, STRTP, Article 07, Section- Physical Plant: 87087.2(a)(4)(A) - The fencing around the pool is leaning due to the weight of the greenery and 80087(a) - The walls in bedrooms one, two, three, and four need smoothing of patching work repair and painting. Additionally, Disaster Preparedness 80023(a) - The binder was thought to have been misplaced in the move. Program Director pulled the information from the Program Statement and plans to get a red binder to add the mass casualty and disaster plan for CFLC Sunset House. These technical violations pose a potential risk to the health and safety of the children. An exit interview was conducted, a copy of this report, and appeal rights were reviewed and given to Administrator, Rafaella Aguilar.

met_with: Sheila Stephenson and Rafaella Aguilar


facility_name: CHAMBERLAIN'S YOUTH-ACRES

summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
the police report from San Benito Police and a copy of the forensic interview for a client involved. The complaint allegation, lack of supervision resulting in minor being sexually abused by an adult while in care, is valid because the preponderance of the evidence standard has been met. Based on two client and nine staff interviews, incident reports, and police reports all document that an adult male had entered the facility, spent the night, and had sexual relations (intercourse twice and oral copulation once) with minors in care. The allegation is found to be substantiated Interim Licensing Standard for STRTP Version 3.1 87072(d)(11) is being cited on the attached LIC9099D. As a result of this visit, there was one Interim Licensing Standard for STRTP Version 3.1 observed (See 9099D dated 08/30/2021 ). Exit interview was conducted and a copy of this report was provided to Patrick Ellis, Administrator whose signature on this form confirm receipt of these documents

Investigation Findings:
13Licensing Program Analyst (LPA) Carolyn Flynn made and unannounced visit to the above list facility at 2: PM on 08/30/2021. LPA met with Patrick Ellis, Administrator (Adm) LPA explained the purpose of the visit was to deliver findings for the above listed allegation. At the time of the visit there were zero clients and zero staff, cottage is still closed. LPA Flynn informed Adm that LPA has reviewed the report that Investigator Mariana Lomeli (IB) returned on 08/18/2021 and that the findings are substantiated. During the course of the investigation, IB, had interviewed five clients, attempted to interview ten staff and did conduct confidential interviews with nine staff, attempted to interview two county social workers and did interview one county social worker between 5/21/2021 and 8/10/2021. LPA Flynn had provided IB with copies of incident reports, staff work schedule, staff roster, graveyard times log, client sleep chart, client notes, C1 and C2's files, pictures of the facility that LPA obtained during LPA's visit on 05/21/2021. IB obtained copies of SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Carolyn Flynn 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: CHAMBERLAIN'S YOUTH-ACRESFACILITY NUMBER: VISIT DATE: 08/30/2021

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

met_with: Patrick Ellis

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
Informal Meeting: Chamberlain's Youth - Acres - Location: N. First St. Ste 350, San Jose, CA Suite Attendees: Chamberlain: Patrick Ellis - Administrator/Chief Executive Officer (Adm), Brenda Jimenez - Chief Programs Officer (CPO), Melanie Davis - Director of Specialty Mental Health (DSMH), and Amber Sanchez - Director of Therapeutic Services (DTS) Counties: Cynthia Elkins - Santa Clara County CCL: Nelson Martinez - Regional Manager (RM), Helga Wong - Licensing Program Manager (LPM), and Carolyn Flynn - Licensing Program Analyst (LPA) Discussed Licensed Facilities: Acres - 350701021, Kipper's - 355201170, Pinnacle - 355100625, and Powell - The purpose of this meeting is to review and clarify trends that have been identified over the past two years from incident reports/complaints as well as during the review of the current program statement. Trends: 1) Intervention using trauma informed practice - what methods are being used 2) Lacking details to support actions on incident reports - what caused the client to escalate and what was done to try and get the client back to baseline. 3) Review of Needs and Service Plans - how is the information relayed to the have consistency with all involved in the care and supervision of the client. Program Statement Revisions: 1) Section 14 - Personal Rights a. indicate that the poster is posted in public view at all times 2) Section 15 - House Rules a. Elaborate on: Dress code, use of phone/computer/electronics/ entertainment equipment, and curfew b. Trauma informed practices - incorporate c. Transitional time - for activities 3) Section 17 - Positive Disciple Polices a. Peer to Peer relationships/conflicts b. CSEC Population Challenges: 1) Staffing Once annual inspections are competed CCL offered Technical Support Program for assistance with clarification. CCL requested that updates to their Program Statement be submitted to LPA Flynn, Adm will email LPA by 7/16 to give date that amendments will be submitted. 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 Patrick Ellis, Administrator whose signature on this form confirm receipt of these documents


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 07/26/2021 at 10: AM, Licensing Program Analyst (LPA) Carolyn Flynn arrived at the above facility, for the purpose of conducting an annual inspection. LPA met with Sarah Recht, Human Resource Manager (HRM) and Justin Qualls, Administrative Assistant/Food Services in the main office and informed then that LPA needed to go to Acres to complete the physical inspection. LPA Flynn transitioned to Acres Cottage at 10: AM where LPA Flynn was met by Albert Ramirez, Maintenance Supervisor (MS) who assisted with the physical plant inspection. Lacisha Zapata-Smith, Cottage Supervisor (ACS) joined LPA at 10: AM. LPA explained that the purpose of the visit was to conduct the annual inspection. LPA reviewed the process and explained that since the cottage is empty at this time, LPA interviewed the Administrator on Friday 7/23 for Powell and will use the same interview for Acres. ACS agreed and the interview was conducted. ACS and MS both were present while LPA reviewed the Operation and Disaster Preparedness sections with ACS at the cottage. LPA then proceeded to the Main Office to review staff files at 11: AM. LPA also completed the Emergency Intervention and Core Therapeutic Services at the main office. Administrator, Patrick Ellis (Adm) informed LPA that they are meeting with JACHO about getting their accreditation approved. They have submitted the application to CARF, but CARF will not be able to get them accredited by October. At the time of this visit one deficiency and one Technical Violation was cited as per California Code Regulation (CCR), Title 22, Division 6. An exit interview was conducted, and a copy of this report was provided to Patrick Ellis, Administrator whose signature on this form confirm receipt of these documents.

Deficiencies:
87095.61(f): Deficient Practice Statement
1
2
3
4

visit_type: Annual

title:
Documentation and Reporting Requirements

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

description:
Deficient Practice Statement
1
2
3
4


summary: Facility Evaluation

raw_content:
Narrative:
An announced Office Meeting was held on Microsoft Teams to discuss a substantiated allegation of lack of supervision resulting in minor being sexually abused by an adult while in care. The meeting was conducted virtually over Microsoft Teams due the COVID 19 pandemic. Present in the meeting from Chamberlain's Youth Services - Acres were Administrator, Amber Sanchez, Interim Chief Executive Officer (ICEO), Brenda Jimenez, Director of Therapeutic Services, Melanie Davis, and Board Members, Pam Holmquist and Eric Taylor . Present from CDSS were Regional Manager (RM) Nelson Martinez, Licensing Program Manager (LPM) Helga Wong, and Licensing Program Analyst (LPA) Carolyn Flynn. Additional attendees include: Sandi Shelgrove - DHCS, David Gutierrez - DHCS, Alexandria Andrew - DHCS, Sandi Shelgrove - DHCS, Marjana Jackson - SOC, Maxe Cendana - SBCBH, Joshua Mercier - Deputy Director San Benito County, Rachel White - Behavioral Health San Benito County, Melissa Lloyd - Sacramento County, Mia Buckner -Preston - Alameda County, Michelle Love -Alameda County, Laura Neal - Monterey County, Cynthia Elkins - Santa Clara County, and Temera Carson - Santa Clara County On 05/18//20/2021, the department received a complaint (Control Number: 26-CR-20210520130313) alleging lack of supervision resulting in minor being sexually abused by an adult while in care. The investigation was referred to and conducted by the Investigation Branch (IB). The investigation revealed that on 05/18/ C1 and C2 (refer to LIC811 - Confidential Names List), while in care, a 21-year-old male (V1) entered the facility without their knowledge, spent the night, and had sexual intercourse twice with C1 and had C2 perform oral copulation once. C2 disclosed to S1 on 05/19/2021 while on a walk the incidents from the night prior and was taken to Hazel Hawkins Hospital where C2 provided a statement to the San Benito Sheriff's Department and was then transferred to South Valley Medical and returned to Chamberlain's at 7: AM on 05/20/2021. C1 disclosed to S2 at 3: PM on 05/19/2021 that she had snuck her boyfriend into the cottage around 1: PM on 05/18/2021 and he remained there till approximately 9: AM on 05/19/2021. C1 also told S2 about the sexual relations that both clients had with V1 the night of the 18th. Based on IB investigation of confidential interviews with two clients and nine staff, incident reports, and the police report from San Benito Sheriff's Department the allegation lack of supervision resulting in minor being sexually abused by an adult while in care was determined to be valid. On 08/30/2021, the department issued substantiated findings for the allegation from 05/20/ Complaint Control Number 26-CR-20210520130313. The allegation lack of supervision resulting in minor being sexually abused by an adult while in care is a violation of Interim Licensing Standards (ILS) for STRTP Version 3.1, Article 6, Section Personal Rights (d) The licensee shall ensure that each child, regardless of whether the child is in foster care, is accorded the personal rights specified in Welfare and Institutions Code Section 16001.9, as applicable. In addition, the licensee shall ensure that each child is accorded the following personal rights: (11)To be free of physical, sexual, emotional, or other abuse, and from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature including, but not limited to, interference with the daily living functions of eating, sleeping, or toileting, or withholding of shelter, clothing, or aids to physical functioning was issued. According to California Penal Code 11165.1 - "sexual abuse" means sexual assault or sexual exploitation...Section 261.5 (statutory rape) and Section 288a (oral copulation). The department has concluded an analysis and has determined that an Enhanced Civil Penalty is warranted for the sexual abuse Health and Safety Code section 1548(f)(1)(C): For a violation that the department determines constitutes physical abuse, as defined in paragraph (2), or resulted in serious bodily injury, as defined in Section 243 of the Penal Code, to a person receiving care at a therapeutic day services facility, community treatment facility, transitional shelter care facility, transitional housing placement provider, small family home, crisis nursery, group home, enhanced behavioral supports home licensed as a group home, group home for children with special health care needs, or short-term residential therapeutic program, the civil penalty shall be assessed as follows:(i) Two thousand five hundred dollars ($2,500) for a facility licensed to care for 40 or fewer children. (2) For purposes of subparagraphs (C), (D), (E), and (F) of paragraph (1), "physical abuse" includes physical injury inflicted upon a child by another person by other than accidental means, sexual abuse as defined in Section 11165.1 of the Penal Code, neglect as defined in Section 11165.2 of the Penal Code, or unlawful corporal punishment or injury as defined in Section 11165.4 of the Penal Code if the person responsible for the child's welfare is a licensee, administrator, or employee of any facility licensed to care for children. Today September 17, 2021, the department will be issuing a Civil Penalty per Health and Safety Code 1548(f1)(1)(c) for $2,500.00. The above was reviewed during the meeting and appeal rights were provided. This report was sent to Interim Chief Executive Officer Brenda Jimenez, who agreed to sign the report and email it back to LPA Flynn. Email was sent with a read receipt notification.

visit_type: Case Management

met_with: Brenda Jimenez


summary: Facility Evaluation

raw_content:
Narrative:
An Office Meeting was held on Microsoft Teams at 2: PM to discuss the issuance of an Enhanced Civil Penalty as a result of complaint 26-CR-20210520130313. Present on the call are Brenda Jimenez, Interim Chief Executive Officer (ICEO), Amber Sanchez, Director of Therapeutic Services (DTS) , Helga Wong Licensing Program Manager (LPM), and Carolyn Flynn, Licensing Program Manager (LPM). This case was discussed on September 21, 2021 with the facility: On 05/18//2021, the department received a complaint (Control Number: 26-CR-20210520130313) alleging lack of supervision resulting in minor being sexually abused by an adult while in care. The investigation was referred to and conducted by the Investigation Branch (IB). The investigation revealed that on 05/18/ C1 and C2 (refer to LIC811 - Confidential Names List), while in care, a 21-year-old male (V1) entered the facility without their knowledge, spent the night, and had sexual intercourse twice with C1 and had C2 perform oral copulation once. C2 disclosed to S1 on 05/19/2021 while on a walk the incidents from the night prior and was taken to Hazel Hawkins Hospital where C2 provided a statement to the San Benito Sheriff's Department and was then transferred to South Valley Medical and returned to Chamberlain's at 7: AM on 05/20/2021. C1 disclosed to S2 at 3: PM on 05/19/2021 that she had snuck her boyfriend into the cottage around 1: PM on 05/18/2021 and he remained there till approximately 9: AM on 05/19/2021. C1 also told S2 about the sexual relations that both clients had with V1 the night of the 18th. Based on IB investigation of confidential interviews with two clients and nine staff, incident reports, and the police report from San Benito Sheriff's Department the allegation lack of supervision resulting in minor being sexually abused by an adult while in care was determined to be valid. On 08/30/2021, the department issued substantiated findings for the allegation from 05/20/ Complaint Control Number 26-CR-20210520130313. The allegation lack of supervision resulting in minor being sexually abused by an adult while in care is a violation of Interim Licensing Standards (ILS) for STRTP Version 3.1, Article 6, Section Personal Rights (d) -The licensee shall ensure that each child, regardless of whether the child is in foster care, is accorded the personal rights specified in Welfare and Institutions Code Section 16001.9, as applicable. In addition, the licensee shall ensure that each child is accorded the following personal rights: (11)To be free of physical, sexual, emotional, or other abuse, and from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature including, but not limited to, interference with the daily living functions of eating, sleeping, or toileting, or withholding of shelter, clothing, or aids to physical functioning was issued. According to California Penal Code 11165.1 - "sexual abuse" means sexual assault or sexual exploitation...Section 261.5 (statutory rape) and Section 288a (oral copulation). Today the department has concluded an analysis and has determined that an Enhanced Civil Penalty is warranted for the sexual abuse Health and Safety Code section 1548(f)(1)(C): For a violation that the department determines constitutes physical abuse, as defined in paragraph (2), or resulted in serious bodily injury, as defined in Section 243 of the Penal Code, to a person receiving care at a therapeutic day services facility, community treatment facility, transitional shelter care facility, transitional housing placement provider, small family home, crisis nursery, group home, enhanced behavioral supports home licensed as a group home, group home for children with special health care needs, or short-term residential therapeutic program, the civil penalty shall be assessed as follows:(i) Two thousand five hundred dollars ($2,500) for a facility licensed to care for 40 or fewer children. (2) For purposes of subparagraphs (C), (D), (E), and (F) of paragraph (1), "physical abuse" includes physical injury inflicted upon a child by another person by other than accidental means, sexual abuse as defined in Section 11165.1 of the Penal Code, neglect as defined in Section 11165.2 of the Penal Code, or unlawful corporal punishment or injury as defined in Section 11165.4 of the Penal Code if the person responsible for the child's welfare is a licensee, administrator, or employee of any facility licensed to care for children. Today November 12 2021, the department will issue a Civil Penalty per Health and Safety Code 1548(f)(1)(c) for $2,500.00. The above was reviewed during the meeting and appeal rights were provided. This report was sent to Interim Chief Executive Officer Brenda Jimenez, who agreed to sign the report and email it back to LPA Flynn. Email was sent with a read receipt notification.


summary: Facility Evaluation

raw_content:
Narrative:
On today's date, this Licensing Program Analyst (LPA) Singh-Sood attempted to make contact with anyone who may be at the facility to ensure it is now closed. This LPA observed the facility to be locked, and no one was available. Although this LPA did observe a parked security guard car inside the gated facility, no one was available to enter the premises.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Carolyn Flynn and Stephanie Martinez, Student Assistant (SA) made an unannounced visit to the above listed facility to discuss findings from a complaint opened in the wrong facility. LPA and SA met with Amber Sanchez, Director of Therapeutic Services at 10: AM on 08/06/2021. LPA explained that there was a complaint filed in Powell regarding two clients (see confidential names list LIC811 date 08/06/2021) eloping at night back on January 6, 2021. Neither of the clients involved in the complaint were residing on the date of the complaint therefore the allegation could not be valid. LPA did discover during confidential interviews with eleven client and eleven staff that during the day, they are able to follow the protocol for clients eloping. However, from 10: PM - 7: AM there is only one staff in the cottage and a floater is to be on campus to help with issues such as elopement. On the night in question, four of the staff reported not having a floater on campus. This meant that when a child left, they could not follow or try to get them to stay because they had to provide supervision to the other clients in care and could not leave the cottage. The Interim Licensing Standard states that, "at least one direct care staff shall be on call and capable of arriving at the facility site within 30 minutes." Confidential interviews with four staff revealed that it is not common for the Manager on Duty (MOD) who is the on-call person at night to go to campus when a client is reported to have left campus. The MOD waits until the client arrives back on campus. As a result of the interviews and copies of incident reports LPA Flynn is issuing two deviancies as documented on LIC809D. At the time of this visit two deficiencies were cited as per California Code Regulation (CCR), Title 22, Division 6 and Interim Licensing Standards 3.1. An exit interview was conducted, and a copy of this report was provided to Amber Sanchez, Director of Therapeutic Services whose signature on this form confirm receipt of these document

met_with: Amber Sanchez


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
Licensing Program Analyst (LPA) Carolyn Flynn made and unannounced visit to the above list facility at 2: PM on 08/30/2021. LPA met with Patrick Ellis, Administrator (Adm). LPA explained the purpose of the visit was to conduct a case management visit regarding having an adult in the facility without criminal record clearance who provided marijuana and wax to the clients in care . At the time of the visit there were zero clients and zero staff, cottage is still closed. Based on the investigation that was conducted between 05/21/2021 and 08/18/2021 by Investigator Mariana Lomeli (IB) it was determined that an adult male resided in the facility on 5/18/2021 and 5/19/2021. IB conducted two client and nine staff interviews, reviewed incident reports, and police reports from 05/18/2021 and 5/19/2021. An adult male (V1) snuck into the facility and sexually abused two minors in care. Male had sexual intercourse with one client twice and had one client preform oral copulation to adult male. V1 did not have criminal record clearance. This is a violation of California Code of Regulations, Title 22, Division Chapter 5, 80019(e)(1) and is being cited on the attached LIC9099D and Civil Penalties are being assessed. IB investigator's confidential interviews with two clients and three staff along with the incident report and San Benito Police Department report from 05/19/2021 the adult male (V1) also brought marijuana and "wax" into the facility without staff supervision and provided it to the clients in care. One of the clients was observed intoxicated by staff in the morning on May 19, 2021. This is a violation of California Code of Regulations, Title 22, Division Chapter 5, 80078(a) and is being cited on the attached LIC9099D. As a result of this visit, there were two California Code of Regulations, Title 22, Division Chapter 5 deficiencies observed (See 9099D dated 08/30/2021). Exit interview was conducted and a copy of this report was provided to Patrick Ellis, Administrator whose signature on this form confirm receipt of these documents

Deficiencies:
80019: (1) Obtain a California clearance or a criminal record exemption as required...

title: Criminal Record Clearance (e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility


facility_name: CHAMBERLAIN'S YOUTH-KIPPERS COTTAGE

summary: Facility Evaluation

raw_content:
Narrative:
On 06/28/2021 at 2: PM, Licensing Program Analyst (LPA) Carolyn Flynn arrived at the above facility, for conducting an annual inspection.. LPA met with Sarah Recht, HR manager (HR) in the main office. While in the main office, HR assisted LPA in providing LPA seven staff records. Files indicates that all facility staff associated to the facility received fingerprint and child abuse index check clearances. Staff files were observed to be complete for seven out of seven staff files reviewed. LPA Flynn transitioned to Brenda Jimenez's, Chief Programs Officer (CPO) office. LPA requested copies of the LIC308 (Designation of Facility Responsibility), LIC309 (Administrative Organization), LIC400 (Affidavit Regarding Client/resident Cash Resources), LIC500 (Personnel Report), and LIC610C (Emergency Disaster Plan Children's Residential Facilities) be updated for the files. LPA went to the Clinical office and was met by Cassi Nicholson, Office Manager (OM) at 4: PM. At the time of the inspection there were four staff and zero clients were present. Two staff members left and Case Manager, Vanessa Arroyo had a meeting with a county social worker. OM and LPA toured the facility both inside and out. Kipper's Cottage is not currently housing any clients and is being used as the Clinical Office. This is one story facility, located on the Chamberlain Campus. The facility was as follows: common area being used as Administrative area, dining area is currently used as a conference area, kitchen, three client bedroom that are being used as offices, a mud room where the copy machine is located, Supervisor's Office is being used as a clinical office, pantry area where files are locked, and two bathrooms. The following documents are posted in the facility: facility license, emergency disaster plan, facility sketch and the Foster Youth Bill of Rights are all posted in visible areas. Due to the lack of clients in the house a menu, chores, and activity LPA Flynn observed at the time of this visit, the facility to be clean, safe and sanitary. No deficiencies were cited as per California Code Regulation (CCR), Title 22, Division 6. An exit interview was conducted, and a copy of this report was discussed and emailed to both Patrick Ellis, Administrator, and Brenda Jimenez, Chief Programs Officer, whose signature on this form confirm receipt of these documents. calendar are not posted. Bedrooms one through three did not have any bedroom furniture in them, but instead had desks. All had closet space and ample lighting. LPA Flynn was told that beds are available in the storage area if the cottage needs to house clients. At 4: PM water temperature in shared bathroom next to pantry area measured at 118.4 degrees Fahrenheit. At 4: PM, LPA entered the laundry area (file cabinets) which leads to the second bathroom. In shared bathroom two, the water temperature measured 117. PM degrees Fahrenheit. Both are in required temperature range. During this visit, LPA observed the following: At 4: PM the kitchen sink's hot water was measured to be 117.7 degrees Fahrenheit which is in the required temperature range. All required signage, soap, paper towels, and trash can was observed. LPA toured the kitchen area and observed a two-day supply of perishable and a seven day supply of non-perishable food. LPA observed that the cabinets all had locks or latches for locks but are not being utilized since only clinical staff are allowed in this office. Locks/keys are available if needed to place clients in the cottage. Two fire extinguishers, last serviced on February 2021, was observed hanging on the walls between the clinical offices in the front of the cottage and between the mudroom and clinical office of Melanie Davis, Director of Specialty Mental Health Services. LPA tested one carbon monoxide/smoke detector located in the entrance way near the front clinical offices. There is a second carbon monoxide/smoke detector located near the kitchen as well as one in each office. All devices were functional monoxide/smoke detectors. The temperature was noted to be 73 degrees Fahrenheit by the temperature control next to the clinical office next to the kitchen. All outdoor areas are clean and free of obstructions. OM stated that there are no weapons on the premises. Zero Client files and medication logs were reviewed since there are not any clients in care in this cottage currently.


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien sent an email on 3/5/25 to Renee Rocha, Former CFO (CFO) to the above listed facility. LPA sent findings for this investigation via email due to the above listed facility no longer existing. Based on confidential interviews conducted it was determined that the allegation listed above is Substantiated. Based on witnesses interviewed, it was determined that a staff member put their hand around a client's neck. Due to multiple staff having the same first name of alleged pertrator, elapsed time from incident, and facility closure date (01/01/2022) LPA was unable to postively identify the alleged pertrator. The preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. As a result of this visit, One Interim Licensing Standards violation ( Personal Rights (c)(16). The facility will be cited (see 809-Ds for details). Appeal rights were attached to the email and provided to CFO. CFO will confirm receipt of these documents by replying to email sent by LPA. CFO's reply will be used in lieu of signature of these documents. SubstantiatedEstimated 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 Control Number 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN JOSE RO, N. First Street, Ste. FACILITY NAME: CHAMBERLAIN'S YOUTH-KIPPERS COTTAGEFACILITY NUMBER: 355201170

met_with: Renee Rocha via email


facility_name: CHAMBERLAIN'S YOUTH PINNACLE

raw_content:
Narrative:
Version 3.1, Article Continuing Requirements 87065.1(c)(6) Training Requirements As a result of this visit, there was one Interim Licensing Standard for STRTP Version 3.1 deficiencies observed. Exit interview was conducted and a copy of this report provided Amber Sanchez, Director of Therapeutic Services whose signature confirms receipt of these documents.

Investigation Findings:
13Licensing Program Analyst (LPA) Carolyn Flynn made an unannounced visit to the above listed facility to inform them of the findings for the above listed allegation. LPA discussed findings with Amber Sanchez, Director of Therapeutic Services at 4: PM on 09/30/2021. During the investigation, LPA Flynn conducted confidential interviews with the nine staff, reviewed over Human Resources CPR certification log, and the cottage schedule for the month of August. Confidential interviews were conducted in September 2021 by LPA Flynn. LPA reviewed all documents in September 2021. LPA also attempted to talk to four other staff and a left message requesting a call back but did not hear from them. Based on LPA's interviews and document review, the preponderance of evidence standard has been met, therefore the allegation is substantiated. There were seven staff working in the cottage that were not CPR certified between August 1 - 31, 2021. This is a violation of Interim Licensing Standard STRTP SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Carolyn Flynn 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: CHAMBERLAIN'S YOUTH PINNACLEFACILITY NUMBER: VISIT DATE: 09/30/2021

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


raw_content:
Narrative:
After multiple attempts, the client involved in this allegation was not able to be contacted. Based on the confidential interviews, the incident report detailing this event, and the training records, the preponderance of evidence standard has been met, therefore the allegation is substantiated. There was a personal rights violation from an inappropriate hold done on a client. This is a violation of STRTP Interim Licensing Standards Version 4, Article 10. Personal Rights 87072 (c)(11). LPM analyzed training records and incident reports. This analysis substantiates the claims that staff had done holds on clients prior to completing their CPI training. Based on LPA Hood and LPM's interviews and record review, the preponderance of evidence standard has been met, therefore the allegation is substantiated. There were eight staff working in the facility that conducted holds who were not CPI trained. This is a violation of STRTP Interim Licensing Standards Version 4, Article 10. Emergency Intervention Staff Training 87095.65(a)(1). As a result of this visit, there was two Interim Licensing Standard STRTRP Version 4 deficiencies cited. Exit interview was conducted at 2:30PM and a copy of this report was provided to Brenda Jimenez, Chief Executive Officer whose signature confirms receipt of these documents. change incident reports to cover for issues. The other seven employees stated that they had never been asked to change their reports to add less information. Although the allegation that staff had been asked to falsify documentation may be true, there is a preponderance of evidence to prove the alleged violation did not occur, therefore the allegation is 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 Brenda Jimenez, Chief Executive Officer at 2:30PM whose signature confirms the recipient of this report.

Investigation Findings:
13Licensing Program Analysts (LPA) Selena Hood, LPA Alyssa Ng, LPA Paul Simien, and Licensing Program Manager (LPM) Carolyn Flynn made an unannounced visit to the above listed facility to inform them of the findings for the above listed complaint. LPAs and LPM met with Brenda Jimenez, Chief Executive Officer on December 30, 2021 at 1:45PM. During the investigation, LPM Flynn conducted confidential interviews with eleven employees between September 10, 2021 and October 29, 2021. LPA Hood and LPM conducted interviews with five clients between December 22, 2021 and December 27, 2021. LPA Hood and LPM received and reviewed staff records, staff training records, and incident reports. LPM interviewed the three staff involved with the alleged personal rights violation. Of the three staff, two detailed that there was an inappropriate hold done by themselves when they were not CPI trained. 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 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: CHAMBERLAIN'S YOUTH PINNACLEFACILITY NUMBER: VISIT DATE: 12/30/2021

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


raw_content:
Narrative:
reports to cover for issues. The other seven employees stated that they had never been asked to change their reports to add less information. Although the allegation that staff had been asked to falsify documentation may be true, there is a preponderance of evidence to prove the alleged violation did not occur, therefore the allegation is 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 Brenda Jimenez, Chief Executive Officer at 2:05PM whose signature confirms the recipient of this report.

Investigation Findings:
13Licensing Program Analysts (LPA) Selena Hood, LPA Alyssa Ng, LPA Paul Simien, and Licensing Program Manager (LPM) Carolyn Flynn made an unannounced visit to the above listed facility to inform them of the findings for the above listed complaint. LPA and LPM met with Brenda Jimenez, Interim Chief Executive Officer on December 30, 2021 at 2:00PM. During the investigation, LPM Flynn conducted confidential interviews with thirteen staff between September 29, 2021 and October 29, 2021. LPA Hood conducted an interview with three clients on December 22, 2021 and December 23, 2021. LPA Hood and LPM Flynn reviewed and obtained copies of training records, staff schedules, and incident reports. LPM Flynn discussed with eleven employees at Chamberlain's regarding the allegations. Four of the eleven employees stated that they had been or observed that others were asked to change incident 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: CHAMBERLAIN'S YOUTH PINNACLEFACILITY NUMBER: VISIT DATE: 12/30/2021

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


raw_content:
Narrative:
inappropriate behavior between staff and clients. Thirteen of the thirteen staff interviewed mentioned that they did not see any inappropriate behavior. Some mentioned the specific incident, stating that the client involved is known to need extra boundary-setting especially with male staff. LPA Hood reviewed the internal investigation and found that there were two internal interviews with facility leadership, the leadership interviewed said that there were no inappropriate behaviors on the staff's part. The internal investigation included an interview with the client the allegations regarded. The client stated that there was no inappropriate behavior and that the staff was bringing her comfort during their hospitalization. LPA Hood conducted an interview with the client on December 23, 2021 at their current placement. The client repeated that they felt that the staff did not act inappropriately and said that the staff member was only being "caring". Although the allegation that a staff member had inappropriate interactions with minor in care may be true, there is a preponderance of evidence to prove the alleged violation did not occur, therefore the allegation is 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 Brenda Jimenez, Interim Chief Executive Officer at 2:30PM.

Investigation Findings:
13Licensing Program Analyst (LPA) Selena Hood, LPA Alyssa Ng, LPA Paul Simien, and Licensing Program Manager (LPM) Carolyn Flynn made an unannounced visit to the above listed facility to inform them of the findings for the above listed complaint. LPAs and LPM met with Brenda Jimenez, Interim Chief Executive Officer at 1:45PM on December 30, 2021. During the investigation, LPM Flynn conducted confidential interviews with thirteen staff between August 30, 2021 and October 6, 2021. LPA Hood conducted an interview with one client on December 23, 2021. LPA Hood and LPM Flynn reviewed and obtained copies of medical records, client files, employee staff schedules, and five incident reports. LPA Hood and LPM Flynn reviewed an internal investigation and interviews done by Director of Therapeutic Services, Amber Sanchez. LPM Flynn discussed with the thirteen employees at Chamberlain's if they ever noticed 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: CHAMBERLAIN'S YOUTH PINNACLEFACILITY NUMBER: VISIT DATE: 12/30/2021


raw_content:
Narrative:
The complaint allegation, Client was given a body piercing by staff, is valid because the preponderance of the evidence standard has been met. Based on the interview with staff member S1, who admitted they performed a piercing on client C1 but could not provide evidence they were professionally licensed. The allegation is found to be substantiated. Interim Licensing Standard for STRTP Version Welfare and Institutions Code section 362.05(c)(1) Reasonable and Prudent Parent Standard is being cited on the attached LIC 9099-D. As a result of this visit, there was one Interim Licensing Standard for STRTP Version 4 observed (See 9099-D dated 03/30/22). Exit interview was conducted and a copy of this report was provided to Renee Rocha, CFO whose signature on this form confirm receipt of these documents.

Investigation Findings:
13Licensing Program Analyst (LPA) Paul Simien went to Starbucks at Walnut Grove Dr, Morgan Hill at 11: AM on 3/30/22. LPA met with Renee Rocha, Former Chief Financial Officer (CFO). LPA explained the purpose of the meeting was to deliver findings for the above listed allegation. At the time of the meeting there were zero clients, zero staff, and the facility is closed. During the course of the investigation, LPA, had conducted a confidential telephone interview with the alleged piercer, staff member S1 on 03/08/22. During the interview S1 said she was approached by MHT to pierce client C1. S1 admitted on 12/28/21 that she did pierce client C1 but claimed to be a licensed professional. LPA Simien asked S1 if they could provide credentials (license or certification) to prove that were a licensed professional. On 03/10/22, S1 told LPA Simien they contacted the counties they work in to see where they last registered to be professional piercer and that they would get back to LPA Simien ASAP. As of 03/30/22, S1 still has not got back to LPA Simien and therefore not able to provide proof they are a professional piercer. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Paul Simien LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 26-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. FACILITY NAME: CHAMBERLAIN'S YOUTH PINNACLEFACILITY NUMBER: VISIT DATE: 03/30/2022

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

met_with: Renee Rocha, Chief Financial Officer


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Carolyn Flynn made an unannounced visit to the above listed facility at 10: AM on June 17, 2021. LPA met with Patrick Ellis, Administrator to discuss what happened on Monday night and that LPA Flynn was not notified by Chamberlain of the incident that caused a staff member to go to the hospital. LPA reviewed ILS for STRTP (Version 3.1) 87061(a) - Reporting Requirements which references the General Regs in Title 22 section 80061(b) and gave a Technical Violation. Administrator, Patrick Ellis was called out ti assist with a situation on campus and was not available to sign this report, LPA Flynn will email a copy of this report to Patrick Ellis Administrator with a read Receipt and request a copy be signed and sent back for the file.


summary: Facility Evaluation

raw_content:
Narrative:
On 06/29/2021 at 11: AM, Licensing Program Analyst (LPA) Carolyn Flynn arrived at the above facility, for conducting an annual inspection at Pinnacle Cottage. LPA met with Patrick Ellis, Administrator in the main office. Human Resource Manager, Sara Recht (HR) had to run an errand so LPA let Adm know that LPA will start in the cottage and then follow up with HR for staff file review later. This is one story facility, located on the Chamberlain Campus. Cottage Supervisor, Jimena Fregoso (JF) met with LPA. At the time of the visit, there were three clients and five staff members. One staff was on her way out with two of the clients for a drive and outing to Target. One staff was getting ready to go pick up one client from school, and JF suggested that the other two staff help at Powell since there was only one client currently in the facility playing on the computer and JF could keep an eye on her. LPA noted the staffing and JF stated that they were training new staff. JF accompanied LPA on a tour of the facility. The facility was as follows: common area, dining area, kitchen are all in the main open design. There are three client bedrooms each set up for double occupancy, a mud room with a freezer for extra food is stored, Supervisor's Office which is locked, and the medication and all client files are stored. There are two bathrooms one has the shower room attached and the other is attached to the laundry room. The following documents are posted the facility: facility license, emergency disaster plan, facility sketch and the Foster Youth Bill of Rights are all posted in visible areas. LPA observed a copy of the menu is in a binder in the kitchen, chores are listed on the whiteboard across from the Supervisor's office, and activity schedule is listed on the laundry room door. Bedrooms one through three all had twin beds and each client has their own closet which Albert Ramirez, Maintenance Supervisor (AR) is adding shelves to one side of each closet to give each client more stackable LPA returned to the main office at 3: PM where HR assisted LPA in providing LPA with ten staff records. Files indicates that all facility staff associated to the facility received fingerprint and child abuse index check clearances. Staff files were observed to be complete for ten out of ten staff files reviewed. LPA Flynn transitioned back to Adm's office. LPA requested copies of the LIC308 (Designation of Facility Responsibility), LIC309 (Administrative Organization), LIC400 (Affidavit Regarding Client/resident Cash Resources), LIC500 (Personnel Report), and LIC610C (Emergency Disaster Plan Children's Residential Facilities) be updated for the files. LPA Flynn observed at the time of this visit, the facility to be clean, safe and sanitary. No deficiencies were cited as per California Code Regulation (CCR), Title 22, Division 6, and one Technical Violation was issued. An exit interview was conducted, and a copy of this report was discussed with Patrick Ellis, Administrator, whose signature on this form confirm receipt of these documents. space. This is to help alleviate the dressers and the problems of having the clients break them. All rooms had adequate lighting. AR is also refreshing the paint in each room to update the look. The water temperature in shared bathroom next to pantry area with the shower room attached measured at 127.6 degrees Fahrenheit at 12: PM. LPA also tested the kitchen sink and the water temperature was 127.6 degrees Fahrenheit as well. JF called AR immediately to inform him that the water temperature was too hot and needed to be adjusted. AR arrived within ten minutes and showed LPA as he lowered the water heater. All required signage, soap, paper towels, and trash can were observed in both bathrooms. JF stated that there are no weapons on the premises. LPA toured the kitchen area and observed a two-day supply of perishable food in the refrigerator and the pantry is locked and has more than a weeks' worth of non-perishable food. LPA observed that the cabinets and drawers were labeled, and all knives and sharp items are locked in a drawer. All cleaning supplies are in the laundry area locked in the cabinets. LPA observed a fire extinguisher near the front door that last serviced on February 2021. JF tested one carbon monoxide/smoke detector located next to the Supervisor's office. There is a second carbon monoxide/smoke detector located near the entrance way and front two client bedrooms. All devices were functional monoxide/smoke detectors and there is one in each client room as well. The temperature was noted to be 69 degrees Fahrenheit by the temperature control mounted to the wall across from the Supervisor's office. LPA observed that all outside areas were free from debris. LPA did notice that one screen on the Supervisor's window in the back of the cottage was bent. AR was sent a maintenance request to fix the screen while I was present. LPA proceeded to the Clinical office and was met by Cassi Nicholson, Office Manager (OM) at 1: PM. OM helped get the client charts for the four clients residing at Pinnacle. During review of the charts, LPA observed that the weight records are not in the chart but are kept on the electronic version of their medical records - Awards. LPA realized that the safeguard logs for cash and property are both located in the cottages, so LPA went back to ensure that they were present for each child.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Carolyn Flynn met with Patrick Ellis, Administrator (Adm) at 4: PM to discuss concerns that LPA had regarding feedback that LPA has received during interviews regarding Manger on Duty (MOD) at night from PM - AM. Adm will discuss the responsibilities of the MOD with the Clinical Staff during their next meeting. At the time of this visit no deficiencies were cited as per California Code Regulation (CCR), Title 22, Division 6. An exit interview was conducted, and a copy of this report was provided to Patrick Ellis, Administrator whose signature on this form confirm receipt of these documents.


facility_name: CHAMBERLAIN'S YOUTH POWELL

raw_content:
Narrative:
in care were still able to take hot showers in another cottage and staff did work to resolve the issue so there is not deficiency cited. Based on review of the staff schedule and time and attendance report that human resources provided LPA Flynn on 09/02/2021 there were twelve days in the month of August 2021 that Powell cottage did not have adequate staffing to meet the Interim Licensing Standard STRTP Version 3.1, Article Continuing Requirements 87065. Direct Care Staff/Child Ratios. The preponderance of evidence standard has been met; therefore, the allegation is substantiated. As a result of this visit, there was one Interim Licensing Standard for STRTP Version 3.1 deficiency observed. Exit interview was conducted and a copy of this report provided Amber Sanchez, Director of Therapeutic Services whose signature confirms receipt of these documents.

Investigation Findings:
13Licensing Program Analyst (LPA) Carolyn Flynn made an unannounced visit to the above listed facility to inform them of the findings for the above listed allegations. LPA discussed findings with Amber Sanchez, DIrector of Theraputic Service at 4: PM on 09/30/2021. During the investigation, LPA Flynn conducted confidential interviews with the ten staff, reviewed over maintenance requests for Powell (August), Powell water heater history, text messages between staff, staff schedule and time and attendance report for August 2021. Confidential interviews were conducted in September 2021 by LPA Flynn. LPA reviewed all documents in September 2021. Based on eight confidential interviews and maintenance reports the water heater at Powell was turning off and parts needed to be replaced. Administrative staff and maintenance were aware of the problem and worked to resolve the issue. The water heater was replaced on 09/02/2021. The preponderance of evidence standard has been met, therefore the allegation that the facility does not have hot water is substantiated. Clients in SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Carolyn Flynn 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: CHAMBERLAIN'S YOUTH POWELLFACILITY NUMBER: VISIT DATE: 09/30/2021

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


raw_content:
Narrative:
appropriate reason for the hold. Two of the clients said they were given a reason, one did not remember, and one declined to carry out the interview. Clients were also asked about the phone protocol and whether clients were ever denied use of the phone to use for emergency purposes. Three clients denied this, one client stated that this had happened to them, one said clients were denied the phone if they were in "actual crisis", and one client declined to answer. LPA and LPM attempted contact with the staff involved in the allegations but did not receive an answer. Staff member no longer works at the facility. Although the allegation that a client was denied access to the phone and that they were put in a manual restraint without explanation may be true, there is a preponderance of evidence to prove the alleged violation did not occur, therefore the allegation is 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 Brenda Jimenez, Chief Executive Officer at 3:00PM, whose signature confirms the receipt of this report.

Investigation Findings:
13Licensing Program Analyst (LPA) Selena Hood, LPA Alyssa Ng, and LPA Paul Simien, and Licensing Program Manager (LPM) Carolyn Flynn made an unannounced visit to the above listed facility to inform them of the findings for the above listed complaint. LPA and LPM met with Brenda Jimenez, Chief Executive Officer on December 30, 2021 at 1:45PM. During the investigation, LPM Flynn and LPA Hood conducted confidential interviews with six clients between December 23, 2021 and December 27, 2021. LPA Hood and LPM Flynn reviewed and obtained copies of three incident reports, daily logs, staff schedules, and Needs and Service Plan for the client that the allegations involved. LPA Hood discussed with the six clients if they had ever been in holds, all said yes. LPA Hood asked if the holds ever hurt or were uncomfortable, five of the six clients said yes. LPAHood asked if the clients were given a reason for the holds, two clients responded that in some instances they were not given an 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: CHAMBERLAIN'S YOUTH POWELLFACILITY NUMBER: VISIT DATE: 12/30/2021

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


summary: Facility Evaluation

narrative: Licensing Program Analyst (LPA) Carolyn Flynn made an unannounced visit to the above listed facility at 10: AM on June 17, 2021. LPA met with Patrick Ellis, Administrator to discuss what happened on Monday night and that LPA Flynn was not notified by Chamberlain of the incident that caused a staff member to go to the hospital. LPA reviewed ILS for STRTP (Version 3.1) 87061(a) - Reporting Requirements which references the General Regs in Title 22 section 80061(b) and gave a Technical Violation. Administrator, Patrick Ellis was called out ti assist with a situation on campus and was not available to sign this report, LPA Flynn will email a copy of this report to Patrick Ellis Administrator with a read Receipt and request a copy be signed and sent back for the file.


summary: Facility Evaluation

raw_content:
Narrative:
On 07/21/2021 at 10: AM, Licensing Program Analyst (LPA) Carolyn Flynn arrived at the above facility, for conducting an annual inspection. LPA met with Patrick Ellis in the main office. LPA Flynn transitioned to Powell Cottage at 11: AM where LPA Flynn was met by Mayra Clemente Rojas, Cottage Supervisor. LPA explained that the purpose of the visit was to conduct the annual inspection. LPA reviewed the process and explained that LPA would need to interview at least five staff plus the Administrator and all clients in care.. LPA Flynn was able to conduct interviews with five staff members and four clients. LPA started to review the staff files, but due to the time, LPA Flynn decided to stop and will resume the inspection at a later date. At the time of this visit no deficiencies were cited as per California Code Regulation (CCR), Title 22, Division 6. An exit interview was conducted, and a copy of this report was provided to Brenda Jimenez, Chief Programs Officer whose signature on this form confirm receipt of these documents.


summary: Facility Evaluation

raw_content:
Narrative:
On 07/21/2021 at 10: AM, Licensing Program Analyst (LPA) Carolyn Flynn arrived at the above facility, for case management inspection. LPA met with Patrick Ellis in the main office. LPA Flynn reviewed over the reporting requirements and discussed two incidents with one client causing self harm with staff supervision on 7/11 and at the same time another client running into the same room where client was self harming and started to jump on the bed which caused further escalation. More details will be provided on the written reports. At the time of this visit no deficiencies were cited but a technical violation was cited as per California Code Regulation (CCR), Title 22, Division 6. An exit interview was conducted, and a copy of this report was provided to Brenda Jimenez, Chief Programs Officer whose signature on this form confirm receipt of these documents.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 07/23/2021 at 10: AM, Licensing Program Analyst (LPA) Carolyn Flynn arrived at the above facility, for continuing the annual inspection. LPA met with Justin Qualls, Administrative Assistant/Food Programs Coordinator in the main office. LPA Flynn transitioned to Powell Cottage at 10: AM where LPA Flynn was met by Lacisha Zapata-Smith Acres Cottage Supervisor (ACS) and Albert Ramirez, Maintenance Supervisor (MS) who both assisted with the physical plant inspection. At the time of the visit there were not any clients present Two technical violations were issued during this part of the inspection. LPA then proceeded to the Clinical Office at 11: AM where Madonna Navarro, Intensive Care Coordinator assisted LPA in the Client Records and Core Therapeutic Services sections. LPA Flynn was returned to Powell where ACS assisted in the Disaster Preparedness section at 1: PM. AT 2: PM, LPA returned to the main office where Patrick Ellis, Administrator (Adm) and Renee Rocha, Office Manager (OM) assisted LPA with the Staff, Operations and Emergency Intervention sections. LPA interviewed Adm for part of the staff review. At the time of this visit one deficiency was cited and two Technical Violation - Advisory Notes were issued as per California Code Regulation (CCR), Title 22, Division 6. An exit interview was conducted, and a copy of this report was provided to Patrick Ellis, Administrator whose signature on this form confirm receipt of these documents.

Deficiencies:
87095.61(f): Deficient Practice Statement
1
2
3
4

description:
Deficient Practice Statement
1
2
3
4


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Isabel Mendoza and Carolyn Flynn on 09/30/2021 at 10: AM. During the inspection, LPAs Mendoza and Flynn met with Brenda Jimenez, Interim Chief Executive Officer in the main office then proceeded to the Clinical office to review client files. LPAs reviewed five of child's records on site at the facility at 10: AM. After reviewing the client files LPA's proceeded to Powell Cottage and toured the facility inside and out. Anisa Donato, Health Coordinator and Ruby Guillen, Residential Counselor assisted with the inspection. LPAs reviewed five of child's psychotropic medications and medication records at 12: PM. LPAs interviewed three of children currently taking psychotropic medication at 1: PM - two clients refused to be interviewed . LPAs interviewed three of staff on site at 2: PM. LPsA reviewed three of staff personnel files on site at the facility at 3: PM. LPA provided the Summary Report to Amber Sanchez, Director of Therapeutic Services upon completion. No deficiencies are being cited at this time and one Technical Advisory Note was given. LPAs conducted exit interview with Amber Sanchez, Director of Therapeutic Services at 4: PM.


facility_name: CHANGING FACES, INC.

raw_content:
Narrative:
Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. The Department has decided that the allegation of Neglect/Lack of Supervision is Unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. 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 conducted, and a copy of this report was left at the facility.

Investigation Findings:
13On 08/25/2021 at, Licensing Program Analyst (LPA) Enrique Hernandez made an unannounced visit to Changing Faces for the purpose of concluding the investigation on the above allegation and to deliver the findings. LPA met with Program Manager Rosalie Ramiro, who granted access to the facility and together discussed the investigation details. Based on the confidential interviews conducted with all parties involved during the investigation process and information gathering, the above allegation cannot be substantiated because the interviews conducted did not produce evidence to support the allegation. Confidential interviews with facility clients confirmed that staff are always supervising them and that it is difficult to AWOL from the facility, and the times they left the facility, staff followed intervention policies and protocol by following the clients out in the community until they lose sight of the clients. Clients also reported feeling safe in the facility because, the facility conducts random room checks in all client's rooms for any contraband. When the facility learned that C1 is receiving gifts by mail, they immediately inform SW. SW confirmed to the facility that they were from A1. During the interviews with C1, S2 and S3 it was confirmed that the iPhone and gift cards were given to C1 by A1. Continue on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Enrique M Hernandez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 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: CHANGING FACES, INC.FACILITY NUMBER: VISIT DATE: 08/25/2021

met_with: Program Manager


raw_content:
Narrative:
AGPA Woodard has determined the preponderance of evidence standard has not been met. Therefore, the allegation is found to be unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged personal rights violation occurred.

Investigation Findings:
13On March 12, 2022 at 09:22AM, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted a follow-up complaint inspection to deliver findings on the above allegation. Upon arrival, AGPA was greeted by Graciela Arredondo, Facility Manager. On January 14, 2022, CCL received a complaint allegation concerning a minor being involved in an argument with another minor at the facility. Minor's head was bash on the side of the door and the child fell to the floor. Staff intervened and broke up the fight. Child was taken to the doctor days after the fight. The investigation included confidential interviews with staff members and clients, and a review of supportive documentation. Youths are friends one day, then not friends the next day, then friends again. Both youths have engaged in previous verbal and physical altercations. Incident report dated January 11, 2022 youths did engage in a verbal altercation that turned physical; hair pulling and kicking. Minor did state that she did hit her head on the wall, but also stated she did not want medical attention. In interview with minor she disclosed that staff did ask her, but she declined to go at time of incident. The following day she did have a headache and asked to go, at which time they took her. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290b El Segundo, CA Facility Name: Changing Faces, INC.FACILITY NUMBER: VISIT DATE: 03/12/2022

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

met_with: Graciela Arredondo


raw_content:
Narrative:
AGPA Woodard has determined the preponderance of evidence standard has not been met. Therefore, the allegation is found to be unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged neglect/lack of supervision violations occurred.

Investigation Findings:
13On March 12, 2022 at 09:22AM, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted a follow-up complaint inspection to deliver findings on the above allegation. Upon arrival, AGPA was greeted by Graciela Arredondo, Facility Manager. On November 4, 2021, CCL received complaint allegations concerning a minor in the home is having sex all night because she's on meth. Staff in the home didn't intervene or say it wasn't happening. The investigation included confidential interviews with staff members and clients. There have been instances of suspected THC use but no use of Meth or any sexual behavior in the facility. If a client is suspected of drug/alcohol use, staff will get them medically cleared. Room searches for paraphernalia, etc. are also performed. Clients are involved in Counseling for Drug and Alcohol Abuse, either individual and/or group. Clients did admit to smoking wax pens, etc. in their room, and staff are aware when they are caught and items are confiscated. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290b El Segundo, CA Facility Name: Changing Faces, INC.FACILITY NUMBER: VISIT DATE: 03/12/2022

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


raw_content:
Narrative:
continued from AGPA Woodard has determined the preponderance of evidence standard has not been met. Therefore, the allegation is found to be unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged personal rights violation occurred.

Investigation Findings:
13On March 12, 2022 at 09:22AM, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted a follow-up complaint inspection to deliver findings on the above allegation. Upon arrival, AGPA was greeted by Graciela Arredondo, Facility Manager. On January 18, 2022, CCL received complaint allegations concerning a male staff sexually assaulting girls at the facility. Client does not feel safe alone with male staff. The investigation included confidential interviews with reporting party, staff members and clients. There were no male staff who worked for Changing Faces previously, however there are a couple of male staff who work at the sister facility that once was an all-boys home. On occasion a male staff will come from the sister facility to fill in as needed, but they work with a female staff. Male staff are never alone with a client. Staff and clients denied the allegation, and state that it is not true. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290b El Segundo, CA Facility Name: Changing Faces, INC.FACILITY NUMBER: VISIT DATE: 03/12/2022

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


raw_content:
Narrative:
The investigation included confidential interviews with, including but not limited to, facility staff members, S1 and C1 as well as review of medical records for C1, reports from California Highway Patrol Santa Maria, Lompoc Police Department report and facility file review. Information obtained revealed enough evidence to prove the alleged, as S1 admitted that S1 was distracted and unintentionally hit C1 with the vehicle as S1 was backing up while attempting to exit the parking lot at the School after dropping off facility clients on August 25, 2021. C1 was taken to the hospital to be treated for injuries. C1 sustained contusion and abrasions as a result. Records reviewed further revealed at the time of the incident, S1 was operating a vehicle in violation of a conditional exemption order for which S1 had previously been restricted from transporting clients. Based on information from record review and confidential interviews, the preponderance of the evidence standard has been met. The Department has determined substantiated finding for neglect/lack of supervision; thus, posing an immediate health, safety and personal rights risk of harm to children placed in care. The facility is issued a citation in accordance with the California Code of Regulations, Title 22, Chapter 1, Article 6, Responsibility for Providing Care and Supervision and Plan of Operation [See page LIC9099-D for cited deficiencies]. An exit interview was conducted, and appeal rights were discussed. A copy of this report, Confidential Names List and appeal rights were provided/emailed to Facility Administrator. (Continued on page LIC9099-D)

Investigation Findings:
13On March 29, 2022 at 6: PM, Licensing Program Analyst, Regina Martin conducted a follow-up complaint inspection to deliver findings on the above allegation. LPA met with Daniella Jimenez, Case Manager and together, discussed the investigative outcome. LPA Martin also spoke with Facility Administrator, Adrian Cooks via phone. On August 31, 2021, Community Care Licensing Division (CCLD) received complaint allegations concerning Staff member #1 (S1) who reportedly hit resident Client #1 (C1) with a vehicle while dropping minor off at school (see Confidential Names form LIC811, dated March 29, 2022). It was reported that C1 sustained injuries requiring medical attention. The allegation was referred to CCLD Investigations Bureau and investigated by Investigator Romelia Munoz. (Continued on page LIC9099-C) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290b El Segundo, CA Facility Name: Changing Faces, INC.FACILITY NUMBER: VISIT DATE: 03/29/2022

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

met_with: Daniella Jimenez, Case Manager