summary: Facility Evaluation

raw_content:
Narrative:
On November 16, 2022, at 9:15AM, Humberto Flores, Licensing Program Analyst (LPA), conducted an announced Pre-Licensing Inspection at McKinley Group Home (GH) and met with Dustin Vander Haar. The purpose of the inspection was stated to the facility representative. LPA Flores conducted a walk-through out and inside Cottages Campbell and Gregory with Dustin Vander Haar. Both Cottages are ready to house children that the Office of Refugee Resettlement (ORR) will place with the GH under the Unaccompanied Undocumented Minors (UUM) program. LPA Flores inspected all the rooms where a total of 20 children will be housed. The smoke detector and carbon monoxide detector where tested and operable. The water temperature was at 107F in Campbell Cottage and at 107F in Gregory Cottage. Cottages Kiwanis and Whittier were inspected on 11/03/2022 and are ready to house the clients from the UUM program. The GH representative stated that the facility is still in the process to obtain a Board Resolution authorizing to reduce the capacity from 60 to 40 children, the resolution will be submitted to Community Care Licensing Division (CCLD) along with an Application for A Community Care Facility LIC200. cont.# LPA Flores informed the GH representative that once the resolution is obtained, a new Fire Clearance request will be sent by CCLD to the local fire authority requesting to conduct an inspection, in order to obtain a Fire Clearance. LPA Flores stated that once the Fire Clearance is obtained, the GH will be ready for licensure. A copy of this report was provided to the facility representative. Exit interview conducted.

met_with: Dustin Vander Haar, Senior Vice-President


state: CA

facility_name: MCKINLEY

summary: Facility Evaluation

raw_content:
Narrative:
On 04/05/2023 at 8: AM Licensing Program Analyst (LPA) Noubar Yerkatyan conducted an announced inspection at McKinley Group Home (GH) and met with facility representatives, Melissa Dalziel and Patricia White. The purpose of the inspection was for the move of clients from one cottage to another. The facility is moving the Short Term Residential Therapeutic Program (STRTP) youth from Cottage Fox and Cottage Kingsley to Cottage Bashor and Cottage Wood. Cottage Fox and Cottage Kingsley will house clients. LPA conducted a walk-through inside and out Cottage Kingsley and Cottage Fox. Cottage Kingsley has 8 bedrooms and 3 bathrooms used for clients. Each bedroom will have a twin size bed, dresser, office table, and locker closet. Cottage Kingsley has a common area with couches, wall mounted TV, dining table, and kitchen appliances. This cottage has rooms designed for staff along with staff restrooms. This cottage also has a locked laundry room which will also be used for client linen, and storage of medication. All staff and storage rooms have a lock. Cottage has (2) camera's facing the common area, (2) camera's facing the hallway, and (2) camera's facing the outside patio. Cottage has (2) fire extinguishers that were last serviced on January 05, 2023. Entering the staff office leads into Cottage Fox. Cottage Fox's layout is parallel and identical to Cottage Kingsley. Cottage Fox has the same number of rooms along with cameras. Cottage Fox has 8 bedrooms and 3 bathrooms used for clients. Each bedroom will have a twin size bed, dresser, office table, and locker closet. Cottage Fox has a common area with couches, wall mounted TV, dining table, and kitchen appliances. This cottage has rooms designed for staff along with staff restrooms. This cottage also has a locked laundry room which will also be used for client linen, and storage of medication. All staff and storage rooms have a lock. Cottage Fox has (2) fire extinguishers that were last serviced on January 05, 2023. The smoke and carbon monoxide detectors for both cottages were tested and operable. Fire alarm for both Cottages were tested and was in working order. The hot water temperature was tested and was in working order. At the time of this inspection the facility was observed to be clean, safe, and in good repair. The facility is increasing their capacity from 40-60. LIC 200 was submitted to CCL. Both Cottages are ready to house clients. A copy of this report was provided to the facility representative. Exit Interview conducted.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Melissa Dalziel, VP/Administrator & Patricia White, Director


summary: Facility Evaluation

raw_content:
Narrative:
On 04/26/2023 at 9: AM Licensing Program Analyst (LPA) Noubar Yerkatyan conducted an announced inspection at McKinley Group Home (GH) and met with facility representative, Patricia White. The purpose of the inspection was to follow-up from a previous visit done on 04/05/23 in order to make sure facility cottages are appropriately suited for client use. LPA conducted a walk-through inside and out Cottage Fox and Cottage Kingsley. All cottage bedrooms have twin size beds, dressers, office tables, and locker closets displayed. Staff offices are appropriately organized. At the time of this inspection both cottages were observed to be clean, safe, and in good repair. A copy of this report was provided to the facility representative. Exit Interview conducted.

met_with: Patricia White, Director


summary: Facility Evaluation

raw_content:
Narrative:
On November 15th at 8: AM Licensing Program Analyst (LPA) Noubar Yerkatyan conducted an unannounced inspection at the above facility for the purpose of conducting an annual/required inspection. LPA met with facility Administrator, Patricia White. LPA and Ms. White toured the facility. LPA obtained and reviewed the following updated documentation: LIC Personnel and Client Roster, LIC C Emergency Disaster Plan, Board of Directors report, Employee Grievance Policy/ Grievance Procedures, Crisis Prevention Intervention Training's, Emergency Preparedness: Disaster and Mass Casualties Drills, Emergency Evacuation Routes, Facility Monthly Activities Calendar, Emergency Intervention Plan, and Complaint Procedures. Community Care Licensing (CCL) focuses its efforts on three priority areas: prevention, compliance, and enforcement. The facility was in full compliance with 7 applicable areas of the Compliance and Regulatory Enforcement (CARE) tools for Children's Residential Licenses. Annual compliance review consisted of the following domains: Physical plant, operations, disaster preparedness plan, emergency intervention, staffing, and client records. The facility consists of six cottages: Whittier, Kiwanis, Campbell, Gregory, Fox, and Kingsley. Cottage Whittier has 8 bedrooms with 10 beds in total. All bedrooms have a twin-size bed, dresser, office table, and locker closet. Cottage has common area with couches, TV, dining table, and kitchen appliances. Cottage has rooms designed for staff along with staff restrooms. Client restrooms were all in working order. The medications and cleaning solutions were locked inside the cabinets in the cottage laundry rooms. There is perishable food enough for 20 days and non-perishable foods enough for client's consumption for more than 3 weeks. All staff and storage rooms have a lock. Cottage has (2) camera's facing the common area, (2) camera's facing the hallway, and (2) camera's facing the outside patio. Fire extinguishers were in working order. Entering the staff office leads into Cottage Kiwanis. Cottage Kiwanis has 8 bedrooms with 10 beds in total. All bedrooms have a twin-size bed, dresser, office table, and locker closet. Cottage has common area with couches, TV, dining table, and kitchen appliances. Cottage has rooms designed for staff along with staff restrooms. Client restrooms were all in working order. The medications and cleaning solutions were locked inside the cabinets in the cottage laundry rooms. There is perishable food enough for 20 days and non-perishable foods enough for client's consumption for more than 3 weeks. All staff and storage rooms have a lock. Cottage has (2) camera's facing the common area, (2) camera's facing the hallway, and (2) camera's facing the outside patio. Fire extinguishers were in working order. Cottage Campbell has 8 bedrooms with 10 beds in total. All bedrooms have a twin-size bed, dresser, office table, and locker closet. Cottage has common area with couches, TV, dining table, and kitchen appliances. Cottage has rooms designed for staff along with staff restrooms. Client restrooms were all in working order. The medications and cleaning solutions were locked inside the cabinets in the cottage laundry rooms. There is perishable food enough for 20 days and non-perishable foods enough for client's consumption for more than 3 weeks. All staff and storage rooms have a lock. Cottage has (2) camera's facing the common area, (2) camera's facing the hallway, and (2) camera's facing the outside patio. Fire extinguishers were in working order. Entering the staff office leads into Cottage Gregory. Cottage Gregory has 8 bedrooms with 10 beds in total. All bedrooms have a twin-size bed, dresser, office table, and locker closet. Cottage has common area with couches, TV, dining table, and kitchen appliances. Cottage has rooms designed for staff along with staff restrooms. Client restrooms were all in working order. The medications and cleaning solutions were locked inside the cabinets in the cottage laundry rooms. There is perishable food enough for 20 days and non-perishable foods enough for client's consumption for more than 3 weeks. All staff and storage rooms have a lock. Cottage has (2) camera's facing the common area, (2) camera's facing the hallway, and (2) camera's facing the outside patio. Fire extinguishers were in working order. Cottage Fox has 8 bedrooms with 10 beds in total. All bedrooms have a twin-size bed, dresser, office table, and locker closet. Cottage has common area with couches, TV, dining table, and kitchen appliances. Cottage has rooms designed for staff along with staff restrooms. Client restrooms were all in working order. The medications and cleaning solutions were locked inside the cabinets in the cottage laundry rooms. There is perishable food enough for 20 days and non-perishable foods enough for client's consumption for more than 3 weeks. All staff and storage rooms have a lock. Cottage has (2) camera's facing the common area, (2) camera's facing the hallway, and (2) camera's facing the outside patio. Fire extinguishers were in working order. Entering the staff office leads into Cottage Kingsley. Cottage Kingsley has 8 bedrooms with 10 beds in total. All bedrooms have a twin-size bed, dresser, office table, and locker closet. Cottage has common area with couches, TV, dining table, and kitchen appliances. Cottage has rooms designed for staff along with staff restrooms. Client restrooms were all in working order. The medications and cleaning solutions were locked inside the cabinets in the cottage laundry rooms. There is perishable food enough for 20 days and non-perishable foods enough for client's consumption for more than 3 weeks. All staff and storage rooms have a lock. Cottage has (2) camera's facing the common area, (2) camera's facing the hallway, and (2) camera's facing the outside patio. Fire extinguishers were in working order. LPA toured the nursing station and facility cafeteria as well. Nursing station has multiple offices with a treatment room and medication room. Both the treatment and medication rooms contained locked cabinets of medications. Attached to the cafeteria was a large auditorium with tables, chairs, and a stage for entertainment. The smoke and carbon monoxide detectors for all cottages were tested and operable. Alarms for both Cottages were tested and was in working order. All cottage hot water temperatures were tested, and all were in working order. Cottages all have working telephones that are accessible to clients and staff. All passageways and grounds were free of any obstructions. The facility utilizes one Chevy Volt vehicle for transportation. Vehicle is serviced as needed. At the time of this inspection the facility was observed to be clean, safe, and in good repair. Administrator is on site at least 20 hours a week and on-call 24/7. For this review, four (4) clients and seven (7) staff were selected for the sample to assess the level of care and services they receive. LPA also conducted interviews with two staff members and two clients. Client's files were reviewed electronically, while staff files were physically reviewed. An exit interview was conducted. LPA provided the facility representative above a signed copy the LIC 809 and LIC 811 reports. There were no deficiencies cited at the time of this inspection.

visit_type: Annual

met_with: Patricia White, STRTP Administrator; Marissa Marti, Director of UCS Program


facility_name: MICHAEL'S YOUTH TREATMENT HOME FOR BOYS

summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On December 13, 2022 at 8: AM, Licensing Program Analysts (LPA's) Jessica Peete and Sarah Lo conducted an unannounced annual inspection at Michael's Youth Treatment Home for Boys Group Home. LPA's were met at the facility by Facility Manager Gabriela Becerra and Administrator Ruby Barajas. LPA's began a physical plant inspection at 9: AM assisted by the Facility Manager and Administrator.. The facility is two stories; a physical plant inspection was completed and included the following checks: Kitchen, dining room, living room refrigerator/freezers, food storage areas, one staff bathroom, one staff office, two client bathrooms, and three client bedrooms (B1-B3) Bedrooms are arranged so that no more than two clients are in a room, and there is one client per bed. Each client room has the appropriate linens, pillows, comforters, and mattresses are in good repair. Extra linens are stored in the hall closet. Additionally, there is adequate drawer space for each client's belongings. Cleansers, chemicals, and cooking knives are inaccessible to clients. Cleaners and chemicals are locked in the downstairs closet. Cooking knives are in a locked in the staff office. Upon inspection the first aid kit was complete and located in the staff office. Licensee maintains an adequate supply of food and a variety of snacks for clients. LPA observed a minimum seven day non-perishable and a two day perishable supply of food. Additionally, LPA observed the following postings: facility license, grievance procedures, personal rights, Ombudsman poster, visitation policies, and current menu. Age appropriate games and books were observed for client's recreation time. The facility's outside grounds were also inspected and found to be clean, well maintained, and free of observable hazards. There is adequate indoor and outdoor activity space, and all exits were free from obstruction. LPA observed the facility pool, in the backyard, to be inaccessible clients. The fence around the pool has a self-latching gate and measured over five feet tall. The pool is clean and well maintained. (Continued on LIC C ) The facility has an operable carbon monoxide detectors and smoke detectors located throughout the facility. The fire extinguishers were properly charged, serviced, and located in the kitchen and upstairs hallway. Medications were centrally stored locked inside of the staff office. The washer and dryer are located inside the facility, next to the garage, and accessible to clients with staff assistance. Per Facility Manager's statement clients are supervised while they do their own laundry and LPA observed detergents are kept locked. The facility has one vehicle used to transport clients to appointments and recreational activities. The vehicle was observed to be in safe operating condition. At 9: AM, LPA observed, client bathroom one had two sinks. Water in sink one measured 136.2 degrees Fahrenheit and sink two measured 133.7 degrees Fahrenheit. The water in client bathroom two measured 133.5 degrees Fahrenheit. At 9: AM the LPA's observed the trash cans in both client bathrooms were missing lids; this was corrected during the visit. At 10: AM, LPA observed window screens were missing from all three client bedrooms. The licensee was cited for the following deficiencies: Title California Code of Regulations (CCR) 80088(e)(1)... Hot water temperature controls shall be maintained to automatically regulate temperature of hot water ...used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). CCR 80088(f)(1) ...(1) All containers, including movable bins, used for storage of solid wastes shall have tight-fitting covers kept on the containers; shall be in good repair, shall be leakproof and rodent-proof. CCR 80088(b) All window screens shall be in good repair and be free of insects, dirt and other debris. At 10: AM, assisted by the Facility Manager and Administrator LPA's began review of the Disaster Preparedness, Operational Requirements, Emergency Interventions. At 10: AM, LPA's observed the licensee's disaster plan did not include documentation of quarterly emergency drills, and there were no procedures addressing the storage and preservation of medications. The licensee was cited with the following technical violations of the Health and Safety Code (HSC): HSC 1565(c) A facility shall conduct a drill at least quarterly for each shift... (Continued on LIC C) HSC 1565(a)(7)(E) A facility shall have an emergency and disaster plan that shall include... (7) Procedures that address...(E) Storage and preservation of medications... At 11: AM LPA observed the licensee had not trained staff on emergency interventions. Per Facility Managers statement, staff was last trained in May 2021. The Facility Manager stated a training is scheduled for 12/16/2022. The licensee was cited with the following technical violations: CCR 84365(d) The licensee must maintain a written record of the facility staff training. CCR 84365(d)(1) ... Documentation of training received must be maintained in the personnel record for each staff member... CCR 84365(d)(1)(A) The licensee must maintain a written record of the facility staff training. (1) Documentation of training received must be maintained in the personnel record for each staff member and must include: (A) Dates, hours, and description of the training completed. CCR 84365(d)(1)(B) The licensee must maintain a written record of the facility staff training... (1) Documentation of training received... must include: (B) Name and training certificate of the instructor who provided the training. CCR 84365(d)(1)(C) The licensee must maintain a written record of the facility staff training... (1) Documentation of training received... must include: (C) Certification from the instructor that the staff member has successfully completed the competency test. CCR 84365(e) Facility personnel must receive on-going training to maintain certification (Continued on LIC C) At 12: PM LPA's began the review of five staff files ( S1-S5). The licensee was cited for the following technical violations regarding staff training (CCR) 84065(i)(3)(V) ...new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training... (3) Training shall include, at a minimum, all of the following topics... (V) A child's right to receive sexual and reproductive health care and information. CCR 84065(i)(3)(W ...new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training... (3) Training shall include, at a minimum, all the following topics...(W) A child's right to have their sensitive health information kept confidential. CCR 84065(i)(3)(X) .... new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training... (3) Training shall include, at a minimum, all of the following topics... (X) The duties and responsibilities of the assigned case management worker and the licensee to ensure that children can obtain sexual and reproductive health services and information. CCR 84065(i)(3)(Y)... new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training... (3) Training shall include, at a minimum, all of the following topics... (Y) Guidance about how to engage and talk with children about healthy sexual development and reproductive and sexual health in a manner that is medically accurate, age or developmentally appropriate, trauma informed, and strengths based. CCR 84065(i)(3)(Z) ... new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training... (3) Training shall include, at a minimum, all of the following topics... (Z) Information about current contraception methods and how to select and provide appropriate referral resources and materials for information and service delivery. During the record review LPA observed staff was hired prior to the effective date of the regulation 10-01-2022. However, the licensee has not updated staff training to include the required information as cited above. (Continued on LIC C) At 1: PM LPA observed the licensee could not provide documentation regarding staff training. The following deficiencies were cited: CCR 84065(i)... new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training. CCR 84065(i)(1)(C)(4) Successful completion of job shadowing shall be verified by a statement completed by the experienced facility personnel.... CCR 84065(i)(1)(D) Within 7 calendar days of completion of the 8 hour training, the administrator or administrator's designee shall assess if each child care staff understands and can apply the training. CCR 84065(i)(1)(D)(2) Within 7 calendar days of completion of the 8 hour training, the administrator or administrator's designee shall assess if each child care staff understands and can apply the training. (2) The assessment shall be documented in each child care staff personnel record. CCR 84065(i)(2)... new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training as specified in (1) and (2) below: (2) Sixteen hours of training shall be completed by new child care staff within 90 days of hire. CCR 84065(i)(2)(A)... new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training... (A) New child care staff who work a maximum of 20 hours per week shall complete the additional minimum 16 hours of training within 180 days of hire. CCR 84065(i)(2)(B)... new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training...(B) Within 30 days of completion of the 16 hour training, the administrator or administrator's designee shall assess if each newly hired child care staff understands and can apply the training. CCR 84065(i)(2)(B)(2)... new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training...(B) Within 30 days of completion of the 16 hour training, the administrator or administrator's designee shall assess if each newly hired child care staff understands and can apply the training. (2) The assessment shall be documented in each child care staff personnel record (Continued on LIC C) CCR 84065(j)(1)... all child care staff shall complete a minimum of 20 hours of annual training... CCR 84065(j)(1)(A)... all child care staff shall complete a minimum of 20 hours of annual training...(A) At least 5 hours of the annual training shall consist of course work from an entity other than the group home... CCR 84065(j)(2)... newly hired child care staff, hired on or after July 1, 1999, shall complete a minimum of 16 hours of annual training within the first 12 months of employment, for a total of 40 hours of initial and annual training... CCR 84065(j)(2)(A)... newly hired child care staff, hired on or after July 1, 1999, shall complete a minimum of 16 hours of annual training within the first 12 months of employment, for a total of 40 hours of initial and annual training... (A) At least 4 hours of the annual training shall consist of course work from an entity other than the group home...or other direct training provided by a qualified individual...who is not affiliated with the group home licensee. CCR 84065(j)(4)(A) A portion of this training shall address oversight and monitoring of psychotropic medications for children in foster care and related topics specified in Section 16501.4(d) of the Welfare and Institutions Code. Based on observations, made during the inspection, deficiencies are being cited, see the LIC D. Due to time constraints, LPA will return to complete the inspection at a later date. An exit interview was conducted, and a copy of this report and appeal rights was provided/emailed to Administrator Ruby Barajas.

Deficiencies:
84065(i): Personnel Requirements

(i) Notwithstanding Sections 80065(f)(1) through (6), new child care staff hired on or after July 1, 1999, shall complete a minimum of 24 hours of initial training comprised of the 8 and 16-hour training as specified in (1) and (2) below

met_with: Gabriela Bacerra Facility Manager, Ruby Barajas Program Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On December 15, 2022 at 9: AM, Licensing Program Analysts (LPA's) Jessica Peete and Linda Haynes conducted an unannounced continuation visit at Michael's Youth Treatment Home for Boys Group Home. LPA's were met at the facility by Facility Manager Gabriela Becerra and Administrator Ruby Barajas. LPA Peete visited the facility on 12/13/2022 to complete inspection of the Physical Plant, Disaster Preparedness, Operational Requirements, and Emergency Interventions. At 9: AM assisted by the Facility Manager, LPA began review of three client files (C1-C3) At 10: AM LPA provided the licensee technical assistance in connection with Title California Code of Regulations (CCR) 84077(a)(2) ... Provision of an allowance to all children no less frequently than once per month...Per Facility Manager and Administrator statement. Client's participation in the program is thirty days or less. The licensee was advised that if the clients are in care longer than thirty days; they must be given an allowance. At 10: AM LPA observed the licensee did not have Needs and Services Plans for clients in care. Per Facility Manager and Administrator's statement client's participation in the program is thirty days or less. Licensee was advised that clients in care, longer than thirty days, are required to have a needs and services plan that address their needs as listed below. The licensee was provided with technical assistance in connection with following Title California Code of Regulations (CCR): CCR 84068.2(a)... Social work staff shall obtain the information specified in Section 84070, and shall develop an individual needs and services plan for the child... CCR 84068.2(b) The needs and services plan shall identify the child's needs in the following areas: CCR 84068.2(b)(1) The needs and services plan shall identify the child's needs in the following areas: (1) Reason for placement. (Continued on LIC C) CCR 84068.2(b)(2) The needs and services plan shall identify the child's needs in the following areas: (2) Education. CCR (b) The needs and services plan shall identify the child's needs in the following areas: (2) Education. (A) If the information specified in Section 84070(b)(4) is not available, the plan shall specify a method for determining such needs. CCR 84068.2(b)(5) (b) The needs and services plan shall identify the child's needs in the following areas: (5) Ability to manage his/her own money, including the maximum amount of money the child shall be permitted to have in his/her possession at any one time. CCR 84068.2(c) The needs and services plan shall include the following information regarding services necessary to meet the child's needs: CCR 84068.2(c)(1) The needs and services plan shall include the following information regarding services necessary to meet the child's needs: (1) Types of services necessary. At 11: AM , LPA observed the licensee did not have documentation pertaining to bedroom sharing arrangements, to be maintained in each client rerecord. The licensee was provided with technical assistance in connection with CCR 84087(e) in every situation where children share a bedroom, the licensee shall document that the bedroom sharing arrangement ensures the health and safety of each child and that the children are compatible... This documentation shall be maintained in the child's record. At 11: AM, LPA measured the hot water in both client bathrooms. Bathroom one, sink one, measured 119.4 degrees Fahrenheit. Sink two measured 118.2 degrees Fahrenheit. Bathroom two measured 117.3 degrees Fahrenheit. LPA Haynes conducted two staff interviews and three client interviews. Based on observations, from today's visit, no deficiencies are being cited. An exit interview was conducted and a copy of this report and appeal rights were given to Administrator Ruby Barajas. This is an amended report of a report that was originally issued on 12/15/2022


summary: Facility Evaluation

raw_content:
Narrative:
On 12/ 21/2022 at 8:37 am, Licensing Program Analyst (LPA) Jessica Peete met with Michael's Youth Treatment Home for Boys Group Home (GH) Facility Manager Gabriela Becerrara to amend the LIC 809 created and provided to the GH on 12/15/2022. Exit interview conducted. A copy of this report and the amended report were provided to Facility Manager Gabriela Becerra.

met_with: Facility Manager Gabriela Becerra


summary: Facility Evaluation

raw_content:
Narrative:
On March 18, 2024 at 8: AM, Licensing Program Analyst (LPA) Jose Gonzalez conducted an unannounced annual inspection at Michael's Youth Treatment Home for Boys Group Home. LPA were met at the facility by Facility Manager Gabriela Becerra and Administrator Ruby Barajas. LPA's began a physical plant inspection at 9: AM assisted by the Facility Manager and Administrator.. The facility is two stories; a physical plant inspection was completed and included the following checks: Kitchen, dining room, living room refrigerator/freezers, food storage areas, one staff bathroom, one staff office, two client bathrooms, and three client bedrooms (B1-B3) Bedrooms are arranged so that no more than two clients are in a room, and there is one client per bed. Each client room has the appropriate linens, pillows, comforters, and mattresses are in good repair. Extra linens are stored in the hall closet. Additionally, there is adequate drawer space for each client's belongings. Cleansers, chemicals, and cooking knives are inaccessible to clients. Cleaners and chemicals are locked in the downstairs closet. Cooking knives are in a locked in the staff office. Upon inspection the first aid kit was complete and located in the staff office. Licensee maintains an adequate supply of food and a variety of snacks for clients. LPA observed a minimum seven day non-perishable and a two day perishable supply of food. Additionally, LPA observed the following postings: facility license, grievance procedures, personal rights, Ombudsman poster, visitation policies, and current menu. Age appropriate games and books were observed for client's recreation time. The facility's outside grounds were also inspected and found to be clean, well maintained, and free of observable hazards. There is adequate indoor and outdoor activity space, and all exits were free from obstruction. LPA observed the facility pool, in the backyard, to be inaccessible clients. The fence around the pool has a self-latching gate and measured over five feet tall. The pool is clean and well maintained. *****CONTINUED on LIC C***** The facility has an operable carbon monoxide detectors and smoke detectors located throughout the facility. The fire extinguishers were properly charged, serviced, and located in the kitchen and upstairs hallway. Medications were centrally stored locked inside of the staff office. The washer and dryer are located inside the facility, next to the garage, and accessible to clients with staff assistance. Per Facility Manager's statement clients are supervised while they do their own laundry and LPA observed detergents are kept locked. The facility has one vehicle used to transport clients to appointments and recreational activities. The vehicle was observed to be in safe operating condition. LPA assisted by the Facility Manager began the began the review of the staff files (S1-S3) and two client files (C1-C2). Staff files were complete with all required documents. LPA observed the licensee did not have Needs and Services Plans for clients (C1- C2) in care. Per Facility Manager and Administrator's statement client's participation in the program is thirty days or less. Licensee was advised that clients in care, longer than thirty days, are required to have a needs and services plan that address their needs as listed below. LPA observed the licensee did not have Needs and Services Plans for clients in care. Per Facility Manager and Administrator's statement client's participation in the program is thirty days or less. Licensee was advised that clients in care, longer than thirty days, are required to have a needs and services plan that address their needs as listed below. The licensee was provided with technical assistance in connection with following Title California Code of Regulations (CCR): The licensee was provided with technical assistance in connection with following Title California Code of Regulations (CCR): CCR 84068.2(a)... Social work staff shall obtain the information specified in Section 84070, and shall develop an individual needs and services plan for the child... CCR 84068.2(b) The needs and services plan shall identify the child's needs in the following areas: CCR 84068.2(b)(1) The needs and services plan shall identify the child's needs in the following areas: (1) Reason for placement. (Continued on LIC C) CCR 84068.2(b)(2) The needs and services plan shall identify the child's needs in the following areas: (2) Education. CCR (b) The needs and services plan shall identify the child's needs in the following areas: (2) Education. (A) If the information specified in Section 84070(b)(4) is not available, the plan shall specify a method for determining such needs. CCR 84068.2(b)(5) (b) The needs and services plan shall identify the child's needs in the following areas: (5) Ability to manage his/her own money, including the maximum amount of money the child shall be permitted to have in his/her possession at any one time. CCR 84068.2(c) The needs and services plan shall include the following information regarding services necessary to meet the child's needs: CCR 84068.2(c)(1) The needs and services plan shall include the following information regarding services necessary to meet the child's needs: (1) Types of services necessary. Per Facility Manager and Administrator statement. Client's participation in the program is thirty days or less. The licensee was advised that if the clients are in care longer than thirty days; they must be given an allowance. LPA provided the licensee technical assistance in connection with Title California Code of Regulations (CCR) 84077(a)(2) ... Provision of an allowance to all children no less frequently than once per month...Per Facility Manager and Administrator statement. Client's participation in the program is thirty days or less. The licensee was advised that if the clients are in care longer than thirty days; they must be given an allowance. Based on staff and client file reviews and observations, from today's visit, no deficiencies are being cited. An exit interview was conducted and a copy of this report and appeal rights were given to Administrator Ruby Barajas.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Sethany Yem conducted a case management inspection on 5/15/24 at 10:30am based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 5 out of Direct Care Staff and 5 out of 5 youth files were reviewed. 2 out of Direct Care Staff and 2 out of 5 youth were interviewed. (See the Confidential Names List, LIC 811, 5/15/24). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, and progress notes, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPA Yem observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Administrator Ruby Bajaras.

met_with: Administrator Ruby Bajaras


facility_name: MILBURN HOUSE

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On this date, Licensing Program Analyst (LPA) Leslie Inouye conducted a complaint inspection for the Group Home (GH) for the purpose of delivering the findings for the above complaint allegation. LPA met with Sharde Carter. . During the course of investigating the allegation, LPA conducted interviews with staff members, conducted a record review and obtained information. The information and interviews revealed inconsistencies. Interviews indicate that client arrived at school with abrasions on his upper arm. Witnesses did not feel it was from his seatbelt harness. Staff interviewed and documentation provided did not reveal any issues that would have caused an injury prior to leaveing for school on that day. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the injury was caused by facility staff or an issue of supervision, therefore the above allegation is unsubstantiated UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Les Inouye LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

report_type: Complaint Investigation

met_with: Sharde Carter

complaint_status: unsubstantiated


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13Complaint Specialist C.K. Kinney(CS) Traveled to Hope for Youth Inc offices and met with Vernell Watts to deliver findings of investigation. Investigator Barragan conducted investigation that included review of documentation, review of video evidence, interviews of staff, clients and witnesses and based on the information obtained has determined there is a preponderance of the evidence the allegation occurred. Allegation is Substantiated. This facility is being cited for violation of Health and Safety Code section 1558(a)(2) Conduct Inimical and Title Division Chapter 5 section 84072(d)(14)(a)(2) Personal Rights. Copy of this report, deficiency citations, and LIC Appeal Rights left with Vernell Watts at conclusion of inspection. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Charles Kinney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, E SHAW AVE FACILITY NAME: MILBURN HOUSEFACILITY NUMBER: 107207169

met_with: Vernell Watts

complaint_status: SUBSTANTIATED


raw_content:
Investigation Findings:
13On this date, Licensing Program Analyst (LPA) Leslie Inouye conducted a complaint inspection for the Group Home (GH) for the purpose of delivering the findings for the above complaint allegation. LPA met with House Manager Jaquia Wynne. During the course of investigating the allegation, LPA conducted interviews with staff members and clients , conducted a record review and obtained information. The information revealed that Client #1 did sustaine an injury but was inconsistent if it was due to a lack of supervision. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the above allegation occurred due to a lack of supervision, therefore the above allegation is unsubstantiated. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Les Inouye LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

met_with: Jaquia Wynne


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


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


summary: Facility Evaluation

raw_content:
Narrative:
On 06/18/2021, Licensing Program Analyst (LPA) Tamara Melikian conducted an annual inspection at the facility. Met at the facility by Program Manager Vernell Watts and House Manager Sharde Carter. Currently there are 4 clients at the facility. Client files and staff files were inspected on this date. Fees checked and the facility is current on all fees. Clients are not home as they are attending school. A physical plant inspection was completed and included the following checks. Facility grounds are clean and free of debris and observable hazard. Adequate indoor and outdoor activity space and materials observed. All facility smoke detectors are in appropriate working order, fire extinguisher is properly charged and serviced. Facility maintains an adequate supply of perishable and non-perishable foods and appears to be following the posted menu. All required forms are posted. Medications are locked and centrally stored. Individual beds were observed with appropriate clean linens and are in good repair. Hot water measured 110 degrees. There are no firearms or pets at the facility. There are no bodies of water. Facility appears to be meeting the terms and conditions of their license. There are no deficiencies to be cited on this date. A copy of this report is left at the facility.

met_with: Vernell Watts, Sharde Carter


summary: Facility Evaluation

raw_content:
Narrative:
On 08/02/2021, an unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Tamara Melikian at 2:00PM. During the inspection, LPA met with House Manager Sharde Carter and inspected the facility inside and out. LPA reviewed three children's records and reviewed two staff personnel records for the facility. LPA interviewed one staff at 2:45PM, the Administrator will be interviewed by telephone on this date. One of the children on psychotropic medication was currently not in placement and the other two children are nonverbal and unable to be interviewed. A medication review was conducted at 3:00PM. LPA conducted exit interview with Sharde Carter, House Manager at 3:30PM. There are no deficiencies to be cited on this date.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analysts (LPAs), Reyna Martinez and Lidia Tinoco traveled to the Hope for Youth main office for the purpose of starting Milburn House annual inspection and met with Clinard Fletcher. 9 records of personnel members were reviewed to ensure staff meet regulatory requirements. All personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. No Deficiencies were cited on today's visit.

met_with: Clinard Fletcher, Administrator


facility_name: MISSION PREP - EAGLE MOUNTAIN

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
It was also reported that some residents expressed frustration about not having enough food and being limited to certain food items. It was further reported that residents are seen looking for any food possible to eat until scheduled meal times. It was reported that some residents do not care for the chef's food, don't eat, and would like additional food items in case they don't like the food. Confidential interviews indicated clients attend a weekly grocery group, participate in menu planning, and suggest menu items. Confidential interviews indicated clients request breakfast items to order. Other confidential interviews indicated clients prepare their own breakfast. Confidential interviews indicated lunch and dinner are provided by a chef. Confidential interviews indicated clients enjoy the food the chef makes. Confidential interviews indicated the chef prepares meals requested by the clients and that are within the facility budget. Confidential interviews indicated items such as scallops, sushi and lobsters have been denied because those items are not within the budget. Confidential interviews denied meals not being provided and denied sufficient food not being available. Based on confidential interviews and records reviewed, the allegation that staff did not ensure adequate meals were provided to minors in care 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. An exit interview was conducted, and a copy of this signed report and appeal rights were provided to Hilda Soriano, Administrator.

Investigation Findings:
13On August 27, 2025 at 9: AM, Licensing Program Analyst (LPA) Lucero Jauregui arrived at the facility unannounced and met with Hilda Soriano, Administrator to discuss the investigative finding for the allegation noted above. LPA Jauregui conducted an inspection of the facility on March 12, 2025, and no deficiencies were noted. During the investigation, LPA Jauregui interviewed three clients (C1-C3) and four staff (S1-S4). LPA attempted to interview one staff (S5), however, after numerous attempts LPA was unsuccessful. Pertinent documents were obtained. On Mach 7, 2025, Community Care Licensing (CCL) received allegation that staff did not ensure adequate meals were provided to minors in care. It was reported that upper management was not allowing residents to order food items requested. It was reported that residents were only allowed to order breakfast items and that lunch and dinner is provided by a personal chef. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Dawn Segura LICENSING EVALUATOR NAME: LUCERO JAUREGUI 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN DIEGO RO, METROPOLITAN DR. # FACILITY NAME: MISSION PREP - EAGLE MOUNTAINFACILITY NUMBER: VISIT DATE: 08/27/2025

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

met_with: Hilda Soriano, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On November 5, 2024, at 9: AM, Licensing Program Analyst (LPA) Jacob Salem and Licensing Program Manager (LPM) Dawn Segura met with Samual Justice, Compliance Specialist and William Mara via Microsoft Teams for a Component II orientation. LPA went over application revisions and discussed the application process prior to licensure. LPA confirmed that they have received fire clearance and criminal background clearances, and a pre-licensing inspection will be scheduled once the applicant's revisions are approved by the Department. A copy of this report was sent to Samual Justice, Compliance Specialist for signature. The original signed copy will be placed in the facility file.

met_with: Samual Justice & William Mara


summary: Facility Evaluation

raw_content:
Narrative:
On December 5, 2024, at 1: PM, Licensing Program Analyst (LPA) Jacob Salem conducted an announced visit to the above facility and met with Mission Prep Health Care Aja Chavez, Administrator for the purpose of conducting a pre-licensing inspection. LPA and the applicants toured the facility inside and out. Currently there are no clients placed in the home. The applicant is applying to serve six ambulatory clients ages 12 to 17. LPA conducted component III of the orientation process and reviewed with the applicants Licensing requirements. The home is a one-story building with three client bedrooms and three client bathrooms which are set up as follows: · Bedroom #1 (Client) has two twin beds and will sleep two clients. · Bedroom #2 (Client) has two twin beds and will sleep two clients. · Bedroom #3 (Client) has two twin beds and will sleep two client. · Kitchen and dining area, multiple family room areas, a laundry room, staff office and storage closet, backyard/patio and pool area with large slide, attached two car garage. The Emergency Disaster Plan and Personal Rights are posted in the front hallway of the home. The license will be posted as soon as it is issued. The client bedrooms are arranged so that no more than two clients will share a room, no room commonly used for other purposes will be used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate closet space for the clients' belongings. Client mattresses, blankets, pillows, and linens are clean and in good repair. There are smoke/carbon monoxide detectors inside all three bedrooms and throughout the common areas of the facility. The smoke/carbon monoxide detectors were tested and are working properly. After adjusting the central water heater, client bathrooms have working faucets measured to run at 116.4 and 105.4, and there are signs above the client sinks to warn of hot water. The showers and toilets in client bathrooms are in clean and operating condition. There are additional bath towels and basic toiletries stored in the home. Continued... ...CONTINUED The kitchen is clean and well maintained with adequate utensils, dishware, and appliances for food storage and preparation. The kitchen contains perishable and non-perishable food supplies ready for clients to consume upon entry into the program. There is a trash can for storage of solid waste in the kitchen with a tight-fitting lid. The home's central air conditioning module was located by the front entrance of the home and the home is kept at a comfortable temperature. There are multiple spacious living room areas located through the home with sofas and chairs and reading material for clients to use for relaxation or visitation from family and friends. There is also an educational room and adjacent office, which can be used for visitation and confidential interviews. The facility has supplies and appliances necessary for laundering clients' personal clothing. The home is well lit and passageways are free from obstructions. The backyard consists of a patio and yard area, and window screens around the facility were inspected and in good repair. There is a covered swimming pool in the lower patio and large slide. A first aid kit is readily accessible and located in the staff office cabinet, as well as throughout the home. Applicant stated there were no weapons/firearms in the home. Harmful cleaning supplies are locked in garage closet, medication is kept locked in the staff office,, and knives are locked in the kitchen cupboard. The facility has telephone service on the premises and provisions for making confidential calls. The client's files will be kept on file electronically, and there are provisions for confidential interviews with clients. The facility has a Emergency and Disaster Plan, which contains all the required procedures, such as provision of emergency power, storage and preservation of medications, and the location of utility shut off valves. The facility has demonstrated compliance with Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was provided to Aja Chavez, Administrator of Mission Prep Healthcare.

visit_type: Prelicensing

met_with: Aja Chavez, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On March 12, 2025 at 8: AM, Licensing Program Analyst (LPA) Lucero Jauregui conducted an unannounced visit to the facility and met with Program Manager Hilda Soriano for the purpose of conducting a post licensing inspection. Program Manager and Clinical Director provided LPA tour of the facility inside and out. The facility serves six ambulatory clients ages 12 to 17. There are currently 4 clients in care. The home is a one-story building with three client bedrooms and three client bathrooms which are set up as follows: · Bedroom #1 (Client) has two twin beds and will sleep two clients. · Bedroom #2 (Client) has two twin beds and will sleep two clients. · Bedroom #3 (Client) has two twin beds and will sleep two clients. · Kitchen and dining area, multiple family room areas, a laundry room, staff office and storage closet, backyard/patio and pool area with large slide, attached three car garages. The Emergency Disaster Plan and Personal Rights are posted in the front hallway of the home. The client bedrooms are arranged so that no more than two clients will share a room, no room commonly used for other purposes will be used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate closet space for the clients' belongings. Client mattresses, blankets, pillows, and linens are clean and in good repair. There are smoke/carbon monoxide detectors inside all three bedrooms and throughout the common areas of the facility. The smoke/carbon monoxide detectors were tested and are working properly. The water temperature was measured to run at 127.7 and there are signs above the client sinks to warn of hot water. The showers and toilets in client bathrooms are in clean and operating condition. There are additional bath towels and basic toiletries stored in the home. Continued... The kitchen is clean and well maintained with adequate utensils, dishware, and appliances for food storage and preparation. The kitchen contains perishable and non-perishable food supplies. There is a trash can for storage of solid waste in the kitchen with a tight-fitting lid. The home's central air conditioning module was located by the front entrance of the home and the home is kept at a comfortable temperature. There are multiple spacious living room areas located through the home with sofas and chairs and reading material for clients to use for relaxation or visitation from family and friends. There is also an educational room and adjacent office, which can be used for visitation and confidential interviews. The facility has supplies and appliances necessary for laundering clients' personal clothing. The home is well lit and passageways are free from obstructions. The backyard consists of a patio and yard area, and window screens around the facility were inspected and in good repair. There is a covered swimming pool in the lower patio and large slide. A first aid kit is readily accessible and located in the staff office cabinet, as well as throughout the home. Per Program Manage there are no weapons/firearms in the home. Harmful cleaning supplies are locked in garage closet, medication is kept locked in the staff office, and knives are locked in the kitchen cupboard. The facility has telephone service on the premises and provisions for making phone calls. The client's files are maintained on file electronically. LPA reviewed four out of four client files, five out of five staff files, and conducted confidential interviews. The facility has a Emergency and Disaster Plan, which contains all the required procedures, such as provision of emergency power, storage and preservation of medications, and the location of utility shut off valves. Based on todays' inspection there are no deficiencies observed. An exit interview was conducted and a copy of this report was provided to Program Manager Hilda Soriano.

met_with: Program Manager Hilda Soriano and Kevin Perez, Clinical Director


summary: Facility Evaluation

raw_content:
Narrative:
On January 14, 2026 at 9: AM, Licensing Program Analyst (LPA) Lucero Jauregui conducted an unannounced visit to the facility and met with Program Manager (PM) Hilda Soriano for the purpose of conducting an annual inspection. LPA Jauregui was provided with an indoor and outdoor guided tour of the facility. The facility serves six ambulatory clients ages 12 to 17. There are currently 6 clients in care. The home is a one-story building with three client bedrooms and three client bathrooms which are set up as follows: · Bedroom #1 (Client) has two twin beds and will sleep two clients. · Bedroom #2 (Client) has two twin beds and will sleep two clients. · Bedroom #3 (Client) has two twin beds and will sleep two clients. · Kitchen and dining area, multiple family room areas, a laundry room, staff office and storage closet, backyard/patio and pool area with large slide, and attached three car garage. The client bedrooms are arranged so that no more than two clients will share a room, no room commonly used for other purposes will be used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate closet space for the clients' belongings. Client mattresses, blankets, pillows, and linens are clean and in good repair. There are smoke/carbon monoxide detectors inside all three bedrooms and throughout the common areas of the facility. The smoke/carbon monoxide detectors were tested on January 8, 2026 and are in proper working order. Additionally, the fire department conducted their annual inspection on September 10, 2025. Continued..... The water temperature was measured to be at 121.5 degrees Farenheit. PM advised that signs will be placed above the client sinks to warn of hot water. The showers and toilets in client bathrooms are in clean and operating condition. There are additional bath towels and basic toiletries stored in the home. The kitchen is clean and well maintained with adequate utensils, dishware, and appliances for food storage and preparation. The kitchen contains perishable and non-perishable food supplies. There is a trash can for storage of solid waste in the kitchen with a tight-fitting lid. The home's central air conditioning module was located by the front entrance of the home and the home is kept at a comfortable temperature. There are multiple spacious living room areas located through the home with sofas and chairs and reading material for clients to use for relaxation or visitation from family and friends. There is also an educational room and adjacent office, which can be used for visitation and confidential interviews. The facility has supplies and appliances necessary for laundering clients' personal clothing. The home is well lit and passageways are free from obstructions. The backyard consists of a patio and yard area, and window screens around the facility were inspected and in good repair. There is a covered swimming pool in the lower patio and large slide. A first aid kit is readily accessible and located in the staff office cabinet, as well as throughout the home with all required items. Per PM there are no weapons/firearms in the home. Harmful cleaning supplies are locked in garage closet, medication is kept locked in the staff office, and knives are locked in the kitchen cupboard. The facility has telephone service on the premises and provisions for making phone calls. The client and staff files are maintained electronically and were readily accessible for review. LPA met via Google Meet with compliance team and reviewed five out of five staff files, and six out of six client files (see confidential names list dated January 14, 2026). All files contained all required items. LPA conducted two client interviews and two staff interviews. Based on todays' inspection there are no deficiencies observed. An exit interview was conducted and a copy of this report was provided to PM Hilda Soriano. Based on printer technical difficulties this report was emailed to PM Hilda Soriano.

met_with: Program Manager Hilda Soriano


facility_name: MISSION PREP HEALTHCARE

summary: Facility Evaluation

narrative: On November 5, 2024, at 9: AM, Licensing Program Analyst (LPA) Jacob Salem and Licensing Program Manager (LPM) Dawn Segura met with Samual Justice, Compliance Specialist and William Mara via Microsoft Teams for a Component II orientation. LPA went over application revisions and discussed the application process prior to licensure. LPA confirmed that they have received fire clearance and criminal background clearances, and a pre-licensing inspection will be scheduled once the applicant's revisions are approved by the Department. A copy of this report was sent to Samual Justice, Compliance Specialist for signature. The original signed copy will be placed in the facility file.


summary: Facility Evaluation

raw_content:
Narrative:
On December 5, 2024, at 12: AM, Licensing Program Analyst (LPA) Jacob Salem conducted an announced visit to the above facility and met with Mission Prep Health Care Kailey Stapel, Administrator for the purpose of conducting a pre-licensing inspection. LPA and the applicants toured the facility inside and out. Currently there are no clients placed in the home. The applicant is applying to serve six ambulatory clients ages 12 to 17. LPA conducted component III of the orientation process and reviewed with the applicants Licensing requirements. The home is a two-story building with three client bedrooms and two client bathrooms which are set up as follows: · Bedroom #1 (Client) has two twin beds and will sleep two clients. · Bedroom #2 (Client) has two twin beds and will sleep two clients. · Bedroom #3 (Client) has two twin bed and will sleep two client. · Kitchen and dining area, family room area, a laundry room, staff office and storage closet, backyard/patio and pool area, attached one car garage, and adjacent office. The Emergency Disaster Plan and Personal Rights are posted in the front hallway of the home. The license will be posted as soon as it is issued. The client bedrooms are arranged so that no more than two clients will share a room, no room commonly used for other purposes will be used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate closet space for the clients' belongings. Client mattresses, blankets, pillows, and linens are clean and in good repair. There are smoke/carbon monoxide detectors directly outside all three bedrooms and throughout the common areas of the facility. The smoke/carbon monoxide detectors were tested and are working properly. Client bathrooms have working faucets measured to run at 118.4 and 117.7 degrees F, as well as showers and toilet that are in clean and operating condition. Continued... ...CONTINUED There are additional bath towels and basic toiletries stored in the home. The kitchen is clean and well maintained with adequate utensils, dishware, and appliances for food storage and preparation. The kitchen contains perishable and non-perishable food supplies ready for clients to consume upon entry into the program. There is a trash can for storage of solid waste in the kitchen with a tight-fitting lid. The home's central air conditioning module was located by the front entrance of the home and the home is kept at a comfortable temperature. There is a spacious living room area with sofas and chairs and reading material for clients to use for relaxation or visitation from family and friends. There is also an educational room and adjacent office, which can be used for visitation and confidential interviews. The facility has supplies and appliances necessary for laundering clients' personal clothing. There is non-working fireplace. The home is well lit and passageways are free from obstructions. The backyard consists of a patio and yard area, and window screens around the facility were inspected and in good repair. There is a swimming pool in the back patio and is covered with netting. A first aid kit is readily accessible and located in the staff office cabinet, as well as throughout the home. Applicant stated there were no weapons/firearms in the home. Harmful cleaning supplies are locked in garage closet. medication is kept locked in the staff office, and knives are locked in the kitchen cupboard. The facility has telephone service on the premises and provisions for making confidential calls. The client's files will be kept on file electronically, and there are provisions for confidential interviews with clients. The facility has a Emergency and Disaster Plan, which contains all the required procedures, such as provision of emergency power, storage and preservation of medications, and the location of utility shut off valves. The following deficiencies were observed: 1. There is no first-aid manual available at the facility. 2. All required toiletries are not present at the facility. The request for a license will be forwarded to Licensing Program Manager Dawn Segura for final approval once the deficiencies are cleared. An exit interview was conducted. A copy of this report was provided to Kailey Stapel, Administrator of Mission Prep Healthcare.

met_with: Kailey Stapel, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On November 7, 2025, at 8: AM, Licensing Program Analyst (LPA) Lucero Jauregui conducted an unannounced visit to the above facility and met with Mission Prep Health Care Community Coordinator I for the purpose of conducting a post-licensing inspection. LPA met with Facility Manager Evan Weidele who provided a guided indoor and outdoor tour of the facility. The facility serves six ambulatory clients ages 12 to 17. The home is a two-story building with three client bedrooms, two client bathrooms, kitchen, dining area, family room, laundry room, staff bathroom, storage closet, two car garage, backyard/patio and pool area. Client bedrooms are on the second floor and are set up to where there are no more than two clients per bedroom, no room commonly used for other purposes will be used as a bedroom, and no bedroom serves as a passageway to another room. LPA observed beds, linen and mattress in good repair. There is adequate dresser and closet space for clients personal belongings. The hot water temperature was measured in the client bathroom to be at 124.8 degrees. Facility will prominently post hot water warning sign. Kitchen was observed to be clean and free from observable hazards. Sharps are maintained locked in a kitchen cabinet. There is a trash can for storage of solid waste in the kitchen with a tight-fitting lid. The laundry room is equipped with a washer and dryer. Chemicals and cleaning supplies are maintained locked in the SDS cabinet in the garage. The garage will be maintained locked at all times. Additionally, the second part of the garage is used as a gym. LPA observed fitness equipment and matting in good repair. Continued...... The medication room is on the second floor. LPA observed medication room and medication cabinet locked. LPA observed sufficient medical supplies and first aid kit with all the required items. Additionally, there is an academic room/ intake room and a bathroom for client use. A physical plant inspection was conducted completed the following checks: There are smoke/carbon monoxide detectors directly outside all three bedrooms and throughout the common areas of the facility and in working conditions. There are fire extinguishers through out common areas of the home that are properly serviced and charged. The home's central air conditioning module was located by the front entrance of the home and the home is kept at a comfortable temperature. There is sufficient emergency water, dry goods and extra refrigerator in the garage. There is adequate indoor and outdoor space for clients relaxation and visitation. There is a swimming pool in the back patio and is covered with netting. There are a total of nine cameras in the exterior of the home. LPA observed the following items posted: House Rules, Community Safety Rules, Physical Safety Rules, Emotional Safety rules, daily schedule, meal menu, Emergency Disaster Plan, Facility Sketch, If you See Something Say Something, Youth Bill of Rights, Grievances, and laundry schedule. Staff files and client files are maintained electronically and were accessible for LPA review. LPA met with Samual Justice virtually on Google Meet. LPA reviewed six out of six client files and five out five staff files. All files contained required items. Based on todays visit, there are no deficiencies cited at this time. An exit interview was conducted and a copy of this signed report was provided to Evan Weidele, Facility Manager. Due to printer difficulties this report was emailed to Evan Weidele.

met_with: Evan Weidele, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On January 21, 2026, at 9: AM, Licensing Program Analyst's (LPA) Lucero Jauregui and Stephanie Arreola conducted an unannounced visit to the above facility for the purpose of conducting an annual inspection. LPA's met with Christine Earley who provided a guided indoor and outdoor tour of the facility. The facility serves six ambulatory clients ages 12 to 17. The home is a two-story building with three client bedrooms, two client bathrooms, kitchen, dining area, family room, laundry room, staff bathroom, storage closet, two car garage, backyard/patio and pool area. Client bedrooms are on the second floor and are set up to where there are no more than two clients per bedroom, no room commonly used for other purposes will be used as a bedroom, and no bedroom serves as a passageway to another room. LPA's observed beds, linen and mattress in good repair. There is adequate dresser and closet space for clients personal belongings. The hot water temperature was measured in the client bathroom to be at 129 degrees and Hot Water Warning prominent posted. Kitchen was observed to be clean and free from observable hazards. Sharps are maintained locked in a kitchen cabinet. There is a trash can for storage of solid waste in the kitchen with a tight-fitting lid. The laundry room is equipped with a washer and dryer. Chemicals and cleaning supplies are maintained locked in the SDS cabinet in the garage. The garage will be maintained locked at all times. Additionally, the second part of the garage is used as a gym. LPA's observed fitness equipment and matting in good repair. Continued...... The medication room is on the second floor. LPA observed medication room and medication cabinet locked. LPA observed sufficient medical supplies and first aid kit with all the required items. Additionally, there is an academic room/ intake room and a bathroom for client use. A physical plant inspection was conducted completed the following checks: There are smoke/carbon monoxide detectors directly outside all three bedrooms and throughout the common areas of the facility and in working conditions. There are fire extinguishers through out common areas of the home that are properly serviced and charged. The home's central air conditioning module was located by the front entrance of the home and the home is kept at a comfortable temperature. There is sufficient emergency water, dry goods and extra refrigerator in the garage. There is adequate indoor and outdoor space for clients relaxation and visitation. There is a swimming pool in the back patio and is covered with netting. There are a total of nine cameras in the exterior of the home. The facility is currently constructing an ADU next to the pool that will be utilized as a therapy room. LPA Jauregui observed Approved Plans and Inspection Record form. LPA observed the following items posted: House Rules, Community Safety Rules, Physical Safety Rules, Emotional Safety rules, daily schedule, meal menu, Emergency Disaster Plan, Facility Sketch, If you See Something Say Something, Youth Bill of Rights, Grievances, and laundry schedule. Staff files and client files are maintained electronically and were accessible for LPA's review. LPA's met with Compliance Associate Josue Ortiz virtually on Google Meet. LPA's reviewed three out of three client files and five out five staff files. All files contained required items. Based on todays visit, there are no deficiencies cited at this time. An exit interview was conducted and a copy of this signed report was provided to Hilda Soriano, Program Manager.

met_with: Hilda Soriano, Program Manager


summary: Facility Evaluation

raw_content:
Narrative:
On December 5, 2024, at 9: AM, Licensing Program Analyst (LPA) Jacob Salem conducted an announced visit to the above facility and met with Mission Prep Health Care Ted Guastello, CEO for the purpose of conducting a pre-licensing inspection. LPA and the applicants toured the facility inside and out. Currently there are no clients placed in the home. The applicant is applying to serve six ambulatory clients ages 12 to 17. LPA conducted component III of the orientation process and reviewed with the applicants Licensing requirements. The home is a one-story building with three client bedrooms and three client bathrooms which are set up as follows: · Bedroom #1 (Client) has two twin beds and will sleep two clients. · Bedroom #2 (Client) has two twin beds and will sleep two clients. · Bedroom #3 (Client) has two twin bed and will sleep two client. · Kitchen and dining area, large entrance and family room area, a laundry room, staff office, storage closet, backyard/patio area, and attached two car garage. The Emergency Disaster Plan and Personal Rights are posted in the front hallway of the home. The license will be posted as soon as it is issued. The client bedrooms are arranged so that no more than two clients will share a room, no room commonly used for other purposes will be used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate dresser space for the clients' belongings. Client mattresses, blankets, pillows, and linens are clean and in good repair. There is a smoke/carbon monoxide detectors in all three bedrooms and throughout the common areas of the facility. The smoke/carbon monoxide detectors were tested and are working properly. After adjusting the central water heater, client bathrooms have working faucets measured to run at 114.1, 113.4, and 114.4 degrees F, as well as showers and toilet that are in clean and operating condition. Continued... ...CONTINUED There are additional bath towels and basic toiletries stored in the home. The kitchen is clean and well maintained with adequate utensils, dishware, and appliances for food storage and preparation. The kitchen contains perishable and non-perishable food supplies ready for clients to consume upon entry into the program. There is a trash can for storage of solid waste in the kitchen with a tight-fitting lid. The home's central air conditioning module was located in dining area and the home, and a second unit for client bedrooms, both kept at a comfortable temperature. There is a spacious living room area with sofas and chairs, TV, reading material for clients to use for relaxation or visitation from family and friends. There is also space and recreational activities in the garage, and educational room, which can be used for visitation. The facility has supplies and appliances necessary for laundering clients' personal clothing. There is non-working fireplace. The home is well lit and passageways are free from obstructions. The backyard consists of a patio and yard area, and window screens around the facility were inspected and in good repair. A first aid kits was readily accessible and located in the staff office cabinet, as well as throughout the home. Applicant stated there were no weapons/firearms in the home and harmful cleaning supplies are locked in garage closet and inaccessible to clients. Knives are locked in the kitchen cupper. The swimming pool is covered with netting has a locked self-latching fence. The facility has telephone service on the premises and provisions for making confidential calls. The client's files will be kept on file electronically, and there are provisions for confidential interviews with clients. The facility has a Emergency and Disaster Plan, which contains all the required procedures, such as provision of emergency power, storage and preservation of medications, and the location of utility shut off valves. The following deficiencies were observed: 1. Hot water temperature controls in client bathrooms does not automatically regulate water temperature between 105 degrees and 120 degrees, and there are no warning signs for hot water. 2. Procedures for clients and their authorized representatives to file complaints with the facility administrator are not posted in an accessible location. The request for a license will be forwarded to Licensing Program Manager Dawn Segura for final approval once the deficiencies are cleared. An exit interview was conducted. A copy of this report was provided to Ted Guastello, CEO of Mission Prep Healthcare.

met_with: Ted Guastello, CEO


summary: Facility Evaluation

raw_content:
Narrative:
On June 27, 2025 at 9: AM, Licensing Program Analyst (LPA) Lucero Jauregui conducted an unannounced visit to the facility and met with Hilda Soriano, Administrator. The purpose of the visit is to conduct a Post Licensing inspection. LPA was provided a guided indoor and outdoor tour of the facility. The facility serves six ambulatory clients ages 12 to 17 with a current census of 5. The facility is a one-story home with three client bedrooms, three client bathrooms, living room, dinning room, kitchen, education room, staff office, group room, medication room, and a two car garage. Bedrooms are set up were there are no more than two clients per room. LPA observed mattress and linens in good repair. There is adequate shelf and closet space for client's belongings. All hazardous items have been properly made inaccessible to clients. The medication is stored in a locked cabinet in the medication room. First Aid Kit is maintained in the medication room and contained all the required items. Cleansers/chemicals are locked and stored in the closet. LPA observed kitchen to be free from observable hazards. Sharps are maintained locked in a safe box and locked in an upper kitchen cabinet. The water temperature was measured in the client bathroom to be at 100.7. LPA advised for water temperature to be adjusted. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Fitness equipment and mats was observed in the garage. All facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher are properly charged and serviced. There are 13 cameras located in the exterior of the facility. Continued.... LPA observed the following items posted: Grievance Procedures, Facility Sketch, Meal Menu, Emergency Disaster Plan, If you See something Say something, Youth Bill of Rights, House Rules, Community Safety Rules, and Emotional Safety Rules. Facility has a pool which is appropriately fenced and secured with a mesh fence. The enclosure was measured to be 5 feet with a self-latching gate that swings outward. Per facility staff, no firearms or weapons are allowed in the facility. Staff files and client files are maintained electronically and accessible for LPA review. LPA virtually reviewed five out of five client files (C1-C5) and five out of five staff files (S1-S5). LPA conducted two of two staff interviews and was unable to conduct client interviews due to clients going on an outing. Based on today's inspection there are no deficiencies cited at this point. An exit interview was conducted and a copy of this signed report was provided to Hilda Soriano, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On June 27, 2025, at 2: PM Licensing Program Analyst (LPA) Lucero Jauregui arrived to the facility. The purpose of the visit is to conduct client interviews from the Post Licensing Inspection. LPA conducted three client interviews. An exit interview was conducted and a copy of this report was provided to Cynthia Orozco, Facility Manager.

met_with: Cynthia Orozco, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On January 29, 2026 at 9: AM, Licensing Program Analyst (LPA) Lucero Jauregui conducted an unannounced visit to the facility and met with Facility Manager Cynthia Orozco. The purpose of the visit is to conduct an annual inspection. The facility is a one-story home with three client bedrooms, three client bathrooms, living room, dinning room, kitchen, education room, staff office, group room, medication room, and a two car garage. Bedrooms are set up were there are no more than two clients per room. LPA observed mattress and linens in good repair. There is adequate shelf and closet space for client's belongings. All hazardous items have been properly made inaccessible to clients. The medication is stored in a locked cabinet in the medication room. First Aid Kits are maintained locked throughout the facility with required items. Cleansers/chemicals are locked and stored in the closet in the garage. LPA observed kitchen to be free from observable hazards. Sharps are maintained locked in a safe box and locked in an upper kitchen cabinet. The hot water temperature was measured at 118 degrees Farenheit. LPA observed Hot Water warning signs prominently posted on sinks. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Fitness equipment and mats was observed in the garage. All facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher are properly charged and serviced. There are 13 cameras located in the exterior of the facility. Continued.... Facility has a pool which is appropriately fenced and secured with a mesh fence. The enclosure was measured to be 5 feet with a self-latching gate that swings outward. Per facility staff, no firearms or weapons are allowed in the facility. LPA observed the following items posted: Facility License, Grievance Procedures, Facility Sketch, Meal Menu, Emergency Disaster Plan, If you See something Say something, and Youth Bill of Rights. Staff files and client files are maintained electronically and accessible for LPA review. LPA met with Compliance Associate Josue Ortiz via Google Meet and reviewed six out of six client files (C1-C6) and five out of five staff files (S1-S5). LPA conducted two of two staff interviews and three out of three client interviews. Based on today's inspection there are no deficiencies cited at this point. An exit interview was conducted and a copy of this signed report was provided to Cynrhia Orozco, Facility Manager.


raw_content:
Narrative:
Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred; therefore, the above allegation is Unsubstantiated. There are no deficiencies being cited at this time.

Investigation Findings:
13REPORT AMENDED FROM 05/19/2023, TO CORRECT LANGUAGE On August 4, at 11:30pm, Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of concluding complaint investigation. LPA met with Administrator, Aja Chavez and was allowed into the facility. A risk and health assessment were conducted. During the investigation, interviews were conducted, and documents were obtained.The interviews did not produce corroborating evidence to support said allegation. Interviews revealed inconsistent statements and no witnesses to suggest allegation occurred. There was no evidence that facility staff did not provide adequate supervision to a minor in care. Statements and documentary evidence were consistent that facility was in staff-client ratio. Staff maintained sight of client on foot and in vehicle. incident report showed that staff followed and documented the elopement of Child #1 until he was apprehended by the police. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: MISSION PREP HEALTHCAREFACILITY NUMBER: VISIT DATE: 05/19/2023

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

met_with: Aja Chavez-Administrator


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Facility staff was unable to provide documentation of communication with hospital staff. C#1 was released to the care of biological mother after being hospitalized for 72 hours. Facility cited for violation 80078(a)(2) The licensee shall provide care and supervision as necessary to meet the client's need. Facility staff did not provide contact information or communicate with hospital staff regarding discharge plan for C#1. A copy of this report will be left with Administrator, Aja Chavez.

Investigation Findings:
13On July 7, 2023, at 12pm Licensing Program Analyst (LPA) Donald Martin arrived at the above facility for the purpose of delivering findings for the above complaint investigation. LPA met with Administrator, Aja Chavez and was allowed into the facility. During the investigation of the allegation of staff are not communicating to medical professional's regarding minor's hospital release, LPA conducted interviews. The confidential interviews indicated that C#1 was hospitalized for evaluation and upon discharge bed was closed. There was no evidence that staff spoke with a hospital representative regarding C#1 discharge plan. There was no evidence that facility staff provided contact information to the hospital representative to be contacted once C#1 discharge from hospital. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Donald C Martin LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: MISSION PREP HEALTHCAREFACILITY NUMBER: VISIT DATE: 08/04/2023

met_with: Aja Chavez-AdministratorNaomi


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Based on the SIR of the incident, interview evidence from witnesses and staff, and photo evidence, LPA concludes that the incident did happen and that a client did AWOL from the facility without staff supervision and resulting in inappropriate behavior in the community. Based on the available information LPA gathered from interviews and observation, the preponderance of the evidence standard has been met, therefore, the allegation of "Staff did not adequately supervise minor resulting in inappropriate behavior in the community" is found to be substantiated. An exit interview was conducted, during which LPA provided the Administrator with a copy of this report and a copy of their appeal rights.

Investigation Findings:
13On 7/2/25 at 3: PM, Licensing Program Analyst (LPA) Reagan Cohen arrived at the above facility and met with Lorenzo Mejia Program Manager for the purpose of delivering complaint findings regarding the above allegation. LPA interviewed involved staff, clients, and witnesses. All staff admitted that there was an incident where C AWOLed from the facility on 1/18/25. No staff were present during the client's alleged interactions with the neighboring community. An SIR of the incident was made at the time and has been given to LPA. LPA was unable to get in contact with C1. Interview and photo evidence from neighbors show the client walking around the area, interacting with workers who were on the roof of a house. Neighbor testimony states that the client was walking around the area and threw objects at houses in the community. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Reagan Cohen 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 EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: MISSION PREP HEALTHCAREFACILITY NUMBER: VISIT DATE: 07/02/2025

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

met_with: Lorenzo Mejia Program Manager


summary: Facility Evaluation

raw_content:
Narrative:
On January 26, 2023 at 9 am Licensing Program Analyst (LPA) Donald Martin and Licensing Program Manager (LPM) JoAunne Griffin arrived at the above facility for the purpose of conducting the Component III and Pre-Licensing inspection. LPA and LPM were met by Aja Chavez, Administrator and William Mara, Director of Business Systems and allowed access into the facility and conducted the tour of the facility. The facility will be licensed to care for six clients, ages 12-17 years, ambulatory only. The facility layout is as follows: The facility has a large common living room with a sectional and two chairs. There is a book shelf and a non-operable fireplace that is covered. The dining room has a large table with 10 chairs. There is a double door that leads to the backyard and also a garage access door. The kitchen is equipped with a stove, in wall range with a microwave above, a dishwashing machine and a large refrigerator filled with perishable foods. There is a large pantry and an adjacent cupboard filled with non-perishable foods and snacks. The sharp knives are kept in a locked cabinet below the kitchen sink. The large group room is located adjacent to the living room. There is a large table and several chairs and also has a covered fire place and a TV mounted to the wall. The medication room is double locked and inaccessible to clients and contains a locked cabinet with six individual boxes for the clients medication storage. There is also a refrigerator to store medications. There is a safe which will contain the keys for the medication cabinet. There is a hazardous waste container and a container for sharps and supplies for first aid emergencies. Continued on 809-C Bedroom #1 contains two beds, two night stands, 1 desk and a large built in cabinet that has dresser drawers and closet space for two clients. There is a large sliding glass door that gives access to the backyard and also a door to access the Bathroom #1. Bedroom #2 has two beds, a closet that contains dresser drawers and closet space for two clients and a desk. Bedroom #3 has two beds, a large closet, two dresser drawers, two night stands, and a desk. Bathroom #2 is located in the room with a sink, toilet, and shower. The bathroom has an access door that leads to the backyard. There are five fire extinguishers located in the facility and were serviced January 18, 2023. The laundry room is located in the hallway and is equipped with a washer and dryer and detergent is and cleaning solutions are locked in cabinet. There is a locked door that contains the hot water heater. The laundry room is kept locked and inaccessible to children in care. The upstairs will only be used for therapy and school. Therapy room #1 has individual seating for family therapy. There is a covered fire place and patio access through a sliding glass door. There is a full bathroom with a toilet, shower and tub. The sink is located right outside of the bathroom. There is a large first aid kit mounted to the wall. Therapy room #2 has two chairs. There is a school room with a large table with seating for all the clients and teachers. The table has 6 computers and there is a sliding glass door with patio access. Outdoor area was observed to be clean and free of debris and hazards. The Backyard has two seating areas. There are no bodies of water on the premises. There is a tankless water heater mounted to the wall and below it are the shut off valves for the home. Above the restraining wall is a hill that has some small debris that was pointed out to Administrator, Aja Chavez as possible hazards. The backyard wraps around the home and leads to the front yard. The garage is a large three car garage that has some personal vehicles in them and there is an additional garage next to that. The front of the home has a long driveway from the street and a large area for additional parking. There are no cameras attached to the home at the time of this visit. The facility vehicle is a Toyota Sienna Van with current registration and insurance. There is a first aid and fire extinguisher located in the trunk of the vehicle. Facility has one or more functioning carbon monoxide and smoke detectors that meet statutory requirements. There were no guns or weapons in the home. Linen closet located in the hallway. Central air and heating unit and all windows had screens and in good repair. Exit interview was conducted and a copy of this report was left with the Administrator, Aja Chavez.