summary: Facility Evaluation

raw_content:
Narrative:
On 12/13/22 at 9: AM, Licensing Program Manager (LPM) Jean Herring, and Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an announced pre-licensing inspection and Component lll at the above facility address. The purpose of the inspection was to license above facility separate from Boys Republic as the licensed facility, after it was assigned a different address by the City of San Bernardino. LPA met Associate Director, Sterling Scott, Treatment Director, Garry Hodge and Director, Serafin Blau, who gave a tour of the facility. Executive Officer, Chris Burns was present during the Component lll discussion. The inspection is considered a relocation. Licensee submitted an application for a license for two separate facilities under one license. Per licensee, the City of San Bernardino already changed the address of both facilities to have the same address. Both facilities are structured the same. Both are one-story home that has 3 bedrooms and 1 bathroom. There are currently six (4) clients in placement in each facility. The following was observed at the time of the inspection. The staff schedule, Emergency Disaster Plan and Foster Youth Rights. Foster Ombudsman phone number and menu. The facility has a staff office, clinician offices, a living room/dayroom equipped with sofas and a TV, a laundry room Seven of the bedrooms have two (2) single beds inside and two bedrooms have one single bed . All the beds have clean mattresses equipped with clean linens and beddings. All the bedrooms have drawers and closet space for the clients' use. The facility has working telephone. There were working smoke/carbon monoxide detectors in the hallways, living room, and in each bedroom. The water temperature in the bathroom sinks was tested (117.6 degrees Fahrenheit within the temperature allowed by Title Regulations. The centralized heating and air were working. All cleaning solutions were observed locked in cabinets. All medications are centrally stored locked in the Nurse Office located Administration Building. The residents in placefoods are being prepared in the cafeteria, where the clients and staff eat. There were adequate foods both perishable and non perishable in the facility. The facility is ready to accept clients after the facility is licensed. The facility provides recreation to the clients where they can lift weights and play pool and table tennis. There is a pool which is also part of their recreation. At around 1: PM, LPM and LPA conducted Component lll with the licensee. The following was discussed: LIC 200: Line 1, The licensee name should be Boys Republic. New LIC 200 with corrections was submitted during the inspection visit. The need for a board resolution designating the administrator. The need for a waiver(s) The licensee will submit the required board resolution by 12/15/22. An exit interview was conducted and copies of the reports were provided to Mr. Hodge.


state: CA

facility_name: BOYS REPUBLIC ILP STRTP

summary: Facility Evaluation

raw_content:
Narrative:
On March 1, 2023 at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez made a case management inspection to the facility and met Lori Kezos, Administrator. The purpose of the case management was to follow-up on a Special Incident Report (SIR) received by the Department 0n 02/03/23. The SIR indicated that 01/27/23 client (C1) went inside the staff office and took staff (S1) see LIC 811 ( Confidential Names List) pens and purse. He was told to return the items, but he refused and left the office. C1 returned to the office and decided to take items belonging to staff. S2 and S3. It was noted that S1 and S2 tried to physically get back their personal belongings. They struggled to get their belongings from C1. On 01/28/23, S2 noticed C1 with a bruise on his triceps. On 02/02/23, Administrator Kezos made a follow-up conversation with C1 and confirmed that the bruise came from S1. S1 was suspended and S2 and S3 were written-up. They will be retrained on boundaries and appropriate interactions. Per Administrator Kezos, C1 does not want to talk about how it happened. it was not clear if C1's bruise was caused by S1's hand accidentally pressed on C1's arm while trying to get her purse or the strap of her purse. S1 was still on probation at the time of the incident and was terminated on 02/06/23. S2 was written up while S3 was not after further follow-up it was determined that he was not involved in the incident. S3 was able to get his backpack from C1 without incident. LPA obtained a copy of proof of S1's termination and S2's write up and the retraining of staff last 02/06/23 regarding staff and student boundaries. Based on the information gathered, S1 and S2 acted inappropriately in handling the situation and were disciplined. The facility took appropriate steps/actions regarding the incident. This incident needs no further follow-up currently. A copy of the report and LIC 811 was provided to the administrator. No deficiency citation issued at the time of the inspection.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Lori Kezos


summary: Facility Evaluation

raw_content:
Narrative:
On March 24, 2023 at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez arrived at the facility to conduct a post-licensing inspection. LPA met with Administrator, Jessica Ruiz and Treatment Director, Garry Hodge who accompanied this LPA to the site of the facility. At the facility LPA met with Administrator, Jayson Moore who gave the tour of whole facility. The facility has 6 clients currently. Physical Plant The inspection of the facility started at around 9: AM. LPA together with Administrator, Lori Kezos toured the facility. The ILP has 2 cottages and each facility has 3 bedrooms and 2 bathrooms. The following was observed at the time of the inspection. The posted license, Emergency Disaster Plan and Youth Personal Rights, and Foster Ombudsman phone number. Seven out of nine bedrooms have two (2) single beds inside and two bedrooms have one single beds . All the beds have clean mattresses equipped with clean linens and beddings. All the bedrooms have drawers and closet space for the clients. There were working smoke/carbon monoxide detectors in the hallways, living room, and in each bedroom. All cleaning supplies were locked inside the cabinets. There were adequate hygiene supplies for the clients. The centralized heating and air were working. All cleaning solutions were observed locked in cabinets. All medications are centrally stored locked in the Nurse Office located Administration Building. There was adequate perishable and non-perishable foods in the facility cafeteria. The first aid kit was complete. There were extra linens, extra towels and hygiene supplies in the facility. All passageways are unobstructed. The water temperature in the bathroom sinks were tested and observed went over the temperature allowed by Title Regulations however, the maintenance person was able to lower cthe temperature to 117.8 before LPA left the facility. An exit interview was conducted and a copy of the LIC 809 and LIC 809D were provided to the facility representative. A deficiency citation is issued at the time of the inspection.

met_with: Jessica Ruiz, Garry Hodge, Lori Kezos


summary: Facility Evaluation

raw_content:
Narrative:
On May 4, 2023 at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an inspection at the facility. The inspection was a continuation of the post-licensing inspection. LPA met with Administrator, Sterling Scott. Licensee provided a copy of the LIC 500, client roster, board minutes meeting, Emergency Disaster Plan, and Activity Report. Client Records All client records reviewed are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, court orders, needs and services plan, removal/discipline/complaint procedures; medical assessment; safeguards for cash resources, personal property and valuables; education records; personal rights forms. Staff Records LPA reviewed five personnel records. The personnel records contain required information including, but not limited to, employee's full name, driver's license, date of employment, home address and phone number, documentation of the educational background, training and/or relevant experience, health screening and tuberculosis test documents. Documentation of successful completion of training is maintained in the personnel record for each staff. The administrator has a valid Administrator's certificate. Personnel records are maintained on the licensee, administrator and each employee. All individuals subject to criminal record review have been fingerprinted. Disaster Preparedness Plan Facility maintains a current disaster and mass casualty plan. Facility maintains register of clients, medication records, and contact information for each client's responsible party and physician. The facility conducts emergency drills once a month. · Emergency Intervention Plan The facility has emergency intervention plan. The staff records contain proof of training. An exit interview was conducted and a copy of the LIC 809, LIC 809C, LIC 9102 and LIC 811s were provided to the facility representative. No deficiency citations issued at the time of the inspection.

met_with: Sterling Scott


summary: Facility Evaluation

raw_content:
Narrative:
On November 13, 2023, at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an unannounced annual/required inspection to the facility. LPA met with Sterling Scott, Administrator. Independent Living Program ( ILP) Administrator, Lori Kezos arrived shortly. The ILP consisted of two (2) one- story buildings (Combs and Boone Cottages) located inside Boys Republic campus. Currently, there are eight (8) clients in placement. LPA obtained and reviewed the roster of clients, Personnel Report, Emergency Disaster Plan, and board minutes. Physical Plant LPA inspected the facility accompanied by Administrator Scott. LPA inspected the building facility, the gym, and cafeteria located inside the campus. LPA observed the following: the posted license, emergency disaster plan, client personal rights, and Ombudsman's flyer and number. The disinfectants, cleaning solutions, sharp objects are locked and inaccessible to clients. The facility maintains supplies of non-perishable foods for at least a week and fresh perishable foods for at least two days. Each bedroom has two (2) single beds in good repair with clean sheets and linens and drawers and closet space for the client's clothing. There are extra linens, towels, and hygiene supplies in the cabinets. No room commonly used for other purposes is being used as a bedroom. The window screens are in good repair and free of dirt. There are lights in the rooms and throughout the facility. The facility has a centralized medication storage inside the nurse office. There is a working telephone in the facility. The first aid kit was complete and readily available. The smoke/carbon monoxide detectors in the facility are in working order. The faucets in both cottages deliver hot water, however, the temperature at Combs Cottage was 140 degrees Fahrenheit while at Boone Cottage it was 117 degrees Fahrenheit. All medications are centrally stored in the nurse station located in the administration building. All gym equipment is stable and secured and the facility maintains supplies of non-perishable foods for at least a week and fresh perishable foods for at least two days. All indoor and outdoor passageways are unobstructed. Operations The facility maintains a register of clients and available upon licensing staff request. The client records are centrally stored on the staff of the facility. The facility has written complaint procedures to file a complaint for the clients and/or their representatives. An exit interview was conducted, and a signed copy of LIC 809, LIC 809C, LIC 809D were provided to the facility representative. A deficiency citation was issued at the time of the inspection.

visit_type: Annual

met_with: Sterling Scott, Lori Kezoa


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On December 12, 2023, at 9: AM, Licensing Program Analysts (LPA) Gilbert Gutierrez and Juliet Robles conducted a continuation of the annual/required inspection at the Short Term Residential Therapeutic Program (STRTP) and met Administrator, Sterling Scott. The facility is licensed to serve 12 males, ages 13-17 and non-minor dependents. There are four (4) clients placed in the facility currently. Client Records LPA reviewed five (5) client records. All client records are available to the licensing to review. Client records contain required information including, but not limited to, consent forms, removal/discipline/complaint procedures, medical assessment, personal property and valuables, education records, personal rights forms and medication administration records. Two (2) clients were interviewed. Staff Records LPA reviewed five (5 ) staff records. Staff records contain documentation of the required education and experience requirements and training. A staff subject to criminal records review was found not associated to the facility at the time of the inspection. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least quarterly. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Needs and Services Plan for each client, medication records, and contact information for each client's responsible party and physician. Operations The facility maintains a register of clients available upon licensing staff request. The client records are centrally stored in the administration building. The board minutes meeting was available for review. The board of directors conducts meetings at least on a quarterly basis to review and discuss the STRTP's operation. The facility has written complaint procedures to file a complaint for the clients and/or their representatives. An exit interview was conducted, and a signed copy of LIC 809, LIC 809C, LIC 809D, LIC 421 and LIC811s was provided to the facility representative. A deficiency citation and a civil penalty was issued at the time of the inspection.

Deficiencies:
80019(f): Deficient Practice Statement
1
2
3
4Based on record review, the licensee did not comply with the section cited above  which poses an immediate health, safety or personal rights risk to persons in care. Staff ref #6, see LIC 811 (Confidential Names List) was not associated and cleared at the time of the inspection.
POC Due Date: 12/13/2023
Plan of Correction
1
2
3
4

title:
or

This requirement is not met as evidenced by


summary: Facility Evaluation

raw_content:
Narrative:
On June 11, 2024, at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez made a case management inspection to the facility and met Administrator, Sterling Scott. The case management was a follow-up regarding the Special Incident Report (SIR) received on 06/03/24. The SIR indicated that on 06/02/24 at around 8: PM, client (C1) was in the living room watching TV and being supervised by staff (S1). C1 asked S1 to move from his seat so that he can lay down on the couch. S1 told C1 he could move to a different seat because he was sitting there at the time. C1 then laid on the couch and started putting his feet on S1's laptop which was placed on his lap. S1 continued to counsel C1 to stop. The third time that C1 put his foot on the laptop, S1 kicked his left leg to prevent him from putting his leg on the laptop. C1 reported the incident to S2 who was in the kitchen at the time cleaning after dinner. S2 checked C1's leg and noticed slight redness but no swelling or noticeable injuries. S1 was sent home for the evening by his supervisor and another staff came to work overnight. C1 was assessed and no medical attention needed. C1 also refused any medical attention. LPA conducted interviews and gathered the following information: S1 just lifted his leg to block C1 from putting his foot down on his laptop and denied kicking C1. C1 confirmed the incident while C2 who was watching TV at the time refused to talk. S2 only heard C1 asking S1 to move to another couch and did not hear S1's response. She did not hear any loud noise coming from the living room while she was in the kitchen. LPA also gathered information that both clients did not like the report that S1 made previously regarding their behavior. Therefore, based on the above information, the incident cannot be substantiated at this time. The incident needs no further follow-up currently. An exit interview was conducted and copy of the LIC 809 and LIC 811 were provided to the facility representative. No deficiency citation was issued at the time of the inspection.

met_with: Lori Kezos, Chris Colflesh


facility_name: BOYS REPUBLIC LAWS STRTP

summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
On 12/08/2023, the Department received a complaint alleging that Boys Republic staff did not safeguard a client's property, a cellular phone. The facility unit supervisor (S4) disclosed that they accidentally lost a client's phone after the focused client requested to access his cellular phone to obtain a contact number on or about 11/16/23. S4 disclosed initially, that it was reported by another staff that she returned the phone to the Program Office (PO) that same day, however, circumstances surrounding the event could no longer be verified that the phone was returned to the PO after the client obtained his contact number. The staff who picked up the phone for the client on 11/16/2023 stated that at first, she believed she returned the phone to the PO, but after speaking with another worker at the PO, she now believes that she left the phone on the counter at the cottage and that is when the phone was reportedly went missing. Staff interviews provided consistent information that the phone went missing and they attempted to locate the phone, but their attempts were unsuccessful. Other confidential interviews with the focused client corroborated the incident and its timeline when his phone was determined lost/missing after he requested to access his cellular phone on or about 11/22/23 (second time). The focused client disclosed that the facility has offered to replace his cellular phone but has declined the offer at this time. Based on the information gathered during interviews and documentary evidence produce corroborating evidence to support the allegation that the staff workers did not properly safeguard the clients cellular phone. The preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated per California Code of Regulations Title Division Six Chapter Five. Facility cited for violation California Code of Regulations Title Division Six, ILS 80026(b). Safeguards for Cash Resources, Personal Property, and Valuables of Residents. LPA Vargas conducted an exit interview, explain appeal rights.

Investigation Findings:
13On 12/18/2023 at 10: AM, Licensing Program Analyst (LPA) Joseph Vargas conducted a follow-up inspection for the purpose of providing findings for the above complaint. LPA met with Mr. Hodge. During the course of the investigation, LPA conducted telephonic interfviews and in-person visits three faciluity staff workers, one client on 12/11/2023, one individual idetified as other on 12/14/2023, and County Probation Officer on 12/11/2023. Reference Confidential Names List LIC811 dated 12/18/2023. During the inspection LPA requested for review and obtained copy of the staff and client facility roster reports, special incident reports, clients' Needs and Service Plan, and placement history, including a review of the county report associated with this complaint investigation. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Joseph Vargas LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BOYS REPUBLIC LAWS STRTPFACILITY NUMBER: VISIT DATE: 12/18/2023

report_type: Complaint Investigation

met_with: Mr. Hodge, Treatment Director, and Assistant Supervisor J.P. Ferrett

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
On 06/21/2024, the Department received a complaint alleging that staff working at the facility do not prevent client(s) from having access to Marijuana. The Facility Supervisor (FS) denied the allegation and stated that Marijuana and other types of contraband are not permitted. FS disclosed that all staff workers at the facility don't allow clients to have any smoking products, including vape pens. FS disclosed that they had one incident on 06/21/2024 that involved a client, and the age of the client appears to match the report that involved Marijuana vape pens. FS disclosed that the contraband was confiscated, and a Special Incident Report dated 06/21/2024 was submitted to the appropriate county and state agencies for review. In confidential interviews with clients, and staff working at the facility provided consistent statements and denied the allegation that the staff does not prevent clients from having access to Marijuana and other contraband. One individual identified as "other" in the report could not be located/contacted therefore no statement was obtained. Based on the information gathered during interviews and documentary evidence, it cannot be determined whether the allegation occurred that staff working at the facility do not prevent client(s) from having access to Marijuana and other types of contraband. Therefore, the above allegation is determined unsubstantiated at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged abuse occurred. The resolution to this complaint was discussed with the facility representative and copies of all licensing reports were provided after the inspection. An exit interview was conducted and the Appeal rights were given and explained. No deficiencies were cited at this time.

Investigation Findings:
13On 07/29/2024 at 1: PM, Licensing Program Analyst (LPA) Joseph Vargas conducted a follow-up inspection for the purpose of providing findings for the above complaint. LPA met with Mr. Garza, Facility Supervisor. During the course of the investigation, LPA conducted telephonic interviews and in-person visits with two clients, one staff workers on 06/25/2024, one staff worker on 6/27/2024, two staff workers and two clients on 07/22/2024. Reference Confidential Names List LIC811 dated 07/29/2024. During the inspection LPA requested for review and obtained copy of the staff and client facility roster reports, special incident reports, including a review of history of complaints. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Joseph Vargas LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BOYS REPUBLIC LAWS STRTPFACILITY NUMBER: VISIT DATE: 07/29/2024

met_with: Mr. Garza, Facility Supervisor

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On 12/13/22 at 9: AM, Licensing Program Manager (LPM) Jean Herring, and Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an announced pre-licensing inspection and Component lll at the above facility address. The purpose of the inspection was to license above facility separate from Boys Republic as the licensed facility, after it was assigned a different address by the City of San Bernardino. LPA met Associate Director Sterling Scott, Treatment Director, Garry Hodge and Director, Serafin Blau, who gave a tour of the facility. Executive Officer Chris Burns arrived shortly. The inspection is considered a relocation. The facility is a two-story home that has 3 bedrooms downstairs and 5 bedrooms upstairs. The facility has 1 bathroom in each floor. There are no clients in placement. The facility was not used as residential facility since 2020 . The following was observed at the time of the inspection. The Emergency Disaster Plan and Foster Youth Bill of Rights and Mental Health Patient's Rights, Foster Ombudsman phone number. The facility has a staff office, a living room/dayroom with sofas and a TV, and a laundry room. All the bedrooms have two (2) single beds inside. All the beds have clean mattresses equipped with clean linens and beddings. All the bedrooms have drawers and closet space for the clients' use. The facility has working telephone. There were working smoke/carbon monoxide detectors, emergency exits on the second floor of the building. There is also emergency exits in the building. The water temperature in the bathroom sinks was tested (119.3 degrees Fahrenheit) within the temperature allowed by Title Regulations. The centralized heating and air were working. All cleaning solutions were observed locked in cabinets. All medications are centrally stored locked in the Nurse Office located Administration Building. The foods are being prepared in the cafeteria, where the clients and staff eat. There were adequate foods both perishable and non- perishable in the cafeteria.The facility provides recreation to the client where they can lift weights and play pool and table tennis. There is a pool which is also part of their recreation. The facility is under refinishing touches and will be ready for placement by Friday 12/16/22. At around 1: PM, LPM and LPA conducted Component lll with the licensee. The following was discussed: LIC 200: Line 1, The licensee name should be Boys Republic. New LIC 200 with corrections was submitted during the inspection visit. The need for a board resolution designating the administrator. The need for a waiver(s) The licensee will submit the required board resolution by 12/15/22. An exit interview was conducted and copies of the reports were provided to Mr. Hodge.

visit_type: Prelicensing

met_with: Sterling Scott, Garry Hodge, and Serafin Blau


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Gilbert Gutierrez made a case management visit to the facility on March 1, 2023 and met Sterling Scott, Administrator. The purpose of the case management was regarding licensee's search protocols to look for contrabands in the facility. Currently, licensee uses the services of a company that conducts searches in the facility premises using sniffing dogs.. The following was discussed at the meeting: The need for searches to be on case by case basis only To cease any blanket policy regarding searches The need for search policies to be trauma informed The need for documentation of the search in the client's records/file. Search policies should not violate the client's personal rights An exit interview was conducted and a copy of the report and LIC 9102 was provided to the facility representative.


summary: Facility Evaluation

raw_content:
Narrative:
On March 28, 2023 at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez arrived at the facility to conduct a post-licensing inspection. LPA met with Associate Director, Sterling Scott who accompanied this LPA to the site of the facility. There were nine clients placed in the facility. Physical Plant The inspection started at around 9: AM. The facility is a two-story building that has 8 bedrooms. The facility has one bathroom in each floor for the clients. The following was observed at the time of the inspection. The posted license, Emergency Disaster Plan, Grievance and Personal Rights. The facility has a staff office, a living room/dayroom with sofas and a TV, and a laundry room. All the bedrooms have two single beds inside except for one bedroom located in the second floor. All the beds have clean mattresses with clean linens and beddings. There were drawers and closets for the clients. The smoke/carbon monoxide detectors were tested and working. The water temperature was tested (118.2 degrees Fahrenheit) and found within the temperature allowed by Title Regulations. All cleaning solutions were observed locked in cabinets. The first aid kit is complete. All medications are centrally stored locked in the Nurse Office located Administration Building. There were adequate perishable foods for at least 2 days and non-perishable foods for at least 7 days in the cafeteria. All passageways are unobstructed. An exit interview was conducted, and a copy of the report was provided to the facility representative. No deficiency citation issued at the time of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On April 12, 2023 at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an inspection at the facility. The inspection was a continuation of the post-licensing inspection conducted last 03/28/23.. LPA met with Administrator, Jessica Ruiz. There were six clients placed in the facility. Licensee provided a copy of the LIC 500, client roster, board minutes meeting, Emergency Disaster Plan, and Activity Report. Client Records All client records reviewed are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, court orders, needs and services plan, removal/discipline/complaint procedures; medical assessment; safeguards for cash resources, personal property and valuables; education records; personal rights forms; and medication administration records. Staff Records LPA reviewed two personnel records. The personnel records contain required information including, but not limited to, employee's full name, driver's license, date of employment, home address and phone number, documentation of the educational background, training and/or relevant experience, health screening and tuberculosis test documents. Documentation of successful completion of training is maintained in the personnel record for each staff. The administrator has a valid Administrator's certificate. Personnel records are maintained on the licensee, administrator and each employee. All individuals subject to criminal record review have been fingerprinted. Disaster Preparedness Plan Facility maintains a current disaster and mass casualty plan. Facility maintains register of clients, medication records, and contact information for each client's responsible party and physician. The facility conducts emergency drills at least once quarterly. · Emergency Intervention Plan The facility has emergency intervention plan. The staff records contain proof of training. An exit interview was conducted and a copy of the LIC 809, LIC 809C LIC TV and LIC 811 were provided to the facility representative. No deficiency citations issued at the time of the inspection.

met_with: Jessica Ruiz


summary: Facility Evaluation

raw_content:
Narrative:
On November 28, 2023, at 12: PM, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an unannounced annual/required inspection to the facility. LPA met with Jessica Ruiz, Administrator, who accompanied this LPA to the site of the facility. There are 12 clients placed in the facility. Physical Plant The inspection started at around 1: PM. The facility is a two-story building that has 8 bedrooms. The facility has one (1) full bathroom on each floor. The following was observed at the time of the inspection. The posted license, Emergency Disaster Plan, Foster Care Ombudsman's information and Youth's Personal Rights. The facility has a staff office and therapist offices, a living room/dayroom, and a laundry room. There is only a maximum of two (2) beds in each bedroom. All bedrooms have drawers and closet spaces for the clients. The smoke/carbon monoxide detectors were tested and working. The water temperature was tested (105 degrees Fahrenheit) using a digital thermometer. All cleaning solutions were observed locked in cabinets. There was extra linens and hygiene supplies in the cabinets and storage room. There was a first aid kit in the facility. All medications are centrally stored locked in the Nurse Office located in the Administration Building. There was adequate perishable foods for at least 2 days and non-perishable foods for at least 7 days in the cafeteria. All passageways are unobstructed. An exit interview was conducted, and a copy of the report was provided to the facility representative. A deficiency citation was issued at the time of the inspection.

met_with: Jessica Ruiz, Sterling Scott


summary: Facility Evaluation

raw_content:
Narrative:
On December 12, 2023, at 9: AM, Licensing Program Analysts (LPA) Gilbert Gutierrez and Juliet Robles conducted a continuation of the annual/required inspection at the Short Term Residential Therapeutic Program (STRTP) and met Administrator, Sterling Scott. The facility is licensed to serve 16 males, ages 13-17 and non-minor dependents. There are 14 clients placed in the facility currently. Client Records LPAs reviewed five (5) client records. All client records are available to the licensing to review. Client records contain required information including, but not limited to, consent forms, removal/discipline/complaint procedures, medical assessment, personal property and valuables, education records, personal rights forms and medication administration records. LPAs interviewed one (1) client. Staff Records LPAs reviewed five (5 ) staff records. All staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least quarterly. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Needs and Services Plan for each client, medication records, and contact information for each client's responsible party and physician. Operations The facility maintains a register of clients available upon licensing staff request. The client records are centrally stored on the staff of the facility. The board minutes meeting was available for review. The board of directors conducts meetings at least on a quarterly basis to review and discuss the STRTP's operation. The facility has written complaint procedures to file a complaint for the clients and/or their representatives. An exit interview was conducted, and a signed copy of LIC 809, LIC 809C and LIC811s were provided to the facility representative. No deficiency citations were issued at the time of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On May 1, 2026 at 11:44AM, Licensing Program Analyst (LPA) Amber Hunter conducted an unannounced case management inspection at the above-named Short Term Residential Therapeutic Program (STRTP). LPA met with Jodi Jacobson, Human Resources Director The purpose of this inspection was to follow up on an unusual incident dated 4/24/2026 involving C1. On April 24,2026, the Department received an incident report, which states that on April 24,2026 a Caseworker attempted to redirect a student from getting involved in a peer's detainment outside the cottage. The Caseworker blocked the door and attempted to redirect the student causing the student to slip and fall on the wet floor face forward resulting in injury to the student's left eyebrow. Student states that the Caseworker pushed him to the ground causing him to fall face first. During today's inspection, LPA reviewed client and staff records. Copies of pertinent documents were obtained. LPA interviewed Human Resources, 2 staff, and 3 clients. Further follow-up is required. A signed copy of this report was provided to the STRTP representative along with LIC 811 (confidential names' list).

met_with: Jodi Jacobson


summary: Facility Evaluation

raw_content:
Narrative:
On May 7, 2026 at 3:13PM, Licensing Program Analyst (LPA) Amber Hunter conducted an unannounced case management inspection at the above-named Short Term Residential Therapeutic Program (STRTP). LPA met with Jodi Jacobson, Human Resources Director. The purpose of this inspection was to follow up on unusual incidents dated 4/8/2026 involving C1 and C9. On 4/10/2026, the Department received an incident report, which states that on April 8,2026 the Unit Supervisor was notified that C1 was upset due to a Facility Case Worker (CW1) allegedly pushing him out of a chair and not allowing him to use the office phone. The department received an additional incident report, which states that on April 8, 2026, the Unit Supervisor was notified that C9 was upset due to a Facility Case Worker (CW3) allegedly pushing him while attempting to retrieve a laptop and charger. Clients at the cottage were upset, resulting in them destroying the cottage. These two incidents occurred in an overlapping time frame involving staff and clients. On 4/15/ LPA obtained and reviewed relevant records, conducted a physical plant inspection, and interviewed C1. C9 was unable to be interviewed as he graduated from the program. On 4/16/ LPA interviewed 6 clients, 1 staff, and Facility Case Workers. On 4/29/ LPA interviewed 2 probation officers. During today's inspection LPA obtained additional records and interviewed staff. Based on the information obtained all clients feel safe in the cottage. The allegations against the Facility Case Workers could not be determined to have occurred due to conflicting statements provided to the LPA during interviews. The Facility Administration recognized patterns of power struggles and poor relationships with the clients from CW3 which resulted in his termination effective, 4/30/2026. Continued on 809C Given the incidents taken place between CW1 and clients, Administration transferred the Facility Case Worker to another cottage to see if patterns continued. No further action is required. A signed copy of this report was provided to the STRTP representative along with LIC 811 (confidential names' list).


summary: Facility Evaluation

raw_content:
Narrative:
On May 12, 2026 at 11:11AM, Licensing Program Analyst (LPA) Amber Hunter conducted an unannounced case management inspection at the above-named Short Term Residential Therapeutic Program (STRTP). LPA met with Sterling Scott, Administrator. The purpose of this inspection was to follow up on an unusual incident dated 4/24/2026 involving C1. On April 24,2026, the Department received an incident report, which states that on April 24,2026 a Caseworker attempted to redirect a student from getting involved in a peer's detainment outside the cottage. The Caseworker blocked the door and attempted to redirect the student causing the student to slip and fall on the wet floor face forward resulting in injury to the student's left eyebrow. Student states that the Caseworker pushed him to the ground causing him to fall face first. During today's inspection LPA interviewed 5 clients. Further follow-up is required. A signed copy of this report was provided to the STRTP representative along with LIC 811 (confidential names' list).


facility_name: BOYS REPUBLIC MCCORMICK STRTP

summary: Facility Evaluation

raw_content:
Narrative:
On 12/13/22 at 9: AM, Licensing Program Manager (LPM) Jean Herring, and Licensing Program (LPA) Gilbert Gutierrez conducted an announced pre-licensing inspection and Component lll at the above facility address. The purpose of the inspection was to license above facility separate from Boys Republic as the licensed facility, after it was assigned a different address by the City of San Bernardino. LPA met Associate Director, Sterling Scott, Treatment Director, Garry Hodge and Director, Serafin Blau, who gave a tour of the facility. Executive Officer, Chris Burns was present during the Component lll discussion. This inspection is considered a relocation. The facility is a two-story building that has 3 bedrooms downstairs and 4 bedrooms upstairs. Licensee will put a wall in two big bedrooms to convert the rooms in two separate bedrooms to meet the regulation requiring only two clients in each bedroom. The facility has 1 bathroom in each floor. The following was observed at the time of the inspection. The Emergency Disaster Plan and Foster Youth Bill of Rights and Mental Health Patient's Rights, Foster Ombudsman phone number. The facility has a staff office, a living room/dayroom with sofas and a TV, and a laundry room. All the bedrooms have two (2) single beds inside. All the beds have clean mattresses equipped with clean linens and beddings. All the bedrooms have drawers and closet space for the clients' use. The facility has working telephone. There were working smoke/carbon monoxide detectors, and fire alarm system in the facility. There is also emergency exits in the building. The water temperature in the bathroom sinks was tested (111.2 degrees Fahrenheit) within the temperature allowed by Title Regulations. The centralized heating and air were working. All cleaning solutions were observed locked in cabinets. All medications are centrally stored locked in the Nurse Office located Administration Building. The foods are being prepared in the cafeteria, the clients and staff eat. There were adequate foods both perishable and non- perishable in the cafeteria. The facility is ready to accept clients after the facility is licensed. The facility provides recreation to the clients where they can lift weights and play pool and table tennis. There is a pool which is also part of their recreation. The following was discussed: LIC 200: Line 1, The licensee name should be Boys Republic. New LIC 200 with corrections was submitted during the inspection visit. The need for a board resolution designating the administrator. The need for a waiver(s) The licensee will submit the required board resolution by 12/15/22. An exit interview was conducted and copies of the reports were provided to Mr. Hodge.

met_with: Sterling Scott, Garry Hodge, Serafin Blau


summary: Facility Evaluation

raw_content:
Narrative:
On March 24, 2023 at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted a pOn March 24, 2023 at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted a post-licensing inspection. LPA met with Administrator, Jessica Ruiz and Treatment Director, Garry Hodge who accompanied this LPA to the site of the facility. At the Administrator, Jayson Moore gave the tour of whole facility. The facility has 8 clients currently. Physical Plant The inspection started at around 10: AM. The facility is a two-story building that has 9 bedrooms. The facility has one bathroom in each floor. The following was observed at the time of the inspection. The posted license, Emergency Disaster Plan, Foster Ombudsman phone number. The facility has a staff office, a living room/dayroom with sofas and a TV, and a laundry room. All the bedrooms have two single beds inside except for one bedroom located in the second floor. All the beds have clean mattresses with clean linens and beddings. All the bedrooms have drawers and closets for the clients. The smoke/carbon monoxide detectors were tested and working. The water temperature was tested using a digital thermometer and observed (114.7 degrees Fahrenheit) within the temperature allowed by Title Regulations. The centralized heating and air were working. All cleaning solutions were observed locked in cabinets. All medications are centrally stored locked in the Nurse Office located Administration Building. There were adequate perishable foods for at least 2 days and non-perishable foods for at least 7 days in the cafeteria. All passageways are unobstructed. An exit interview was conducted, and a copy of the report was provided to the facility representative. No deficiency citation issued at the time of the inspection.

met_with: Jessica Sanchez, Garry Hodge, Jayson Moore


summary: Facility Evaluation

raw_content:
Narrative:
On April 26, 2023 at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an inspection at the facility. The inspection was a continuation of the post-licensing inspection.. LPA met with Administrator, Jayson Moore. Licensee provided a copy of the LIC 500, client roster, Emergency Disaster Plan, and Activity Report. Client Records All client records reviewed are available to the licensing agency to inspect, audit and upon demand. Client records contain required information including, but not limited to, consent forms, court orders, needs and services plan however, one of the client's NSPs was not signed by the authorized representative. Also the records contain removal/discipline/complaint procedures; medical assessment; safeguards for cash resources, personal property and valuables; education records; personal rights forms. Staff Records LPA reviewed five personnel records. The personnel records contain required information including, but not limited to, employee's full name, driver's license, date of employment, home address and phone number, training and/or relevant experience, health screening and tuberculosis test documents. Documentation of successful completion of training is maintained in the personnel record for each staff. The administrator has a valid Administrator's certificate however the proof of education was not on file.. Personnel records are maintained on the licensee, administrator and each employee. All individuals subject to criminal record review have been fingerprinted. Disaster Preparedness Plan Facility maintains a current disaster and mass casualty plan. Facility maintains register of clients, medication records, and contact information for each client's responsible party and physician. The facility conducts emergency drills once a month. · Emergency Intervention Plan The facility has emergency intervention plan. The staff records contain proof of training. An exit interview was conducted and a copy of the LIC 809, LIC 809C, LIC 9102 and LIC 811s were provided to the facility representative. A deficiency citation issued at the time of the inspection.

met_with: Jayson Moore


summary: Facility Evaluation

raw_content:
Narrative:
On December 12, 2023, at 9: AM, Licensing Program Analysts (LPAs) Gilbert Gutierrez and Juliet Robles conducted an unannounced annual/required inspection to the facility. LPA met Jason Moore, Administrator, who gave the tour of the facility. There are six (6) clients placed in the facility currently. Physical Plant The inspection started at around 9: AM. The facility is a two-story building with 9 bedrooms. The facility has one (1) full bathroom on each floor. The following was observed at the time of the inspection. The posted license, Emergency Disaster Plan, Foster Care Ombudsman's information and Youth's Personal Rights, Complaint and Grievance Procedure, and Mental Health Program Approval. The facility has a staff office and therapist offices, a living room/dayroom, and a laundry room. There is only a maximum of two (2) beds in each bedroom. All bedrooms have drawers and closet spaces for the clients. The fire alarm was tested and working. The water temperature was tested (118) degrees Fahrenheit) using a digital thermometer. All cleaning solutions were observed locked in cabinets. There was extra linens and hygiene supplies in the cabinets and storage room. There was a first aid kit in the facility. All medications are centrally stored locked in the Nurse Office located in the Administration Building. There was adequate perishable food for at least 2 days and non-perishable foods for at least 7 days in the cafeteria. All passageways are unobstructed. An exit interview was conducted, and a copy of LIC 809 was provided to the facility representative. No deficiency citations were issued at the time of the inspection.

met_with: Jason Moore, Sterling Scott


summary: Facility Evaluation

raw_content:
Narrative:
On December 14, 2023, at 9: AM, Licensing Program Analysts (LPA) Gilbert Gutierrez and Juliet Robles conducted a continuation of the annual/required inspection at the Short Term Residential Therapeutic Program (STRTP) and met Administrator, Jason Moore. The facility is licensed to serve 16 males, ages 13-17 and non-minor dependents. There are seven (7) clients placed in the facility currently. Client Records LPA reviewed six (6) client records. All client records are available to the licensing to review. Client records contain required information including, but not limited to, consent forms, removal/discipline/complaint procedures, medical assessment, personal property and valuables, education records, personal rights forms and medication administration records. Staff Records LPA reviewed six (6') staff records. All staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least quarterly. The drills are documented, and the documentation is maintained in the facility for at least a year. Facility maintains an emergency and disaster plan, register of clients, Needs and Services Plan for each client, medication records, and contact information for each client's responsible party and physician. Operations The facility maintains a register of clients and available upon licensing staff request. The client records are centrally stored at the staff of the facility. The board minutes meeting was available for review. The board of directors conducts meeting at least on a quarterly basis to review and discuss the STRTP's operation. The facility has written complaint procedures to file a complaint for the clients and/or their representatives. An exit interview was conducted, and a signed copy of LIC 809, LIC 809C,and LIC811s were provided to the facility administrator. No deficiency citations were issued at the time of the inspection.

met_with: Jason Moore


summary: Facility Evaluation

raw_content:
Narrative:
On November 14, 2024, at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an unannounced annual/required inspection to the facility. LPA met Administrator, Sterling Scott and Treatment Director, Garry Hodge. There are ten (10) clients placed in the facility currently. Physical Plant LPA conducted the inspection accompanied by Administrator, Scott and Treatment Director, Hodge. The facility is a two-story building with 9 bedrooms. The facility has one (1) full bathroom on each floor. The following was observed at the time of the inspection. The posted license, Emergency Disaster Plan, Foster Care Ombudsman's information and Youth's Personal Rights, Complaint and Grievance Procedure, and Mental Health Program Approval. The facility has a staff office and therapist offices, a living room/dayroom, and a laundry room. A maximum of two (2) beds in each bedroom. All bedrooms have cabinet spaces for the clients clothing. The water temperature in each bathroom was tested (113.5- and 115.4-degrees Fahrenheit) and within the temperature allowed by regulation. All cleaning solutions were observed locked in cabinets. There was extra linens and hygiene supplies in the cabinets and storage room. There was a first aid kit in the facility. All medications were centrally stored locked in the Nurse Office located in the Administration Building. There were adequate perishable foods for at least 2 days and non-perishable foods for at least 7 days in the cafeteria. All indoor and outdoor passageways were unobstructed. An exit interview was conducted, and a copy of LIC 809 was provided to the facility representative. No deficiency citations were issued at the time of the inspection.

met_with: Sterling Scott, Garry Hodge


summary: Facility Evaluation

raw_content:
Narrative:
On November 21, 2024, at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an unannounced annual/required inspection continuation to the facility and met with Administrator, Jessica Ruiz and Administrator, Lori Kezos. Client Records LPA reviewed five (5) client records. All client records are available to the licensing to review. Client records contain required information including, but not limited to, consent forms, removal/discipline/complaint procedures, medical assessment, personal property and valuables, education records, and personal rights forms. Disaster Preparedness The facility has a disaster and mass casualty plan of action and conducts disaster drills at least quarterly. The facility maintains register of clients, Needs and Services Plan for each client, medication records, and contact information for each client's responsible party and physician. Operations The facility maintains a register of clients available upon licensing staff request. The board minutes meeting was available for review. The board of directors conducts meetings at least on a quarterly basis to review and discuss the STRTP's operation. The facility has written complaint procedures to file a complaint for the clients and/or their representatives. An exit interview was conducted, and a copy of the report was provided to the administrator. No deficiency citations issued at the time of the inspection.

met_with: Jessica Ruiz, Lori Kezos


summary: Facility Evaluation

raw_content:
Narrative:
On November 6, 2025, at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an unannounced annual/required inspection at the facility. LPA met Associate Directors, Sterling Scott and Jessica Ruiz, who accompanied this LPA to the facility. There are nine (9) clients placed in the facility currently. Physical Plant The facility is a two-story building with 9 bedrooms. The facility has one (1) full bathroom on each floor. The following was observed at the time of the inspection. The posted license, Emergency Disaster Plan, Foster Care Ombudsman's information and Youth's Personal Rights, Complaint and Grievance Procedure, and Mental Health Program Approval and CARF Accreditation. The facility has a staff office and therapist offices, a living room/dayroom, and a laundry room. There is only a maximum of two (2) beds in each bedroom. All bedrooms have drawers and closet spaces for the clients. The fire alarm was tested and working. The water temperature was tested (108.7 degrees Fahrenheit) using a digital thermometer. All cleaning solutions were observed locked in cabinets. There were extra linens and hygiene supplies in the cabinets and storage room. There was a first aid kit in the facility. All medications are centrally stored locked in the Nurse Office located in the Administration Building. There was adequate perishable food for at least 2 days and non-perishable foods for at least 7 days in the cafeteria. All passageways are unobstructed. An exit interview was conducted, and a copy of LIC 809 was provided to the facility representative. A deficiency citation was issued at the time of the inspection.


facility_name: BOYS REPUBLIC MONROVIA RESIDENCE

summary: Facility Evaluation

raw_content:
Narrative:
On November 28, 2023, at 8: A.M, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an announced pre-licensing inspection to the above address and met Administrator, Lance Parks and Supervisor, Steve Tavera. This site will be a Short Term Residential Therapeutic Program (STRTP) facility. The facility will provide services to six (6) clients. At around 8: A.M, LPA with Administrator and Supervisor toured the facility. The facility is a one story house with four (4) bedrooms and two (2) full and two (2) half bathrooms and attached garage. At the time of the inspection, the following was observed: a staff office and therapist office, family room, living room, dining room/kitchen area. There is a working telephone, copy, fax, printer all in one machine and computer(s) filing cabinets with lock, tables, chairs inside the staff office. In this office is where confidential records, the first aid kit and personal hygiene, and office supplies will be stored. Each bedroom has working lights, adequate drawers, closet spaces, two (2) single beds with clean beddings and linens. There is extra linens and towels in the cabinets located in the hallway. The carbon and smoke detectors located in the bedrooms, hallways, living rooms and kitchen are in working order. There is a refrigerator, a freezer, dishwasher, microwave, oven, clean plates, and utensils in the kitchen. There are perishable and non-perishable foods in the facility. The garage will be the workout/exercise area and laundry area of the clients. The temperature inside the home was 68 degrees Fahrenheit at the time of the inspection. The following documents will be resubmitted: - Orientation Certification (Copy) - Board resolution (Copy) - ACCREDITATION (Copy) Cont. - Application (LIC 200) - Board Resolution - Administrative Organization (LIC 309) - Board of Director's Statement for new members - Surety Bond (LIC 402) - Monthly Operating Statement (LIC 401) - Supplemental Financial Information (LIC 401a) - Proof of education (Transcript/Diploma/license) - Personnel record (LIC 501) for the agency social worker/therapist. The required documents will be resubmitted by 12/01/23. After the required documents are received the facility will be issued a license. An exit interview was conducted and a copy of the LIC 809, LIC 809C were provided to the administrator.

met_with: Lance Parks


summary: Facility Evaluation

raw_content:
Narrative:
On March 26, 2024, at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez went to the facility to conduct a post-licensing inspection. When LPA arrived, no one was home. LPA called the facility contact number and spoke to Facility Manager (FM), Steve Tavera. LPA waited outside the facility, and he arrived after a while. The facility has 4 clients currently. Physical Plant At around 9: A.M, LPA with FM toured the facility. At the time of inspection, the following was observed: a posted license, Emergency Disaster Plan, Foster Care Ombudsman's Information, Youth's Personal Rights, and Accreditation and Mental Health Approval. There is only a maximum of two (2) beds in each bedroom. All bedrooms have drawers and closet spaces for the clients. The smoke and carbon monoxide alarms were tested and working. The water temperature was tested (120) degrees Fahrenheit) using a digital thermometer. All confidential records, sharp objects, medications, and cleaning solutions were observed locked in cabinets. There were extra linens, towels and hygiene supplies in the cabinets and staff office. There was a complete first aid kit in the facility. Al There was adequate perishable food for at least 2 days, however not enough non-perishable foods for at least 7 days. All passageways were unobstructed. Client Records All client records reviewed are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, court orders, needs and services plan, removal/discipline/complaint procedures; medical assessment; safeguards for cash resources, personal property and valuables; education records; personal rights forms. An exit interview was conducted and a copy of the LIC 809,LIC 809D and LIC 811 were provided to the facility representative. A deficiency citation is issued at the time of the inspection.

met_with: Steve Tavera


summary: Facility Evaluation

raw_content:
Narrative:
On December 4, 2024, at 10: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an un-announced annual-required inspection to the facility and met Administrator, Steve Tavera. The facility has four clients currently. Physical Plant LPA with Administrator toured the facility. At the time of inspection, the following was observed: a posted license, Emergency Disaster Plan, Foster Care Ombudsman's contact information, Youth's Personal Rights, Grievance Procedure, and Mental Health Program Approval (MHPA). All bedrooms have two single beds, drawers, and closet spaces. The smoke and carbon monoxide alarms were tested and working. The water temperature was tested (118.2) degrees Fahrenheit) using a digital thermometer. All confidential records, sharp objects, medications, and cleaning solutions were observed locked in cabinets in the staff office. Extra linens, towels and hygiene supplies available for the clients. There was a complete first aid kit in the facility. There were adequate perishable foods for at least 2 days and non-perishable foods for at least 7 days. The passageways and hallways were unobstructed. Client Records All client records reviewed are available to the licensing agency to inspect. Client records contain required information including, but not limited to, consent forms, court orders, needs and services plan, removal/discipline/complaint procedures; medical assessment; safeguards for cash resources, personal property and valuables; education records; personal rights forms. Continued.... Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least quarterly and documented. Facility maintains an emergency and disaster plan, register of clients, Needs and Services Plan for each client, medication records, and contact information for each client's responsible party and physician. Operations The facility maintains a register of clients available upon licensing staff request. The client records are centrally stored in the staff office. The board minutes meeting was available for review. The board of directors conducts meetings at least on a quarterly basis to review and discuss the STRTP's operation. The facility has written complaint procedures to file a complaint for the clients and/or their representatives. An exit interview was conducted, and a signed copy of LIC 809, LIC 809C and LIC811 were provided to the administrator. No deficiency citations were issued at the time of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
A continuation of the annual/required inspection was conducted by Licensing Program Analyst (LPA) Gilbert Gutierrez at the facility and met Administrator Steve Tavera on December 11, 2024. The facility is licensed to serve six males, ages 13-17 years old. There are four clients placed in the facility currently. Staff Records LPA reviewed five staff records. All staff subject to criminal records review have been fingerprinted and cleared. There was documentation of the required education and experience requirements and training. Emergency Intervention Plan The facility has written emergency intervention plan. The staff records have proof of training. An exit interview was conducted and a copy of the LIC 809 and LIC 811 were provided to the administrator. No deficiency citations issued at the time of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On March 19, 2025, at 1: PM Licensing Program Analyst (LPA) Gilbert Gutierrez made a case management inspection to the facility and met Administrator, Steve Tavera. The case management was a follow- up to a Special Incident Report (SIR) received by the Department. The SIR indicated that a staff (S1) allegedly allowed the clients to smoke a substance in the car or in the community. No specific date and time reported. LPA conducted interviews on 12/04/24, 12/06/24, 12//09/24, and 02/03/25. S1 denied the allegation while C1 was not interviewed after attempts failed. LPA gathered the information that C1 was already discharged prior to S1 started working at the facility. S1 no longer working in the facility because he found a new job prior to the allegation. The clients interviewed denied the allegation. They indicated that S1 did not allow them to smoke any substance. No staff allowed the clients to smoke any substance. Based on the information gathered, the incident needs no further follow-up currently unless added information will come up in the future. A copy of the LIC 809, and LIC 811 were provided to the administrator. No deficiency citation issued at the time of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On November 10, 2024, at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez went to the facility to conduct an unannounced annual required inspection. When LPA arrived, no one was home. LPA called the facility contact number and spoke to Administrator, Steve Tavera. LPA waited outside in the car until a staff member arrived. Administrator arrived shortly but must leave for an urgent matter. The facility has 6 clients currently. Physical Plant LPA with staff toured the facility. At the time of inspection, the following were observed: a posted license, Emergency Disaster Plan, Foster Care Ombudsman's Information, Youth's Personal Rights, and Accreditation and Mental Health Approval. There is only a maximum of two (2) beds in each bedroom. All bedrooms have drawers and closet spaces for the clients. The smoke and carbon monoxide alarms were tested and working. The water temperature was tested (117.6 degrees Fahrenheit) using a digital thermometer. All confidential records, sharp objects, medications, and cleaning solutions were observed locked in cabinets. There were extra linens, towels and hygiene supplies in the cabinets and staff office. There was a complete first aid kit in the facility. There were adequate perishable foods for non-perishable foods for at least 7 days. All passageways were unobstructed. Client Records All client records reviewed are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, needs and services plan, removal/discipline/complaint procedures; medical assessment; safeguards for cash resources, personal property and valuables; education records; personal rights forms. An exit interview was conducted, and a copy of the LIC 809 and LIC 811 were provided to the facility representative. No deficiency citation was issued at the time of the inspection.

met_with: Steve Tavera, Hernan Sanchez, Brianna Andrade


facility_name: BOYS REPUBLIC SILVERLAKE RESIDENCE

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13On 06/29/2021, Licensing Program Analyst (LPA) Kevin Sauk arrived at the above-said facility, and met with the Unit Supervisor (US), for the purpose of interviewing staff (S2), and for the purpose of delivering findings of this complaint investigation, regarding the above allegation perpetrated against the alleged victim (C1) [See Confidential Names form (LIC811), 06/29/2021, for names]. Based on all of the interviews conducted, the Department has concluded that the above allegation of Personal Rights to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Supporting evidence includes the following: Although the alleged victim (C1) reported that staff (S1) kicked C1 on purpose, there were no witnesses to the alleged incident, and everyone else that was interviewed did not have any issues with S1, and stated that if S1 had kicked C1, it was probably an accident. If any additional information is received, this complaint can be amended and the finding can be changed. Per California Code Regulation, Title 22, Division 6, Chapters 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), there are no deficiencies to be cited at this time. Exit interview was conducted and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Alan Henry LICENSING EVALUATOR NAME: Kevin C Sauk LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Unit Supervisor (US)


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13On July 12, 2023 at 9:15: AM, Licensing Program Analyst (LPA) Zena Phillips conducted an unannounced visit to BOYS REPUBLIC SILVERLAKE RESIDENCE for the purpose of concluding the investigation and delivering findings on the above allegation. LPA met with STRTP Devon Hosey/Assistant Supervisor and discussed the findings. During the course of this investigation, LPA Phillips interviewed pertinent parties and reviewed records. Confidential interviews and records produced corroborating evidence to support the allegation. Staff interviews and video recording revealed Staff #2 allowed Child #1 to smoke vape pen in staff's vehicle. Client statements revealed that Staff #2 did not say anything or stop Child #1 from smoking vape pen. Based on information obtained and documentary evidence, the preponderance of standard has been met, therefore the above allegation is found to be substantiated. Facility cited on the attached LIC D for violation of California Code of Regulations, Title 22, Division 6, regulation 80078(a) Responsibility for Providing Care and Supervision. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Zena Phillips 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: BOYS REPUBLIC SILVERLAKE RESIDENCEFACILITY NUMBER: 191800953

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

met_with: Devon Hosey/Assistant Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On December 31, 2021 at 9: AM, Licensing Program Analysts (LPA) Zena Phillips made an unannounced visit to Boys Republic Silverlake Residence STRTP for the purpose of an Annual/Required Inspection. LPA Phillips was greeted by Devon Hosey /Assistant Supervisor who granted access to the facility. A complete tour was provided inside and outside of the facility. The facility is located in a residential area and was set as follows: There are currently three (3) children placed in the facility. Facility was set up as follows:3 bedrooms, 2 bathrooms, with 2 stalls, 2 urinals and 2 showers. Additional 2 restrooms for staff use. LPA Phillips observed main staff office with clients files, additional clean linen, doubled locked door for medications and clinician office. Living room, TV room/recreational area, dining room and kitchen. There was a fireplace in the home non operational. There are no bodies of water on the premises. Kitchen: There is a stove/oven with four (6) burners all working properly. There is a microwave and 2 refrigerators/ 1 freezer. LPA observed one week supply of non-perishable and two days of perishable foods, including nutritious snacks. Bedroom # Occupied by client #1, has two twin size beds and adequate cabinet space, shelves for personal storage and lighting.. Bedroom # Occupied by client #2, has two twin size beds and adequate cabinet space, shelves for personal storage, and lighting.. Bedroom # Occupied by client #3, has two twin size beds and adequate cabinet space, shelves for personal storage, and lighting. The facility was inspected, and the following was observed: Facility is safe, sanitary, and in good repair. Passageways, stairways and open porches are unobstructed. Knives, disinfectants, cleaning solutions, and poisons are made inaccessible to clients. . . Medications are locked/accessible only to employees responsible for stored medications. Smoke detectors/ carbon monoxide were working properly in the home. Fire extinguisher were available and working properly in the facility. There were no bars on the windows at the time of the visit. There are no firearms or weapons on the premises. Facility operates within license conditions and limitations including capacity limitations. Facility posts child's rights if licensed to provide care for six clients. Facility has Nissan Armada van equipped to transport six (6) residents with current registration and valid insurance. Clients are not restricted in telephone use except by court order. Clients in care are supervised and always protected. Clients attend school, extracurricular, cultural, and personal enrichment activities. Facility personnel instructed to report violations of personal rights. LPA Phillips interviewed three (3) clients in care and two (2) staff. All other interviews will be conducted at a later date. LPA Phillips will come back at a later date to complete a records review. LPA Phillips collected a copy of the personnel report, client roster and emergency disaster plan. . There were no deficiencies cited at this time. Exit Interview was conducted, and a copy of this report was left at the facility

met_with: Devon Hosey/Assistant Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 01/27//2022 at 9: AM PM Licensing Program Analysts (LPA's) Zena Phillips with Steve Tevera / Supervisor , made an announced visit to Boys Republic Silverlake Residence for Case Management Annual Continuation Inspection. LPA reviewed the following during the inspection: Staff records review; the information regarding the Emergency Preparedness. LPA reviewed Criminal Records and confirmed that all current and former staff were also cleared. LPA reviewed Supervisor and Direct Care staff records. LPA reviewed the facility binder that included Specific Training's include the following: Policies & Procedures; Health & Safety: Emergency Procedures: Medication; Trauma-Informed Care; Boundaries; Job Duties; and information about the Stakeholders. LPA observed the Board of Directors Meeting Notes and confirmed that meetings are held quarterly. There were no deficiencies cited at this time. Exit Interview was conducted and a copy of this report will be emailed to L Parks/ Administrator..

met_with: Steve Tavera/Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On 03/23/2023 at 1:17PM, Licensing Program Analyst (LPA) Zena Phillips arrived at the facility to conduct a case management due to incident report submitted.. LPA Phillips met with Devon Hosey/ Assistant Supervisor who granted access and provided the census. LPA Phillips request LIC 500 and client roster, internal investigation report in regards to SIR# 848126.. The Special Incident Report states that three youth on 2/26/23 allowed to use nicotine vape pens. LPA Phillips conducted two (2) confidential interviews. Not all parties were available at the time of the visit. A decision cannot be rendered. This case management incident needs further investigation Exit interview was conducted with Devon Hosey/ Assistant Supervisor. There are no deficiencies cited at this time and a copy of this report will be email to Lance Parks /Associate Program Director..


facility_name: BRIDGE TO LIFE TEEN HOMES, THE

summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA), Lidia Tinoco met with Marissa Shipman virtually via Teams for the purpose of discussing the Program Statement and Plan of Operation Licensing review. LPA provided Technical Assistance for the Plan of Operation and went over sections A through Q. LPA provided a document detailing the changes in the LIC9106A. LPA also included review notes. At this time the Program Statement sections 1-26 are being returned for review and will be resubmitted with updates to meet the current regulations and the LIC9106A(09/24). A copy of this report was provided to Marissa Shipman for signatures. The signed report will be filed at the RO.

met_with: Marissa Shipman


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA), Lidia Tinoco along with Licensing Program Manager (LPM), Lourey Bartolome, Staff Service Manager (SSM) Marjana Jackson and Associate Governmental Program Analyst (AGPA) Cynthia Galindo met with Marissa Shipman and Tiffani Shipman virtually via Teams for the purpose of conducting a Technical Assistance (TA) meeting discussing the Program Statement and Plan of Operation Licensing in review. LPA Tinoco and AGPA Galindo provided Technical Assistance for the Plan of Operation and Program Statement based on the revision notes sent 8/8/25. A new submission date was agreed upon for October 3, 2025 to submit the revisions. A copy of this report was provided to Marissa Shipman for signatures. The signed report will be filed at the RO.

met_with: Marissa Shipman, Tiffani Shipman


summary: Facility Evaluation

raw_content:
Narrative:
On November 25, 2025, a Component II Orientation was conducted by Licensing Program Analysts (LPAs) Lidia Tinoco and Vanessa Galvan with Administrator, Peter Scott, Board Member, Tiffani Shipman, and President Board Member, David Shipman. The purpose of the Component II Orientation was to review the application, Program Statement/Plan of Operation and to discuss the process. The following were addressed and discussed: An overview of the program statement and program expectations. Revisions to the Plan of Operation/Program Statement (POO/PS) to meet regulatory standards. A review of the programs Emergency Intervention Plan, Staffing, Neighborhood Complaint Policy, Mental Health Program Approval, Reporting requirements, Financial, Money Handling of client's funds, Property ownership, Foster Care Rates and transferring and associating employees and board members in Guardian. The pre-licensing inspection is scheduled for 12/16/2025 at 10: AM. The facility is located at S. Cedar Street, Visalia, CA 93292. A copy of this report was provided to David Shipman.

met_with: Peter Scott, Tiffani Shipman, and David Shipman


summary: Facility Evaluation

raw_content:
Narrative:
On December 16, 2025, Licensing Program Analyst (LPA) traveled to Bridge to Life Teen Homes located in Visalia, CA and met with Administrator Peter Scott, Direct Care Staff Tiffani Shipman, Direct Care Staff Tamara Shipman, Board Member Felix Mata, and Board Member Marissa Shipman. The purpose of the inspection is to conduct a pre-licensing Facility Inspection. A physical plant inspection was completed and included the following observations and checks: Facility grounds are clean and free of debris. There are three ambulatory bedrooms that are double occupancy and two bathrooms, all located on one single level. Bedrooms are accommodated with all required furnishings and storage space. Individual beds were observed and appropriate clean linens and are in good repair. Facility has two full bathrooms, and they are in operable condition. The bathrooms are stored with hand soap, toilet paper, and paper towels. There is an open staff office that is equipped with a desk and a locked file cabinet. Adequate indoor and outdoor activity space and materials observed. All required forms are posted. The temperature of the facility was a comfortable temperature. All facility smoke detectors are in appropriate working order, and a fire extinguisher is properly charged and serviced. The kitchen has a full-size refrigerator and is operating at safe temperature. A sample menu is posted in the kitchen. Knives, sharps, chemicals, disinfectants, and cleaning solutions are inaccessible to clients. The dining room is equipped with a large table and with ten chairs. First Aid kit is stored in the kitchen and is complete with all first aid items. The facility stores extra supplies of linens, personal hygiene products, and emergency food supply. There are no firearms or weapons allowed in the facility. There are no bodies of water on the facility grounds. A copy of this report was provided to Peter Scott at the conclusion of the inspection via email.

met_with: Peter Scott, Felix Mata, Tamara Shipman, Tiffani Shipman, Marissa Shipman


summary: Facility Evaluation

raw_content:
Narrative:
On February 5, 2026, Licensing Program Analyst (LPA) Vanessa Galvan met with Administrator Peter Scott, Board Member Marissa Shipman, Facility Manager Tamara Shipman, Direct Care Staff Monica Gonzalez, Yesenia Monje Navarro, Tiffani Shipman. The purpose of the Component III Orientation was to review the Short-Term Residential Threptic Program Rules and Regulations, to prepare Licensee to maintain and operate their facility, and provide information to avoid potential problems areas. The following were addressed and discussed: Interim Licensing Standards (ILS) Short Term Residential Therapeutic Program (STRTP) and General Regulations. Safeguards for Cash Resources, Personal Property, and Valuables, Bonding, Finances, Accountability. Reporting Requirements, Emailing Incident Reports to the CCLD Inbox Fresno. Administrator & Social worker- Qualifications and Duties, Personnel Requirements, and Criminal Record Clearance. Admission Agreements, Participants Medical Assessment, Register of Clients, Personal Rights. Telephones, Transportation, Health Related Services, Food Services, Responsibility for Care & Supervision, Activities, Building and Grounds. Inspection Authority of Licensing Agency, Department Approval for Remote Site Model, Waivers and Exceptions. Complaints and the LPA, Deficiency Types, Extension Request, Types of Civil Penalties, Providers Information Notices (PINs), Complaint and Regulatory Enforcement CARE Tools, Officer of the Day, TSP Services. This report was discussed and provided to Peter Scott at the conclusion of the inspection.

met_with: Peter Scott


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA), Lidia Tinoco traveled to Bridge to Life Teen Homes located in Visalia, CA and met with Administrator Peter Scott and Direct Care Staff Tiffani Shipman, the purpose of the inspection is to conduct a post-licensing Facility Inspection. A physical plant inspection was completed and included the following observations and checks: Facility grounds are clean and free of debris. There are three ambulatory bedrooms that are double occupancy and two bathrooms, all located on one single level. Bedrooms are accommodated with all required furnishings and storage space. Individual beds were observed and appropriate clean linens and are in good repair. Facility has two full bathrooms, and they are in operable condition. The bathrooms are stored with hand soap, toilet paper, and paper towels. There is an open staff office that is equipped with a desk and a locked file cabinet. Adequate indoor and outdoor activity space and materials observed. All required forms are posted. The temperature of the facility was a comfortable temperature. All facility smoke detectors are in appropriate working order, and a fire extinguisher is properly charged and serviced. The kitchen has a full-size refrigerator and is operating at safe temperature. A menu is posted in the kitchen. Knives, sharps, chemicals, disinfectants, and cleaning solutions are inaccessible to clients. The dining room is equipped with a large table and with ten chairs. First Aid kit is stored in the kitchen and is complete with all first aid items. The facility stores extra supplies of linens, personal hygiene products, and emergency food supply. LPA Tinoco observed cameras in common areas of the facility. There are no firearms or weapons allowed in the facility. There are no bodies of water on the facility grounds. Continued on LIC809-C ... A Guardian Check conducted on 4/14/26 confirmed that all the staff listed on the LIC500 have received fingerprint clearances. 5 staff files and 1 child file was reviewed. Confidential interviews were conducted. LPA Tinoco requested updates regarding accreditation and mental health program approval. LPA issued 2 technical assistance, 2 technical violations. 2 type B deficiencies were issued for ILS (Interim Licensing Standards) 87075(c) Health Related Services and 87061(a) Reporting Requirements. A copy of this report was provided at the conclusion of the inspection along with appeal rights.


facility_name: BRIGHT HORIZON

raw_content:
Narrative:
On 05/25/2022, the Department received a complaint alleging that clients are smoking marijuana in the facility. Staff members who were interviewed denied the allegation that clients are allowed to smoke in the facility, including activities outside of the facility grounds. LPA was informed by staff members that they have caught client(s) smoking inside the facility, including while conducting routine checks and were able to confiscate the contraband and document the incident. Staff workers, including the Administrator, stated that staff are always present and are working professionally. Staff interviewed stated that they are not supplying marijuana to the clients and do not condone this type of activities. In confidential interviews, all clients interviewed denied the allegation that staff working at the facility allowed them to smoke marijuana or any other form of tobacco or device such as a vape. All clients denied that staff are supplying marijuana or other forms of contraband. Several clients disclosed that they obtain their smoke and other devices, such as a vape while at school. Clients interviewed stated that staff are quick to take away any contraband they discover while at the facility. The clients that admitted smoking inside the facility is done without staff having any knowledge. L.A. County representative that was identified in the referral as having direct information about the allegation could not be contacted, therefore no statement was obtained. The county emergency response worker (ER) who was assigned to the referral made the determination that the referral is to be evaluated out. It should be mentioned that LPA Vargas determined that there were some irregularities in the manner that the facility were under reporting special incident reports (SIR) with respect to discovering contraband. Statements obtained could not corroborate the allegation reported. Therefore, the above allegation of neglect/lack of supervision is determined unsubstantiated at this time. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged abuse occurred. An exit interview was conducted and copy of this report was provided to the facility representative for review and signature. No deficiencies were cited at this time

Investigation Findings:
13On 10/04/2022 at 10: AM, Licensing Program Analyst (LPA) Joseph Vargas conducted a follow-up inspection for the purpose of providing findings for the above complaint. LPA met with Mr. Garces. During the course of the investigation, LPA conducted in-person visits, and telephone interviews with four staff workers, five clients, on 5/31/2022, county emergency response worker (ER) on 06/02/2022, that included two attempted contacts with two individuals that could not be contacted. (reference confidential names list LIC811 dated 10/04/2022. During the inspection LPA requested for review and obtained copy of the staff and client facility roster reports, special incident reports, clients Needs and Service Plan and placement history, including a review of the county report associated to this complaint investigation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Joseph Vargas LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BRIGHT HORIZONFACILITY NUMBER: VISIT DATE: 10/04/2022

met_with: Mr. Carlos Garces, Administrator


raw_content:
Narrative:
It was alleged that minors had access to illegal substances and inappropriate items while in care. Information obtained from confidential interviews did not support the allegation. Clients, non-minor dependents and staff denied the allegation and the alleged source of the illegal substances and inappropriate items. LPA attempted to obtain statements from a former client in placement, but attempts were unsuccessful. There was no evidence found to corroborate the allegation. Based on information obtained during the investigation, the allegation is unsubstantiated. Although the allegation may have happened or is valid, the preponderance of evidence to prove the allegation was not met. A copy of this report and the Confidential Names Form were provided to the facility representative. Appeal rights provided and explained.

Investigation Findings:
13On October 7, 2022, at 12: PM, Licensing Program Analyst (LPA) Claudia Portillo conducted a complaint inspection at the facility to deliver the finding of the above allegation on behalf of investigating LPA Irene Yamamoto. LPA Claudia Portillo met with the facility representative named above. LPA Yamamoto investigated the allegations by conducting interviews with clients and non-minor dependents in care, facility staff and other related parties. Records were reviewed such as but not limited to, Personnel Report, Register of Clients/NMDs in Placement, Incident Reports and Needs and Services Plans. There was no placement agency report found. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Claudia Portillo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BRIGHT HORIZONFACILITY NUMBER: VISIT DATE: 10/07/2022

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

met_with: Shaun Fernandez, Youth and Family Specialist


raw_content:
Narrative:
It was alleged that staff provided a minor with a vape pen while in care. Confidential interviews reveal that former and current clients in care denied the allegation. They denied being provided with a vape pen by any staff. They denied witnessing any staff provide a vape pen to other clients. The identified client denied the allegation. Staff who were interviewed denied providing any minor with a vape pen. The identified staff denied the allegation and accused another staff of the allegation. However, records reviewed support the allegation that the identified staff provided the identified client with an vape pen on more than one occasion. The records reviewed include an admission to the allegation by the identified staff. The facility terminated the identified staff's employment on January 31, 2023, due to the allegation. Based on the above information, the preponderance of evidence standard has been met, therefore, the allegation is substantiated. A deficiency citation is issued under Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS) 87072(c)(11) Personal Rights - To be free of physical, sexual, emotional, or other abuse, and from corporal or unusual punishment, exploitation, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse... This requirement was not met as evidenced by records reviewed which include the admission by the identified staff to providing a client with a vape pen while in care. This poses an immediate health, safety, and personal rights risk to clients in care. An exit interview was conducted, and copies of the following licensing reports were provided: LIC 9099, LIC 9099-C, LIC 9099-D and LIC Confidential Names Form. Appeal rights forms were provided and explained.

Investigation Findings:
13On July 21, 2023 at 10: AM, Licensing Program Analyst (LPA) Irene Yamamoto conducted an unannounced complaint inspection at the facility. LPA met with the facility representative named above. The purpose of the inspection is to deliver the finding for the above allegation. The investigation into the allegation includes the following: On 2/9/23, LPA conducted the10-day inspection at the facility; interviews were conducted with three staff and an attempt was made to interview one client. Between 3/1/23 to 7/20/23, LPA conducted interviews with four additional staff, four current and former clients in placement, and multiple placement agency staff. During the same period, attempts were made to obtain statements from other clients and placement agency staff. Records were reviewed including, but not limited to the Personnel Report, Register of Clients in Placement, History of Placements, Discharge Report and Needs and Services Plan. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Irene Yamamoto LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BRIGHT HORIZONFACILITY NUMBER: VISIT DATE: 07/21/2023

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

met_with: Carlos Garces, Administrator