summary: Facility Evaluation

raw_content:
Narrative:
Please note this document is a late entry.This meeting was held on 04/03/25 and signed on 07/15/25. On Thursday, April 3, 2025 at 10AM, a noncompliance conference was held to discuss compliance concerns at the facility. Licensee was informed of the purpose of the meeting. The specific areas of concern were discussed, and a corrective action plan was developed in consultation with Licensee. In attendance representing Licensee: - Aaron Busalacchi, Licensee & Administrator - Ryan Busalacchi, Licensee - Edwin Isip, Facility Supervisor In attendance representing the Department: - Helga Wong, Regional Manager - Carolyn Flynn, Licensing Program Manager - Kristin Pierotti, Licensing Program Analyst In attendance representing Regional Center: - Michael Minton (Regional Center of the East Bay) - Nicole Hill-Nawy (Regional Center of the East Bay) The meeting adjourned at 11:15AM. A copy of this report was provided to Edwin Isip, Facility Supervisor whose signature confirms receipt.

met_with: Aaron Busalacchi, Licensee & Administrator Ryan Busalacchi, Licensee Edwin Isip, Facility Supervisor


state: CA

facility_name: DELTA RESIDENTIAL - STONY HILL

summary: Facility Evaluation

raw_content:
Narrative:
On 05/21/25 at 10:30am, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct the required SB Psychotropic Medications inspection. LPA met with Carlos Pambid, Direct Care Staff. At 11:00am, Aaron Busalacchi joined the inspection. At the time of the inspection, there were 0 clients and 2 staff members in the facility. The facility has a census of 4 clients. The facility has 1 client that meets the criteria for the SB Psychotropic Medication Inspection. LPA reviewed staff files and training records for 4 staff members. LPA reviewed the client files for the 1 client that met the criteria. LPA did not observe any deficiencies in regards to the medication inspection. LPA conducted 2 staff interviews. LPA conducted 0 client interviews. LPA observed the medications with Facility Administrator. The medications are in bubble packs. Each pack was labeled with the medication, the date, the time, and dosage. LPA did not observe any medication errors. LPA observed the locked cabinet where the medications were kept in the kitchen. LPA conducted a walk through of the facility. LPA did not observe any physical plant deficiencies. At this time, the SB Psychotropic Medications inspection is complete. LPA conducted an exit interview with Facility Administrator, whose signature confirms the receipt of this document.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Carlos Pambid, Direct Care Staff Aaron Busalacchi, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 06/17/25 at 1:35pm, Licensing Program Analyst (LPA) Kristin Pierotti and LPA Simran Nayar conducted a case management inspection in order to follow up on a submitted incident report. LPAs met with Mariaozita Pambid, Direct Care Staff and informed of the purpose of the visit. Based on the submitted incident report, an allegation was made of inappropriate conduct by a staff member during an interaction with a client. LPAs conducted confidential interviews with 1 staff and 1 client. Further investigation is needed to resolve the incident. At this time, no deficiencies were found. An exit interview was conducted and a copy of this report was provided to Mariaozita Pambid, Direct Care Staff, whose signature confirms receipt.

met_with: Mariaozita Pambid, Direct Care Staff


summary: Facility Evaluation

raw_content:
Narrative:
On 07/15/25 at 10:00am, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced case management inspection in order to follow up on a submitted incident report. LPA met with Edwin Isip, Facility Supervisor and informed of the purpose of the visit. Based on the submitted incident report, an allegation was made of inappropriate conduct by a staff member during an interaction with a client. LPA conducted confidential interviews with 1 staff and collected documentation pertaining to the incident. Further investigation is needed to resolve the incident. At this time, no deficiencies were found. An exit interview was conducted and a copy of this report was provided to Edwin Isip, Facility Supervisor whose signature confirms receipt.

met_with: Edwin Isip, Facility Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On 07/21/25 at 10:30am, Licensing Program Analyst (LPA) Kristin Pierotti conducted a quarterly case management inspection in accordance with the terms agreed upon during the April Noncompliance Conference (NCC). LPA met with Edwin Isip, Facility Supervisor and explained the purpose of the visit. As outlined in the NCC terms, several requirements were reviewed. The administrator is working the required 16 hours per week at the facility and they have submitted a request for a new administrator. The facility has conducted the compatibility review for residents in care. LPA reviewed 4 resident files and found them to be up to date and containing all required documents. LPA reviewed 7 staff files and found that all staff have current Mandated Reporter certificates. LPA observed that an in-house training on Title 22 reporting requirements was developed, and staff were trained on 04/07/2025. LPA observed three mandated reporter postings where visible to all personnel. No deficiencies were found. LPA toured the facility and found it to be clean and in good repair. There were two days of perishable foods and seven days non-perishable foods present. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. No deficiencies were found at this time. An exit interview was conducted and a copy of this report was left with Edwin Isip, Facility Supervisor whose signature confirms receipt.


summary: Facility Evaluation

raw_content:
Narrative:
On 08/06/25 at 12:45pm, Licensing Program Analyst (LPA) Kristin Pierotti conducted a case management inspection in order to follow up on a submitted incident report. LPA met with Mariaozita Pambid, Direct Care Staff and informed of the purpose of the visit. Based on the submitted incident report, an allegation was made of inappropriate conduct by a staff member during an interaction with a client. Based on confidential interviews and record review, the allegation could not be proven to have occurred. No deficiencies were found. An exit interview was conducted and a copy of this report was provided to Mariaozita Pambid, Direct Care Staff.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/28/25 at 10:00am, Licensing Program Analyst (LPA) Kristin Pierotti and LPA Simran Nayyar conducted a quarterly case management inspection in accordance with the terms agreed upon during the April Noncompliance Conference (NCC). LPA met with Edwin Isip, Facility Administrator and explained the purpose of the visit. As outlined in the NCC terms, several requirements were reviewed. The administrator is working the required 16 hours per week. The facility has conducted the compatibility review for residents in care. LPA reviewed 3 staff files and found that 2 of 3 files contained current Mandated Reporter Training, the 3rd file review was of a new staff member who is in progress on the training. LPA observed that an in-house training on Title 22 reporting requirements was developed, and staff were trained on 04/07/2025. LPA observed three mandated reporter postings where visible to all personnel. No deficiencies were found. Licensee is finalizing edits to the application for the transition into an Adult Residential Facility and will be submitting sometime in November. LPA toured the facility and found it to be clean and in good repair. A drawer in the bathroom was broken, the Facility Administrator is fixing it today. LPA is offering Technical Assistance. There were two days of perishable foods and seven days non-perishable foods present. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. An exit interview was conducted and a copy of this report was left with Edwin Isip, Facility Administrator whose signature confirms receipt.

met_with: Edwin Isip, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 5/6/2024 at 10:35am, Licensing Program Analyst (LPA) Selena Hood and LPA Mona Lam conducted a visit to the licensed facility. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9(a)(2). LPAs met with Frances Nelson, Manager, at 10:50am. LPAs reviewed two of child's records and two of staff personnel files on site at the facility. Two children met SB Psychotropic Medications inspection criteria. . LPAs did not interview staff present because they were not involved in psychotropic medication administration. LPAs did not interview children currently prescribed psychotropic medication during this visit. One child was present, this child did not meet inspection criteria. During the inspection the LPAs observed that the facility did not have documentation that one child had engaged in the planning of their services, LPAs delivered a Technical Violation for California Code of Regulations 84068.2(d)(1) (see attached LIC9102). LPAs observed that one staff member that was administering medications had not received Psychotropic Medications training. This poses a potential risk to the health, safety, and/or personal rights of clients in care. LPAs delivered a Type B citation for California Code of Regulations 84065(i)(3)(M) Personnel Requirements (see LIC809D). LPAs observed Edwin Isip, Supervisor conducted a medication count at 1:30pm. This inspection was not finished during this visit. LPA(s) will return to interview one child and two staff members. LPAs conducted an exit interview and delivered appeal rights at 2:12pm and provided a copy of this licensing report to Edwin Isip, Supervisor.

met_with: Frances Nelson


summary: Facility Evaluation

raw_content:
Narrative:
On 02/19/2025 at 10:45am, Licensing Program Analyst (LPA) Kristin Pierotti conducted an unannounced Case Management - Deficiencies inspection at the facility. The inspection is regarding the conduct of S1. LPA met with Liza Tagpis, Assistant Facility Manager and informed them of the purpose of the visit. Based on confidential interviews, observation, and record review it was found that S1 had hit a client with a belt multiple times. LPA determined that this conduct is inimical to the safety of resident(s) of the facility. LPA is issuing a citation of Health and Safety Code (HSC) Section 1558(2). An exit interview was conducted, appeal rights provided, and a copy of this report was left with Liza Tagpis, Assistant Facility Manager.

met_with: Liza Tagpis, Assitant Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 03/11/2025 at 1:50pm, Licensing Program Analyst (LPA) Kristin Pierotti and LPA Simran Nayyar conducted an unannounced Case Management - Deficiencies inspection at the facility. The inspection is regarding the conduct of S2. LPA met with Edwin Isip, Facility Manager and Aaron Busalacchi, Facility Administrator and informed them of the purpose of the visit. Upon further review of an incident that occurred at the facility, S2 did not intervene when S1 hit a client with a belt. LPA has determined that S2's conduct is inimical to the safety of resident(s) of the facility. LPA is issuing a citation of Health and Safety Code (HSC) Section 1558. See attached LIC 809-D. LPA developed a plan of correction with Facility Manager and Facility Administrator. An exit interview was conducted and a copy of this report and the licensee's appeal rights were provided to Facility Administrator whose signature on this form confirms receipt.

met_with: Edwin Isip, Facility Manager Aaron Busalacchi, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 02/05/26 at 10:47AM, Licensing Program Analysts (LPAs) Kaitlyn Wong and Cole Oliver conducted a quarterly case management inspection in accordance with the terms agreed upon during the April Noncompliance Conference (NCC). LPAs met with Ryan Busalacchi, Licensee, and explained the purpose of the visit. LPAs requested a tour of the facility and found it to be in good repair. There were two days of perishable foods and seven days non-perishable foods present. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. No deficiencies were found at this time. The facility has a census of 3. Facility is currently licensed to serve a capacity of six clients, up to two non-ambulatory, and ages 6-17. Licensee explains the application to transition into an Adult Residential Facility is written up, that they are finalizing edits and stated he will submit next week. As outlined in the NCC terms, several requirements were reviewed. LPA Wong reviewed current staff schedule and observed that Administrator was working +16 hours/week. The facility has a compatibility review plan for new residents in care which will be sent to LPA Wong via email. LPA Wong reviewed 2 resident files and found them to be up to date and containing all required documents. LPA Oliver reviewed 10 staff files and found that all staff have current Mandated Reporter certificates and in-house training on Title 22 reporting requirements was completed. LPA observed three mandated reporter postings in staff office and visible to all personnel. No deficiencies were found. [Continued on LIC 809-C] An exit interview was conducted and a copy of this report was left with Ryan Busalacchi, Licensee whose signature confirms receipt, and a copy will be emailed to Edwin Isip, Facility Administrator.

met_with: Ryan Busalacchi, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On 2/19/2026 at 11:00am, Licensing Program Analysts (LPAs) Kaitlyn Wong and Simran Nayyar conducted a case management visit at the facility. LPAs met with Edwin Isip, Facility Administrator, and informed them of the purpose of the visit. At the time of arrival 2 staff and 0 clients were present. The purpose of the visit was to provide technical assistance based on review of documentation during an investigation and/or inspection at the facility, which an area was found where a technical assistance may be beneficial. Please refer to the (LIC TA) attached to today's report for more details. No citations were issued at this visit. An exit interview was conducted, and a copy of this report was provided to Edwin Isip, Administrator.

met_with: Edwin Isip, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 2/19/2026 at 11:05AM, Licensing Program Analysts (LPAs) Kaitlyn Wong and Simran Nayyar conducted an unannounced Annual Inspection at listed facility. At 11:20AM LPAs met with Edwin Isip, Facility Administrator, who assisted with the facility walk through. The Group Home is licensed to serve 6 clients. Present during the inspection were 2 staff and 0 clients. During the facility walk through, LPAs observed 3 bedrooms and 2 bathrooms. LPAs observed one out of three client dresser drawers were difficult to open. LPAs advised facility to fix or replace the drawers. LPA Wong is issuing one Technical Assistance for CCR 84487(f) Buildings and Grounds (refer to LIC Technical Assistance dated 2/19/2026). LPAs observed facility license, personal rights, and other forms posted on the walls throughout the facility. LPAs tested the water temperature and found it to be 106.3 degrees F which is in range. The hallway thermostat read 70 degrees F which is within range. Sharps were locked in the hallway locked cabinet and chemicals were safely stored in the locked cabinet in the laundry room. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored safely and in a locked cabinet in the kitchen. LPAs tested the smoke detectors and observed that one client bedroom smoke detector was out of battery and did not beep upon testing. Administrator replaced the battery during the inspection and successfully retested the smoke detector. LPAs are issuing one Technical Violation for CCR 84087(d) Buildings and Grounds (refer to LIC Technical Violation dated 2/19/2026). [Continued on LIC 809-C] Then LPAs toured the backyard. There were no open bodies of water. LPAs observed a metal plant hangar was on the side fence with one out of two loose screws. Administrator immediately removed the metal hangar and screws from the fence, explaining that the hangar was used by a staff member for a hanging plant. At this time, LPAs are issuing one Technical Violation for CCR 84088.3(a)(1) Buildings and Grounds (refer to LIC Technical Violation dated 2/19/2026). Next, LPAs interviewed 2 staff and 0 clients. All clients were at school for the majority of the inspection. The majority of the clients who reside in the home are non-verbal. LPA will attempt to conduct client interviews with the verbal client at a later date. At this time the inspection is not complete and will be continued at a later date. LPAs conducted the inspection for the following domain: Physical Plant. LPAs will return at a later date to continue the Required Annual Inspection. An exit interview was conducted, appeal rights provided, and a copy of this report was given to Edwin Isip, Facility Administrator whose signature confirms receipt. [End of document]

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
On March 25, 2026 at 11:25AM, Licensing Program Analysts (LPA) Kaitlyn Wong and Cole Oliver conducted an unannounced case management inspection to follow up on a submitted incident report. LPAs met with Edwin Isip, Administrator, and informed them of the purpose of the visit. At the time of the inspection there were two (2) staff and two (2) clients present. One (1) additional staff arrived during the time of the inspection. The purpose of this investigation was to gather additional information regarding an incident that occurred on March 21, 2026. Per the incident report, one client ran away from the facility and was returned to the facility by the police. LPA conducted two (2) staff interviews and one (1) client interview. No documents were requested during this inspection. Additional information can be found on the LIC 812's dated 3/25/26. LPA Wong spoke with Edwin Isip, Administrator regarding details of the IR follow-up which will be documented on an LIC 812. LPAs toured the facility inside and out. LPAs observed one (1) client dresser to have one drawer difficult to open and, when forcibly opened, revealed a dent on the right inside wall of the pull-out drawer. LPAs are issuing one Technical Violation for CCR 84487(f) Buildings and Grounds (refer to LIC Technical Assistance dated 3/25/2026). An exit interview was conducted and a copy of this report was provided to Edwin Isip, Administrator, whose signature on this form confirms receipt.


summary: Complaint Investigation - Unsubstantiated - 5 allegations

raw_content:
Narrative:
This is a violation of Title 22, Division 6, Chapter 5, Article Section 84065. Personnel Duties. The facility is being issued a Type B citation for Personnel Duties Section 84065.2(b)(1) Child care staff shall perform the following duties: (1) Supervision, protection and care of children individually and in groups at all times. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Edwin Isip, Facility Administrator whose signature on this form confirms receipt.

Investigation Findings:
13On March 25, 2026 at 11:24AM, Licensing Program Analysts (LPA) Kaitlyn Wong and Cole Oliver conducted an unannounced inspection to the facility to deliver findings for the above allegation. LPA Wong met with Edwin Isip, Administrator, and explained the purpose of the visit. LPAs toured the facility inside and out. At the time of the visit there were three (3) staff and two (2) clients present. During the investigation, LPA Wong conducted confidential interviews and reviewed client and facility records. It was found that staff had attempted to prevent clients from injuring another client following the facility's Emergency Intervention Plan but were unsuccessful, resulting in client injuring another client. Based on confidential interviews, observations, and record review, the preponderance of evidence standard has been met, and therefore the above allegation: Staff did not prevent client from injuring another client is found to be SUBSTANTIATED. [Continued on LIC-9099C] SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kristin Pierotti LICENSING EVALUATOR NAME: Kaitlyn Wong 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 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: DELTA RESIDENTIAL - STONY HILLFACILITY NUMBER: VISIT DATE: 03/25/2026

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 0

report_type: Complaint Investigation

complaint_status: unsubstantiated


facility_name: DELTA SERENITY HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
SubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion: UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

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

met_with: Jamila Wilson-Smith, Facility Manager


raw_content:
Investigation Findings:
UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

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

met_with: Jamila Wilson, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 12/19/24 at 11AM, Licensing Program Analyst (LPA) Mariah Hawkins met with Chief Executive Officer Ron Dhillon, Chief Financial Officer Mandave Sandhu, Administrator Nick Moriana, and Consultant Amy Fox for the scheduled Component II face-to-face meeting. The meeting was held over Microsoft Teams. The purpose of this meeting was to discuss the facility's Plan of Operation and Program Statement. The following items were discussed: - Goal/Purpose of the Group Home - Admission Criteria - Basic Services and Planned Activities - Needs and Services Plans - Care and Supervision Policies - Staff Training - Emergency Intervention Policies - Reporting Requirements - Visitation Policies - Background Clearance/Guardian Process LPA provided clarification on the next steps in the application process. An exit interview was conducted, and a copy of this report was provided to Chief Executive Officer Ron Dhillon via email.

met_with: Director Ron Dhillon


summary: Facility Evaluation

raw_content:
Narrative:
On 2/6/25 at 12PM, Licensing Program Analyst (LPA) Mariah Hawkins met with Executive Director Ron Dhillon, Administrator Nick Moriana, and Board Member Mandave Sandhu for a schedule prelicensing inspection. Using the CARE Inspection Tool, LPA toured the facility site and grounds and discussed the facility's application. The facility is a single-story house in a residential neighborhood. The house is set up with three double-occupancy bedrooms, one and a half bathrooms, and a master suite bedroom currently set up as a staff office with locked storage for medications and emergency supplies. There are three living areas, one dining area, a laundry room, and a two-car garage. There are multiple closets and cabinets throughout the facility for storage of linens and other facility supplies. Hot water initially measured above the permitted range, but the water heater setting was lowered, and hot water measured within range by the end of the visit. The facility has a thermometer and the Applicant plans to monitor hot water temperatures. The facility has a video camera set up beside the garage that is not in use. However, Appilcant expressed interest in putting up cameras, and LPA suggested Applicant refer to PIN 24-09-CRP. Additionally, there are unsecured paint cans in the garage that Applicant agreed to remove upon completion of planned painting touch-ups and notify LPA once that is complete. LPA discussed the forms still needed for the application and the pending program statement updates. Most forms were obtained at visit. LPA informed Applicant to expect a summary of all pending items by 2/11/25. Based on this inspection, upon completion of the items discussed above, the facility will be ready for licensure. A copy of this report was provided to Executive Director Ron Dhillon.

visit_type: Prelicensing

met_with: Director Ron Dhillon, Administrator Nick Moriana, Board Member Mandave Sandhu


summary: Facility Evaluation

raw_content:
Narrative:
On 06/17/25 at 10:50am, Licensing Program Analyst (LPA) Kristin Pierotti and LPA Simran Nayar conducted a post-licensing inspection. LPAs met with Nick Moriana, Facility Administrator and informed of the purpose of the visit. LPAs used the CARE Inspection Tool and conducted a tour of the facility site, review of 5 personnel records and 2 resident records, and confidential interviews with 1 staff member and 1 resident. LPAs observed the facility to be in good condition, clean and well organized. Kitchen and bathrooms are sanitary. The facility currently has 2 residents and each resident has their own bedroom with individual beds and plenty of storage for personal items. The rooms and common spaces are nicely decorated and furnished. Medications, sharps, and chemicals are stored where inaccessible to the residents. LPAs observed personnel and resident records to be complete and had all necessary documents. Staff have full background clearances, and first aid training certifications. All staff are actively completing the initial training requirements. Residents' records contain current emergency contact information, complete care plans, accurate medication records and cash records. Based on interviews, LPAs observed staff to be knowledgeable of facility policies, mandated reporting, and intervention procedures. LPAs observed residents to each be provided 1:1 supervision, to be dressed in well-fitting, appropriate, and clean clothes, and to appear comfortable in care, showing no hesitation around staff or in responding to staff guidance. Continue on LIC812C No deficiencies were observed. An exit interview was conducted and a copy of this report, was left with Facility Administrator whose signature confirms receipt.

met_with: Nick Moriana, Facility Administrator


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13On 11/18/2025 at 11:00am, Licensing Program Analyst (LPA) Jonathan Medina conducted a visit at the facility regarding the above complaint allegation. During visit LPA amended and corrected previous licensing visit reports for this complaint. LPA met with Jamila Wilson, Facility Manager and informed them of the purpose of the visit. Based on confidential interviews the preponderance of evidence standard has been met. Therefore, the allegation "Licensee encourages youth to depart from the facility for long periods of time" is SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6, Chapter 1, Section 80022(k). See attached LIC9099-D. An exit interview was conducted, appeal rights discussed and a copy of this report was left with Jamila Wilson, Facility Manager whose signature on this form confirms receipt. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Jonathan Medina 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 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: DELTA SERENITY HOMEFACILITY NUMBER: 075650180

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

met_with: Jamila Wilson-Smith (Facility Manager)

complaint_status: SUBSTANTIATED


investigation_findings: UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

allegations: UnsubstantiatedEstimated Days of Completion: Unsubstantiated Estimated Days of Completion: Unsubstantiated Estimated Days of Completion:


raw_content:
Investigation Findings:
13On December 11, 2025, at 12:00 p.m., Licensing Program Analyst (LPA) Jonathan Medina conducted a complaint inspection at the facility and spoke with Facility Manager Jamila Wilson-Smith. The purpose of the visit was to deliver findings for the above listed complaint allegation. Through interviews with staff and clients, and a review of facility records, the preponderance of evidence standard has been met. The allegation that facility staff are not providing a safe environment to clients in care is SUBSTANTIATED. According to the facility's Program Statement, staff are required to be certified in Pro-Act training within 90 days of being hired. This requirement was not met. Pro-Act is a training program designed to help staff respond to and de-escalate challenging behaviors safely. Because this training was not completed as required and there were several incidents of clients experiencing escalated behaviors, the facility is being cited for violating California Code of Regulations (CCR), Title 22, Division 6, Section 80022(k) - Plan of Operation. Please refer to the attached LIC9099-D for more details. An exit interview was conducted, appeals rights discussed, and a copy of this report was provided to Facility Manager Jamila Wilson-Smith. Her signature confirms receipt of the report. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Jonathan Medina LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE This is an official report of an unannounced visit/investigation of a complaint received in our office on 10/30/2025 and conducted by Evaluator Jonathan Medina COMPLAINT CONTROL NUMBER: 14-CR- FACILITY NAME:DELTA SERENITY HOMEFACILITY NUMBER: ADMINISTRATOR:CRYSTAL LANDAFACILITY TYPE: ADDRESS: INCLINE CTTELEPHONE: (925) 300- CITY:ANTIOCHSTATE: CAZIP CODE: CAPACITY:6CENSUS: 4DATE: 12/11/ UNANNOUNCEDTIME BEGAN: 12: PM MET WITH:Jamila Wilson-Smith, Facility ManagerTIME COMPLETED:01: PM 9Lack of supervision - staff allowing inappropriate interaction between youth. INVESTIGATION FINDINGS: 13On December 11, 2024, at 12:00 p.m., Licensing Program Analyst (LPA) Jonathan Medina conducted a complaint investigation visit to deliver the findings. LPA met with Facility Manager Jamila Wilson-Smith and explained the purpose of the visit. Based on confidential interviews and record review, although the above allegation may have happened or is valid, there is not a preponderance of evidence to prove that the above-listed allegation did or did not occur. Therefore, the above allegation is UNSUBSTANTIATED. Due to conflicting statements and review of video footage, there is insufficient evidence to confirm that staff are allowing inappropriate interactions. An exit interview was conducted, appeal rights were discussed, and a copy of this report was provided to Facility Manager, Jamila Wilson-Smith. Her signature on this form confirms receipt. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Jonathan Medina LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: DELTA SERENITY HOMEFACILITY NUMBER: 075650180

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


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
Control Number - 2479-FN On December 11, 2025, at 10: AM, Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced case management visit at the facility to follow up on a submitted Incident Report. LPA met with Facility Manager Jamila Wilson-Smith. At the time of the visit, one staff member and one client were present. The Incident Report being reviewed was submitted regarding an event that occurred on December 4, 2025. According to the report, a client became escalated and engaged in self-harming behavior. During the visit, LPA interviewed staff and client. Unfortunately client from incident was not available during visit due to being AWOL. Confidential interviews confirmed that client drank bleach. Hospital discharge paperwork confirmed that the client was placed on a 72-hour hold and later discharged back to the facility. Staff also shared that the client owns a guinea pig and frequently has to clean. Facility procedures require clients to request cleaning products from staff and explain why they need them. As a result of today's investigation, staff did not provide adequate supervision, particularly given the client's known history of self-harm from previous incidents. Additionally, clients should not be left unattended with cleaning solutions. This is a violation of California Code of Regulations (CCR), Title 22, Section 80078(a) - Responsibility for Providing Care and Supervision, and Section 80087(g) - Building and Grounds. Please refer to LIC809-D for additional details. An exit interview was conducted, appeals rights discussed, and a copy of this report was provided to Facility Manager Jamila Wilson-Smith. Her signature confirms receipt of the report.

Deficiencies:
80087(g): (g) Disinfectants, cleaning solutions, poisons, firearms and other items that could pose a danger if readily available to clients shall be stored where inaccessible to clients.

title:
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780087(g) Building and Grounds


summary: Facility Evaluation

raw_content:
Narrative:
On 1/21/ Licensing Program Analyst (LPA) Jonathan Medina made a visit to the facility to amend a report. LPA met with Facility Manager, Kim Patton and informed them of the purpose of the visit. Facility Manager Jamila Wilson-Smith was also present during visit. The report was amended. Furthermore upon returning to the home client C1 was leaving the home to go to school. Due to previous concerns of client owning a vehicle LPA advised if staff can walk client out to confirm client had a ride. Staff member Jamila Wilson-Smith reported to LPA that she believes she saw client drive off in a grey Toyota. LPA advised staff to submit an incident report and follow up with client upon arrival if she has a vehicle. An exit interview was conducted, and a copy of this report was left with the facility. Signature on this report acknowledges receipt.

met_with: Kim Patton - Kim Patton


summary: Facility Evaluation

raw_content:
Narrative:
On February 24, Licensing Program Analyst (LPA) Jonathan Medina conducted a POC visit with the facility regarding a past due POC. LPA met with Mandave Sandhu, Program Supervisor to discuss the POC. During the time of the visit a new resident was conducting their intake assessment along with County of Contra Costa placement staff. LPA cited a deficiency on December 11, 2025, as a result of a complaint investigation. Not all staff had completed emergency preparedness training in Pro-Act within 90 days of hire, as required and outlined in the Plan of Operation/Program Statement. LPA provided a one-month timeframe to complete the Plan of Correction (POC), which was due on January 11, 2026. Unfortunately, the POC was not completed due to insufficient availability of Pro-Act training dates. LPA was unable to conduct the 10-day follow-up visit to assess penalties. On today's date, LPA re-assessed the deficiency in accordance with California Code of Regulations (CCR), Title 22, Division 6, Section 80022(k) - Plan of Operation. All staff must receive Pro-Act training within 90 days of hire. Please refer to the attached LIC 9099-D for additional details. An exit interview was conducted, appeals rights discussed, and a copy of this report was provided to Program Supervisor, Mandave Sandhu. Her signature confirms receipt of the report.

met_with: Mandave Sandhu - Program Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On March 04, 2026, at 10: AM, Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced comprehensive inspection at the above listed facility. LPA Medina met with Carolyn Williams, Administrator, and conducted a comprehensive tour of the facility, both inside and outside. Program Director, Mandave Sandhu assisted with the inspection as well. The group home is licensed to serve six clients. Present during the inspection was 1 clients and 4 staff members. During the visit staff was working on their Pro-Act training for a pending Plan of Correction. At approximately 10:45 a.m., LPA began reviewing staff and client files. Files were selected at random. LPA began with the staff files. LPA observed CPR certificates, criminal record clearances, and training records. Staff reviewed either met the educational requirements or satisfied the one-year experience requirement for the population served. However, documentation of required facility manager training was not found in the file. In accordance with California Code of Regulations (CCR), Title 22, Section 84065(k)(5), Personnel Requirements, facility managers are required to complete training that includes interaction with the Department, including inspection authority, licensee appeal rights, and interaction with placement agencies. LPA reviewed program statement and confirmed this training is listed under Facility Managers. Additionally, all but one staff member had a health screening on file. The Program Director stated that previously the TB test alone would suffice for health sceening; however, this does not align with Title 22 requirements as stated in Section 80065(g)(2), Personnel Requirements. LPA referred the facility to LIC 503 as a reference for the required physician-completed health screening form. Due to the miscommunication regarding the health screening requirement, LPA issued a Technical Violation. LPA then reviewed staff training records. During review of a previous licensing visit, LPA noted that the facility did not have documentation of emergency intervention training. Staff are currently in the process of completing Pro-Act training to satisfy the Plan of Correction issued on February 24, 2026. All staff training documents were maintained in a single folder. LPA advised the facility to maintain individualized training files for future licensing visits. Continues on LIC809-C At approximately 12:00 p.m., LPA began reviewing client files. Four client files were reviewed for the clients present during the inspection. The files contained admission agreements, emergency information, medical and mental health assessments, Medication Administration Records (MAR), Personal Rights forms, and client inventories. However, LPA identified that two clients did not have documentation of a TB test on file, and a Type B deficiency was issued. Additionally, two client files were missing signed complaint grievance forms. A Technical Violation was issued for this item, as the complaint grievance procedures were properly posted on the wall. LPA reminded staff of the requirement to review the grievance form with each client, obtain the client's signature, and maintain the signed form in the client's file. At 1:15 p.m., LPA conducted a walk-through inspection of the facility. The home consists of four bedrooms and three bathrooms, one of which is designated for staff use only. Required facility documents, including the license, grievance procedures, Personal Rights poster, facility sketch, meal menu, and other required postings, were properly displayed throughout the premises. LPA observed that all sharp objects and chemicals were securely locked, and trash was properly secured. The facility maintained the required food supply, including two days' worth of perishable food and seven days' worth of nonperishable food. Medications were stored in a locked cabinet located in the garage. LPA tested the water temperature and recorded 109 degrees Fahrenheit in the kitchen and 118 degrees Fahrenheit in the clients' bathroom, both of which are within the required range. The thermostat was set at 72 degrees Fahrenheit, which is also within the required range. No deficiencies were noted during this portion of the inspection. At approximately 2:30 p.m., LPA began reviewing the facility's disaster preparedness plan, operational requirements, and Emergency Intervention Plan. Disaster drills were reviewed and found to be conducted quarterly as required. The emergency disaster plan was reviewed and found to be current and up to date. LPA also reviewed emergency client folders, which contained essential documentation, including consent forms, immunization records, and medication lists. As previously stated, all staff are currently in the process of completing Pro-Act training. Mandave Sandhu was certified as a Pro-Act instructor on February 13, 2026. The facility remains under a provisional license. Due to deficiencies cited during the provisional period, the Department will exercise its authority to extend the provisional period for an additional three months. At this time, two deficiencies were cited in accordance with California Code of Regulations (CCR), Title 22, Sections 84065(k)(5) and 80069(c)(1). The comprehensive inspection has been completed. An exit interview was conducted at approximately 4:00 p.m., and a copy of this report was provided to Mandave Sandhu, Program Director. A signature on this report acknowledges receipt.

met_with: Mandave Sandhu - Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On 03/18/ Licensing Program Analyst (LPA) Jonathan Medina made a visit to the facility to amend a report made on 03/11/2026. LPA met with Administrator, Carolyn Williams and informed them of the purpose of the visit. The reports were amended to replace the deficiency and include a new Plan of Correction (POC). An exit interview was conducted, appeals rights discussed, and a copy of this report was left with the facility. Signature on this report acknowledges receipt.

met_with: Carolyn Williams - Administrator


raw_content:
Narrative:
The facility is being cited under California Code of Regulations (CCR), Title 22, Division 6, Section 80068(h) Admission Agreement. Please refer to the attached LIC9099-D for more details. An exit interview was conducted, appeals rights discussed, and a copy of this report was provided to Administrator, Carolyn Williams. Her signature confirms receipt of the report.

Investigation Findings:
13On March 11, 2026, at 10:40 a.m., Licensing Program Analyst (LPA) Jonathan Medina conducted a complaint inspection at the facility and spoke with Facility Manager, Kim Patton. The purpose of the visit was to deliver findings for the above listed complaint allegation. Through confidential interviews and a review of facility records, the preponderance of evidence standard has been met. The allegation that facility staff did not consult with appropriate parties regarding a minor's care is SUBSTANTIATED. The investigation determined that a resident had an out-of-state trip that was not approved by the resident's primary social worker. The trip was approved only by the facility without notifying primary social worker. As the resident is a foster youth, out-of-state travel requires coordination with the placing agency and approval through the appropriate court process (ex parte) involving the resident's authorized representatives. The group home admission agreement notes the facility will "Immediately notify agency of significant changes in the child's health, behavior or location". Continues on LIC9909-C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Joel Segura LICENSING EVALUATOR NAME: Jonathan Medina 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 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: DELTA SERENITY HOMEFACILITY NUMBER: VISIT DATE: 03/11/2026

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

met_with: Kim Patton - Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 04/14/2026 at 11:45 a.m., Licensing Program Analyst (LPA) Jonathan Medina conducted an unannounced inspection at the facility and met with Carolyn Williams, Administrator to follow up on outstanding Plans of Correction (POCs). LPA Medina disclosed the purpose of the visit and was granted entry. At the time of the inspection, there was 3 staff member and 2 clients present. On 03/04/2026, LPA Medina conducted the facility's comprehensive inspection. LPA has not received POCs for the following deficiencies. California Code of Regulations, Title 22, Section 84065(k)(5) Personnel Requirements. California Code of Regulations, Title 22, Section 80069(c)(1) Client Medical Assessment. During today's visit, LPA Medina reviewed the Plans of Correction (POCs) with Carolyn Williams. Both POCs were due on 03/31/2026. During the visit, LPA followed up with Administrator Carolyn Williams regarding the status of both POCs. She informed LPA that a TB test was completed for one client, and the other client has been discharged. Regarding staff training for facility managers, all facility managers have completed the required training as outlined in Title 22. Both POCs will be cleared and sent together once LPA reviewed all staff training certificates are complete. Additionally, on todays visit LPA also interviewed one client. LPA Medina also did a walk-through of the home and observed it was clean, in good repair, and observed the required regulatory amount of food in refrigerator and pantry. An exit interview was conducted. The report, along with appeal rights, was reviewed with and provided to Carolyn Williams. Signature on this report acknowledges receipt.


facility_name: DIAMONDS IN THE ROUGH GROUP HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 08/23/21 at 9: AM, Licensing Program Analyst's (LPAs), Pamela Silva and Juliet Robles, conducted an unannounced Post Licensing inspection at the facility and met with Dr Dwon Phillips, Administrator. This is a 24-hour facility which offers services and supervision to ambulatory clients with developmental disabilities. The facility is licensed for a capacity of four (4) clients, male or female ages 8 to 17 years old. There are currently three (3) clients in placement. The LPAs requested the following items and information: Personnel Report LIC 500, client roster, Plan of Operation/Program Statement (POO/PS), Board of Directors Meeting Minutes, and client and staff files. At 9: AM, LPAs and the Administrator did a walkthrough of the entire facility. The facility is clean, safe and in good repair. All exits and hallways were observed to be free and clear of hazards and obstruction. There are no bodies of water in the premises. There are no weapons or firearms in the facility. Facility has all required posters throughout the facility. Smoke detectors and carbon monoxide alarms were tested and are operable at the time of the inspection. Hot water temperatures are maintained between 105 and 120 degrees (F). Temperature in clients' rooms are maintained between 68 and 85 degrees (F). All sinks, showers and toilets were clean and in working order. First aid kit was readily available and complete. Medications were observed to be centrally locked and are accessible only to staff responsible for stored medications. Medication Administration Records (MAR) versus medication logs were checked. The facility has perishable food supplies for at least 2 days and non-perishable food supplies for two weeks. The facility provides nutritious snacks between meals. Food Menu is posted. Knives and other sharps were observed to be locked in the kitchen cabinet. Disinfectants, cleaning solutions and toxins are locked and inaccessible to clients. Children live in a safe, healthy and comfortable home. Bedrooms are accommodating of all required furnishings. Individual beds are in good repair, equipped with good springs, clean mattresses and pillows observed. Adequate supply of additional bedding and linens observed. All children attend school when school is in session. The facility's Emergency Disaster Plan needs to be updated per Provider Information Notice (PIN) 21-03-CRP 2020. At 10: AM, LPAs reviewed three (3) client and five (5) staff files. All facility staff or other individuals who require caregiver background checks have received DOJ/FBI criminal record and child abuse index check clearances or exemptions. At the conclusion of the inspection, LPAs discussed the findings with the facility administrator. LPAs issued five (5) Technical Advisories on the following: CCR 84365(d)(1)(A) and 84365((d)(1)(C) Emergency Intervention Plan, CCR 84065(i)(3) Staffing Records, CCR 84070(b)(12) and CCR 84070(b)(13) Client Records. LPAs agreed to work with facility administrator to collaborate with guidance to get the facility in compliance with CCR Regulations. The administrator was provided information on where to locate Provider Information Notices (PINs), guidance of the new CARE Tools Inspection Process and Guardian. Exit interview was conducted and a copy of this report, LIC9102TAs and the confidential names list were provided to the Administrator.

met_with: Dr, Dwon Phillips


summary: Facility Evaluation

raw_content:
Narrative:
On 09/24/21, at 1:30 pm Licensing Program Analyst (LPA) Belinda Gilmer made an unannounced case management visit to the above facility. The purpose of the visit was to verify information Community Care Licensing received regarding the facility staff contacting the client's placement agency requesting the removal of the children because they were closing in fourteen (14) days. When LPA arrived at the home no one answered the door, the ring doorbell wasn't working, but the home doorbell worked. LPA rang the doorbell, knocked on the security door, walked around the home with no answer, and left a business card on the door. LPA Gilmer knocked on the neighbors at 15313 doors a young lady answered said she hadn't seen anyone at 15312 and that her mother has the telephone number of the licensee. LPA left a card and asked if she would have her mother call LPA with the telephone number. LPA also knocked on 15318 and 15319 doors no one answered. LPA later learned that the Licensee/Owner of the group home Dwon Phillip Hill passed away on 09/23/21. No further information has been provided.


facility_name: DISCOVERY ADOLESCENT PROGRAM II

summary: Facility Evaluation

raw_content:
Narrative:
On August 24, 2022 at 9: AM, Licensing Program Analyst (LPA) Charmetha White arrived at the above facility, for the purpose of conducting a Required 2-Year Inspection. LPA met with Blaise Eversole, Milieu Manager who granted access to the location. LPA met with Maribel Eck, On Call Program Director and together a tour of the entire facility was conducted both inside and out. The facility is a private pay substance abuse & mental health facility licensed to provide care and supervision services for six (6) children ages 11-17 years old, ambulatory only. The census at the time of the inspection was six (6). The facility is a two story 3-bedroom, 2 ½ bathroom house which includes a Living room, Dining room, Kitchen, Laundry area, a Classroom area, Staffing offices, a Den/Group room, a Wrap-around Patio, a Gurage, and a Backyard. The home is set up as follows: Living room: Is equipped with two sofas. Dining room: Is equipped with a table with seating for 8 people. Kitchen: Is equipped with is 5 burner gas operated stove/oven (4 out of 5 were operational), a double door refrigerator/freezer, a dishwasher, and a microwave. The home was observed to have one-week supply of non-perishable and two days of perishable foods, including nutritious snacks, and the weekly menu is posted. The trash can is equipped with tight fitting lid. Laundry area: Is located in the locked staffing area. It is equipped with a washer/dryer, found to be in working order, and a locked storage cabinet containing all disinfectants, and cleaning solutions. Den: Is located on the second floor at the top of the stairs is used for group therapy sessions. It is furnished with equipped 3 sofas, a table with 8 chairs, and a mounted TV. This room has two separate doors leading to the outside wrap-around patio. Wrap-Around Patio: is covered, it has two (2) small locked storage bins, observed to store tools, two (2) seating areas, and a grill. Classroom: is equipped with tables, chairs, two (2) computers, school supplies, storage area for each client, and a sink for hand washing. Report continued on LIC 809C Gurage: is equipped with a pool table, a ping pong table, a locked deep freezer and refrigerator which stores extra food, and two locked storage cabinets which store the facilities emergency disaster equipment. Staffing Offices: are located on the first floor and remain locked. Backyard: has a basketball court. Bedroom #1- upstairs- two twin Beds, closet Space, dresser, window, working light, and an attached bathroom. Bedroom #2 - upstairs - two twin Beds, closet Space, dresser, window, and working light. Bedroom #3 - upstairs - two twin Beds, closet Space, dresser, window, and working light. Each room is occupied by two clients. Bathrooms: All bathrooms were checked and found to be in good repair and working order. The hot water temperature was tested and found to be between 105-120 degrees (F). The home was inspected, and the following was observed: The smoke and carbon monoxide detectors were tested and found to be in working order. The first aid kit was checked and found to be complete. The home has 3 regulation fire extinguishers. There is a working telephone readily accessible. Medications are locked in staffing office and made inaccessible to clients in care. Temperatures in client's room are maintained between 68-85 degrees (F). Sharp knives are locked in a toolbox stored in a locked pantry located at the front of the house. Overall LPA observed the home to be clean, safe, and sanitary. The front and backyard were clean and free of debris. Passageways, stairways, inclines, ramps and open porches are unobstructed. There are no firearms or dangerous weapons in the facility. There was no swimming pool or bodies of water located at the facility. The facility operates within license conditions and limitations including capacity limitations. LPA discussed and advised the Licensee to ensure the following: Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency or the Foster Care Ombudsperson, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. All posting requirements for Group Home Licensure and Emergency Plan were met. The Program has a total of fourteen Staff. LPA received copy of the LIC 500. LPA will return on a later date to review staff and client records and complete staff and client interviews. There were no deficiencies noted on this date. Exit interview was completed and a copy of this report was left at the facility.

met_with: Milieu Manager - Blaise Eversole & Maribel Eck - On Call Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On September 8, 2022 at 9: AM, Licensing Program Analyst (LPA) Charmetha White arrived at the above location for the purpose of reviewing staff and client records to complete the Required 2-Year Inspection which began on 08/24/2022. LPA met with the Program Director, Shelby Thirkill and Milieu Manager, Blaise Eversole who granted access to location and provided the files. The Program has a total of twelve staff. LPA reviewed six staff files, and interviewed five Staff. LPA observed all Staff records included annual personnel performance evaluations, all staff have met the education and experience requirements, and have completed the required training's. All staff that work directly with clients have current First Aid/CPR cards in their files. The Program currently has a total of twelve staff and six clients. LPA reviewed a total of six staff files and interviewed a total of five staff. LPA reviewed six client files and interviewed all six clients. There were no deficiencies noted on this date. An exit interview was conducted and a copy of this report was signed and left with the Program Director.

met_with: Milieu Manager - Blaise Eversole & Shelby Thirkill - Program Director


facility_name: DISCOVERY ADOLESCENT PROGRAM IV

raw_content:
Narrative:
There was no evidence to support C1's limitations on phone calls and family visits due to their non-participation in the program. Documentary evidence revealed C1's attendance and participation in some program group activities. There is no evidence or witnesses to support that "Facility staff did not seek minor appropriate medical attention". Based on the interviews conducted, the information gathered did not produce corroborating evidence to support the above said allegation. LPA Edison was unable to determine if the above said allegation occurred, therefore the allegation is determined 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 a violation occurred. If any additional information is received, this complaint can be amended, and the finding can be changed. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Program Director.

Investigation Findings:
13This an amended report from the original date of 12/12/2022. On December 12, 2022 at 2:29pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Discovery Adolescent Program IV and spoke with Evan Sahn, Program Director. The purpose of this visit was to deliver the findings for the above complaint allegation. During the investigation LPA Edison interviewed and accounted for all available relevant parties; and gathered pertinent information regarding the allegation. Based on the interviews and statements obtained during the investigation process, the allegation could not be corroborated. Confidential interviews with staff, client, and witnesses revealed facility staff transported client to urgent care on multiple occasions to have eye infection treated. Inconsistent statements did not corroborate staff denied Client #1 (C1) participation in the program at Discovery Adolescent Program IV, however, it was stated that as a result of the temporary vision problems and eye pain C1 suffered, C1 was unable to participate in program at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison 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: DISCOVERY ADOLESCENT PROGRAM IVFACILITY NUMBER: VISIT DATE: 12/12/2022

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

met_with: Evan Sahn-Program Director


summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Investigation Findings:
13On 1/30/2025 at 1:00pm Licensing Program Analyst (LPA) Justine Armstrong conducted an unannounced visit to Discovery Adolescent Program IV to conclude the investigation of the above allegations and deliver the findings. LPA met with Blaise Eversole, who granted access to the facility, and together, they discussed the investigation details. During the investigation process, all relevant parties have been accounted for. It was reported that Facility staff did not prevent inappropriate behaviors between youths in care. After conducting confidential interviews and reviewing documents, there was insufficient evidence or testimony to substantiate the allegations. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. LPA determines that the allegation of Neglect/Lack of Supervision is Unsubstantiated There were no deficiencies cited. An exit interview was completed, and a copy of this report was provided to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Enrique M Hernandez LICENSING EVALUATOR NAME: Justine Armstrong 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: 60

met_with: Blaise Eversole


raw_content:
Investigation Findings:
13On July 25, 2025, at 3:00PM , Licensing Program Analyst, (LPA), Justine Armstrong, conducted an unannounced visit to DISCOVERY ADOLESCENT PROGRAM IV facility for the purpose of delivering findings for a complaint investigation alleging that staff did not adequately supervise minor resulting in minor leaving the facility This complaint was received by the Department on May 21, 2024. Upon arrival, LPA was granted access to the facility by the Facility Manager Blaise Eversole. During the investigation process, all relevant parties have been accounted for. After conducting confidential interviews and reviewing documentary evidence, there was insufficient evidence or testimony to substantiate the allegations. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. The Department has decided that the allegation are Unsubstantiated, but if any additional information is received, this complaint can be amended and the finding can be changed. There were no deficiencies cited. An exit interview was completed, and a copy of this report was provided to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Enrique M Hernandez LICENSING EVALUATOR NAME: Justine Armstrong 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:


summary: Facility Evaluation

raw_content:
Narrative:
On September 21, 2022 at 11: AM, Licensing Program Analyst (LPA) Charmetha White arrived at Discovery Adolescent Program IV, for the purpose of conducting a Required 2-Year inspection. LPA met with Evan Sahn, Program Director and Elizabeth Smith, Milieu Manager, and was granted access into the facility. The facility was toured at 11: AM both inside and out. The facility is a private pay mental health facility licensed to provide care and supervision services for sixteen (16) children, ages 11-17 years old, ambulatory only. The census at the time of the inspection was nine (9). The facility is two story, 8 bedroom, 7 bathroom house and it is set up as follows: Bedrooms: there are four bedrooms each, on opposite wings of the second floor, and separated by the staff station and classroom area. Each bedroom has two twin beds, which include two attached storage drawers; two separate closets; working lights; and non-operating windows. Bathrooms: there are three bathrooms on the first floor, and four bathrooms, two in each wing, on the second floor. Laundry rooms: there are a total of two laundry rooms, one in each wing on the second floor, and both remained locked. Dining Area: equipped with multiple tables and chairs. Kitchen: equipped with an electric stove, two ovens, 3 microwaves, a double door refrigerator, a double door freezer, a pantry, and a dishwasher. Classroom area: equipped with computers, chairs, TV, and bookshelves. Outdoor recreation area: there are two outdoor areas, one on each side of the dining room area. The areas are equipped with basketball court, ping pong table, and multiple sitting areas. Medication room: located on the first floor and remains locked. Report continued on LIC 809C. Staffing offices/Therapist rooms: there two staffing offices and five therapy offices. The carbon monoxide detectors were tested and found to be in working order. Facility fire alarm is hard wired and was not tested during inspection. Medications are locked medication room and made inaccessible to clients in care. Additionally, medications that require refrigeration is stored in a double locked refrigerator located in the medication room. First Aid Kit was checked and found to be complete. Sharp knives are stored in a locked box locked in the kitchen pantry. The facility has 7 regulation fire extinguishers. The facility has a working telephone readily accessible. Menu is posted in kitchen area. Facility has non-perishable foods for one week, perishable foods for two days, and clients are provided nutritious between meals. Temperatures in client rooms and common areas were found to be between 68 - 85 degrees (F). Hot water temperature was tested and found to be between 105 - 120 degrees (F). Disinfectants/cleaning solutions and poisons inaccessible to clients. Overall LPA observed the facility to be clean, safe, sanitary and in good repair. The front yard and outdoor recreation area were clean and free of debris. Passageways, stairways, inclines, ramps and open porches were unobstructed. There are no firearms or dangerous weapons in the facility. There was no swimming pool or bodies of water located at the facility. The facility operates within license conditions and limitations including capacity limitations. LPA discussed and advised the Licensee to ensure the following: Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency or the Foster Care Ombudsperson, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. All posting requirements for Group Home Licensure and Emergency Plan were met. Program Director provided LPA with a copy of the Personnel Report (LIC 500). LPA will return to facility at a later time to review client and staff records. There are no deficiencies observed or cited at this site visit. Exit interview was completed and a copy of this report was left at the facility.

met_with: Evan Sahn- Program Director & Elizabeth Smith - Milieu Manager


summary: Facility Evaluation

raw_content:
Narrative:
On September 29, 2022 at 11: AM, Licensing Program Analyst (LPA) Charmetha White arrived at the above location for the purpose of reviewing staff and client records to complete the Required 2-Year Inspection which began on 09/21/2022. LPA met with the Program Director Evan Sahn and Milieu Manager Elizabeth Smith who granted access to location and provided the files. The Program has a total of twelve staff. LPA reviewed ten staff files, and interviewed five Staff. LPA observed all Staff records included annual personnel performance evaluations, all staff have met the education and experience requirements, and have completed the required training's. All staff that work directly with clients have current First Aid/CPR cards in their files. The Program currently has a total of eleven clients. LPA reviewed a total of four client files and interviewed a total of four clients. There were no deficiencies noted on this date. An exit interview was conducted and a copy of this report was signed and left with the Program Director.


summary: Facility Evaluation

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Narrative:
On December 5, 2023, Licensing Program Analyst (LPA) Charmetha White made an unannounced visit to Discovery Adolescent Program IV, for the purpose of conducting a Case Management for Special Incident Report #11-2023-34-CM-08. The incident occurred 11/20/2023 and the incident report was received by the Department on 11/27/2023. LPA met with Program Director, Shelby Thirkill and and discussed the incident. During this visit, LPA conducted confidential interviews. LPA was informed that Client #1 and Client #2 are no longer in placement at the facility. LPA requested a copy of the following documents: LIC 500 and contact information for Client #1 and Client #2. Additional interviews will be conducted on a later date. Based on interviews and information gathered, this case management needs further investigation. Exit interview was conducted, and a copy of this report was left with the Program Director.

met_with: Shelby Thirkill - Program Director


summary: Facility Evaluation - 1 deficiency

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Narrative:
On September 18, 2025, at 9: AM, Licensing Program Analyst (LPA) Aimee Moratalla arrived at the above facility for the purpose of conducting an Annual/Random inspection of the group home. This is a private pay, two-story substance abuse and mental facility. LPA met with the Nurse, Ashley Carter who granted access to the facility. At 10: AM an in-depth tour of the interior and exterior of the facility was conducted with Milieu Manager (MM), David Woodall. The facility is licensed to provide care and supervision for sixteen (16) children ages 11-17 years old, ambulatory only. The census today is eleven (11). The home was inspected, and the following were observed: The facility is set as follows: Bedrooms: There is a total of eight bedrooms equipped with two twin beds each (located on the second floor; girls and boys on the opposite wings of the floor separated by a staff station and classroom area). Bathrooms: There are seven bathrooms (three on the first floor, four on the second floor), Laundry rooms: There are a total of two, both remained locked. There are two multi-purpose rooms downstairs, used for group therapy and a tv viewing with DVD player area. The kitchen and food storage area are all located on the 1st floor. On the 2nd floor, there is another multi-purpose area with computers and chairs. There are two outdoor recreation areas including a sports court and multiple activity/game options. The one on each floor which remained locked. The medication room is located on the 1st floor which remains locked with clients' medication. Offices/Therapy rooms are located on the 1st floor. The staff station is located on the 2nd floor. Page 1 of The facility is clean, safe, sanitary and in good repair. Passageways, stairways, inclines, ramps and open porches are unobstructed. Disinfectants/cleaning solutions and poisons inaccessible to clients. Hot water temperatures are maintained between 105 and 120 degrees (F). Children in care are always supervised & protected. Facility has non-perishable foods for one week and perishable foods for two days. The facility provides nutritious snacks and meals. Medications are locked and accessible only to employees supervising stored medications. Facility posts child's rights if licensed to provide foster care for six or more children. Children are not restricted in telephone use except by court order. Children accorded dignity in personal relationships with others in the home. Children live in a safe, healthy, comfortable facility and are treated with respect. Children can contact the licensing agency or foster Care Ombudsperson in confidence without threats or punishments for making complaints. Children attend school, extracurricular, cultural and personal enrichment activities. Facility maintains personal property and valuables. Facility operates within license conditions & limitations including capacity limitation. Program Administrator (PA), Blaise Eversole provided a copy of the Personnel Report (LIC 500) and Client Roster (LIC 9020). LPA conducted the LPA will return to the facility later to complete the annual visit. As per PA, the cameras in the facility are non-operational. All fire extinguishers were visually inspected on 9/1/25 by PA. Alarm system was tested and working. LPA reviewed the following sections: Physical plant, operations, and disaster preparedness. LPA reviewed the LIC Personnel Report and Guardian Roster. LPA informed the Program Manager that the following three (3) staff members: John Garcia, Sandra Mendoza, and Ashley Carter, who were working and present in the facility at the time of the inspection, were not associated to the facility per licensing regulations. The PA was informed that the facility will be cited for, 80019(e) Criminal Record Clearance; LPA will return at a later date to review client files and complete Staff file review. Exit interview was completed and a copy of this report will be emailed to the Program Administrator. Page 2 of 2

Deficiencies:
80019(e): Criminal Record Clearance

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

met_with: Program Administrator, Blaise Eversole


summary: Facility Evaluation - 1 deficiency

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Narrative:
On September 22, 2025, at 09: AM Licensing Program Analyst (LPA) Aimee Moratalla made an unannounced visit to the above facility for the purpose of conducting a Case Management - Annual Continuation inspection from the initial visit conducted on 9/18/2025. LPA was met by Milieu Manager (MM), David Woodall and informed him the purpose of the visit was to conduct and complete the Annual inspection. LPA inquired about the current census, requested the staff roster. LPA requested staff and client files, and MM sat with LPA because the files are stored electronically through Kipu App and Workforce App. At the time of the visit the census is one (1). File reviews: LPA conducted 3 staff files and 3 client files. Interviews Conducted: 3 staff and 3 clients During the time of inspection, LPA completed the related Care Tools and addressed the following sections: Clients and staff files, interviews, and emergency intervention plan. PER California Code Regulations, TITLE 22, DIVISION 6, CHAPTERS 5, General Licensing Regulations the following deficiencies were observed and cited at the time of this inspection, 80066(a)(12)(B)(1) Personnel Records; 84064(b) Administrator Qualifications and Duties. An exit interview was conducted, and the Program Administrator was informed that the Annual Inspection was completed. A copy of this report will be emailed to the Administrator.

Deficiencies:
84064(b): Deficient Practice Statement
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2
3
4Based on interview and record review, the licensee did not comply with the section cited above which is not having a current and valid Administrator certificate which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/26/2025
Plan of Correction
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2
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4

title:
Administrator Qualifications and Duties

(b) Effective January 1, 2000, all group homes shall have a qualified and currently certified administrator.

This requirement is not met as evidenced by


summary: Facility Evaluation

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Narrative:
On September 22, 2025, Licensing Program Analyst (LPA) Aimee Moratalla made an unannounced visit to Discovery Adolescent Program IV, for the purpose of conducting a Case Management for Special Incident Report the department received on 09/11/25. The incident occurred on 09/04/2023. LPA met with Milieu Manager (MM), David Woodall and discussed the incident. The Staff and the Client involved were no longer in the facility. The Staff was not present in the facility during the visit and the Client left the facility on September 5, 2025. During this visit, LPA could not conduct any interviews as the individuals were not in available in the facility. LPA requested a copy of the following documents: LIC 500 and contact information for Client #1 and Staff#1. Additional interviews will be conducted on a later date. Based on information gathered, this case management needs further investigation. Exit interview was conducted, and a copy of this report was be emailed to the Program Director.

met_with: Blaise Eversole, Program Administrator


summary: Complaint Investigation - Unsubstantiated

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Investigation Findings:
13Licensing Program Analyst (LPA) Aimee Moratalla conducted a complaint investigation regarding the above allegations which were received by the Department on September 25, 2025. The investigation consisted of interviews with the reporting party, minors, and facility staff. Due to the facility closure, the findings will be sent by email on 03/16/26 to request for signature from the Director of Regulatory Affairs, Jeff Marshall through Adobe Sign. Information obtained through interviews with minors and staff revealed that the incident occurred in the recreation room while minors were watching a movie. One minor admitted to pinching another minor. Minors reported that staff members were present; however, none of the staff interviewed witnessed the incident and the minor did not report the incident to staff at the time it occurred. The facility reported they became aware of the incident after being notified by the complainant. Although the allegations may have occurred, there is not a preponderance of evidence to determine that the alleged violations occurred. Therefore, the allegations are unsubstantiated. No deficiencies are being cited at this time. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Enrique M Hernandez LICENSING EVALUATOR NAME: Aimee Moratalla LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Jeff Marshall, Director of Regulatory Affairs


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Narrative:
Confidential witness statements indicated that facility staff (S1 and S2) were conducting bedroom checks throughout the night every 15 minutes. Confidential witness statements revealed that C1 hid C2 under C1's blankets as facility staff conducted their routine bedroom checks. Confidential interviews stated that C1 and C2 did not remember the names of the facility staff on shift that night. Confidential witness statements disclosed that the allegation could not have happened on S1 and S2's night shift. Confidential interviews indicated that S1 and S2 are alert during their shifts. Confidential witness statements indicated that S1 and S2 conducted body and breath checks every 15 minutes and that all clients were asleep. Confidential witness statements indicated that S1 and S2 did not observe clients outside their bedrooms. Confidential witness statements disclosed that C2 would need to walk across the main common area where S1 or S2 were positioned to get to C1's bedroom on the opposite side of the facility. It is unknown which staff was on shift during the incident. Although confidential interviews stated that S1 and S2 did not observe clients outside their bedrooms, C1 and C2 engaged in consensual inappropriate sexual interactions during the staff night shift. Based on confidential interviews, the preponderance of evidence standard has been met, and the allegation that the minors (C1 and C2) engaged in inappropriate sexual interactions and staff are not providing adequate supervision is substantiated. The facility is cited for violation of Children's Residential Group Home Title Division Chapter Article Continuing Requirements 84065. Personnel Duties (b) Child care staff shall perform the following duties: (1) Supervision, protection and care of children individually and in groups at all times. Confidential witness statements disclosed that C1 and C2 engaged in inappropriate sexual interactions, and staff are not providing adequate supervision, which poses an immediate Health, Safety, or Personal Rights risk to children in care. An exit interview was conducted, appeal rights were explained, and a copy of this report was provided to Discovery Mood & Anxiety Program Riverside Facility Chief Executive Officer (FCEO) John Smith.

Investigation Findings:
13On October 19, 2023, at 12:16 pm, Licensing Program Analyst (LPA) Jose Gonzalez conducted an unannounced visit and met with Discovery Mood & Anxiety Program Riverside Facility Chief Executive Officer (FCEO) John Smith to deliver the findings for the above-stated allegation. LPA inspected Discovery Mood & Anxiety Program Riverside Group Home at 11:19 am on March 9, 2023; no health and safety hazards were observed. LPA reviewed two client's records (C1 and C2). During the investigation, interviews were conducted with six clients (C1, C2, C3, C4, C5, and C6), the Program Director (PD), the Education Liaison (EL), and two Facility Staff (S1 and S2). The Department received an allegation on March 3, 2023, that the minors (C1 and C2) engaged in inappropriate sexual interactions, and staff are not providing adequate supervision to minors (C1 and C2). Confidential witness statements disclosed that inappropriate sexual interactions occurred in C1's bedroom. Confidential witness statements revealed that C2 snuck out of their bedroom and placed clothes underneath their blankets to make it appear as if C2 was in bed sleeping.**CONTINUED on LIC 9099C** SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Cheraki Davis LICENSING EVALUATOR NAME: Jose Gonzalez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: DISCOVERY MOOD & ANXIETY PROGRAM RIVERSIDEFACILITY NUMBER: VISIT DATE: 10/19/2023

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


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Narrative:
Confidential witness statements indicated that the facility staff nurse (FN) and facility staff (FS) instructed C1 to remove their clothes from their underwear and put on the hospital gown provided by the facility staff. Confidential witness statements revealed that the FN and FS conducted a "body check" of C1. Confidential witness statements revealed that the body check consisted of C1 undressing down to their underwear and putting on the hospital gown provided. Confidential interviews stated that FN and FS instructed C1 to remove their clothes and underwear and for C1 to put on a hospital gown. Confidential interviews stated that FS and FN never instructed C1 to remove their underwear. Confidential interviews indicated that C1 was not provided with a safe and comfortable environment. Confidential witness statements disclosed that C1 did not feel comfortable and safe during the "body check." Confidential interviews stated that C1 felt vulnerable and violated during the "body check" procedure. Confidential witness statements indicated that C1 was not treated with dignity and respect. Confidential interviews stated that C1 did not want to complete a "body check." Confidential witness statements disclosed that C1 needed to complete a "body check" and was part of the admission intake process. Confidential interviews indicated that they were aware of the "body check" procedure as part of the intake process but unaware of the details of clients having to remove all their clothes and put on a gown. Confidential interviews stated that it was not indicated on the intake form that C1 was to undress down to their underwear and that C1 would be provided with a hospital gown to wear as FN and FS checked C1 for bruises, injuries, and marks. Based on confidential interviews and record review, the preponderance of evidence standard has been met, and the allegations that the staff violated the minor's (C1) personal rights, staff did not treat the minor (C1) with dignity and respect, and the staff did not provide a safe and comfortable environment are substantiated. The preponderance of evidence standard has been met. The facility is being cited for violation of the California Code Regulations Title Division Chapter Article Continuing Requirements, section Personal Rights (d) The licensee shall ensure that each child, regardless of whether the child is in foster care, is accorded the personal rights specified in Welfare and Institutions Code section 16001.9...Confidential witness statements disclosed that staff violated C1's personal rights and did not provide a safe and comfortable environment for C1, which poses a potential Health, Safety, or Personal Rights risk to children in care. An exit interview was conducted, appeal rights were explained, and a copy of this report was provided to Discovery Mood & Anxiety Program Riverside Facility Chief Executive Officer (FCEO) John Smith.

Investigation Findings:
13On April 29, 2024, at 11:48 am, Licensing Program Analyst (LPA) Jose Gonzalez conducted an unannounced visit and met with Discovery Mood & Anxiety Program Riverside Facility Chief Executive Officer (FCEO) John Smith to deliver the findings for the above-stated allegations. LPA inspected Discovery Mood & Anxiety Program Riverside Group Home at 9:23 am on June 20, 2023; no health and safety hazards were observed. LPA reviewed two client's records (C1 and C2). During the investigation, interviews were conducted with five clients (C1, C2, C3, C4, and C5), the Program Director (PD), the Facility Nurse (FN), and a Facility Staff (FS). The Department received an allegation on June 16, 2023, that the staff violated the minor's (C1) personal rights, the staff did not treat the minor (C1) with dignity and respect, and the staff did not provide a safe and comfortable environment for C1. Confidential witness statements disclosed that facility staff violated C1's personal rights. R- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: DISCOVERY MOOD & ANXIETY PROGRAM RIVERSIDEFACILITY NUMBER: VISIT DATE: 04/29/2024

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


raw_content:
Narrative:
Confidential interviews indicated that the maintenance workers repaired all broken fixtures, furniture, and tiles. Other confidential interviews indicated that the facility has a housekeeper who cleans the facility's common area, nurses' station, staff offices, and staff restrooms. Confidential interviews revealed that the housekeeper cleans the clients' bedrooms, restrooms, and dining areas. Confidential interviews stated that all broken furniture and fixtures are reported to administrative staff to submit a request for maintenance repairs. The Department also received a second allegation that the facility staff does not provide staff/client ratio care and supervision to minors. Confidential interviews indicated that the facility maintained one staff per eight clients ratio. Other confidential interviews indicated that the staff-to-client ratio is one staff per six clients. Confidential interviews stated that the nurse will assist with supervision when staff leave on break. Confidential interviews revealed that administrative staff and nurses are utilized to ensure the facility maintains one staff per six-client ratio. During the inspection, LPAs and LPM observed one staff per four clients at the facility. The Department also received a third allegation that the facility does not have trained staff to meet the minor's medical needs. Confidential interviews indicated that the staff does not know how to check the client's vitals or properly distribute medication to clients. Confidential interviews indicated that the facility nurse manager (NM) trains particular staff to check the client's vitals and dispense medication. Confidential interviews stated that NM would monitor the staff to check the client's vitals and dispense medications to ensure the staff followed the procedure. Confidential interviews indicated that there is a nurse on duty every shift: morning, afternoon, and overnight. Confidential interviews stated that not all the clients need their vitals checked before and after medication passing. The Department also received a fourth allegation that the facility staff does not ensure minors are provided adequate food service. Confidential interviews revealed that the facility staff do not have a food handlers' card. In addition, confidential interviews also stated that leftover meals are left on the counter for hours. During the inspection, LPA observed the food handler cards in the staff facility file and did not observe food being left on the kitchen counters. Confidential interviews stated that the facility has a lead chef (LC) and a weekend chef (WC). Confidential interviews indicated that LC prepares and cooks lunch and dinner during the week. Confidential interviews stated WC prepares and cooks lunch and dinner on the weekends. ******CONTINUED on LIC 9099C****** Confidential interviews indicated that meal leftovers are stored in plastic Ziplock bags and containers after the food has cooled down, labeled with the date the meals were cooked, and stored inside the refrigerator by LC and WC. Confidential interviews indicated that the leftover meal is discarded three days after the date the meals were cooked. Confidential interviews stated the facility staff served the clients prepackaged food for breakfast, such as cereal, bagels, milk, and juice. Confidential interviews indicated the facility staff cooks and prepares the meals. The Department also received a fifth allegation that the facility staff does not ensure the facility is free of insects. Confidential interviews revealed that they had observed flies and roaches inside the facility. Confidential interviews indicated that they had not seen an infestation of insects inside the facility. However, other confidential interviews stated that they have occasionally observed a fly and spider inside the facility. Confidential interviews stated that pest control sprays the inside and outside of the facility every three months. Based on inconsistent confidential interviews and facility record review, the facility staff does not ensure the facility is clean, safe, sanitary, and in good repair at all times for the safety and well-being of clients, the facility staff does not provide staff/client ratio care and supervision to minors, the facility does not have trained staff to meet minor's medical needs, the facility staff does not ensure minors are provided adequate food service, the facility staff does not ensure minors are provided sufficient food service, and the facility staff does not ensure facility is free of insects are unsubstantiated. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted, appeal rights were explained, and a copy of this report was provided to Discovery Mood & Anxiety Program Riverside and met with Program Director (PD) Olevia Labeeb.

Investigation Findings:
13On September 17, 2024, at 11:07 am, Licensing Program Analyst (LPA) Jose Gonzalez conducted an unannounced visit and met with Discovery Mood & Anxiety Program Riverside Program Director (PD) Olevia Labeeb to deliver the findings for the above-stated allegations. LPA inspected Discovery Mood & Anxiety Program Riverside Group Home at 9:00 am on June 19, 2024; no health and safety hazards were observed. LPA reviewed six client's records (C1, C2, C3, C4, C5, and C6). During the investigation, interviews were conducted with six clients (C1, C2, C3, C4, C5, and C6), the Lead Chef (LC), the Nurse Manager (NM), the Mental Health Technician (MT), the Education Liaison (EL), and the Interim Program Administrator/ Milieu Manager (MM). The Department received a complaint on June 11, 2024, that the facility staff does not ensure the facility is clean, safe, sanitary, and in good repair at all times for the safety and well-being of clients. Confidential interviews indicated they observed mold in the bathrooms, and some floor tiles were lifting. *R- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: DISCOVERY MOOD & ANXIETY PROGRAM RIVERSIDEFACILITY NUMBER: VISIT DATE: 09/17/2024

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

met_with: Program Director (PD) Olevia Labeeb