summary: Facility Evaluation

raw_content:
Narrative:
On August 19 2024 at 12: PM, LPA Guadalupe Munoz conducted an unannounced post-licensing annual inspection. LPA met with Licensees Jackson Inima. The purpose of this visit is to conduct an annual required inspection of the small family home. The home is licensed for 2 ambulatory clients. The home resides in an apartment complex with multiple units the apartment is a second floor unit. The front door opens to the living room which is adjacent to the dinning and kitchen area. The balcony is located next to the dinning area. The hallway connects two bathrooms and 3 bedrooms. Bedroom #1, It was furnished with two twin beds. It is for two residents and has ample storage space. Bedroom #2, The room consisted of a queen bed and a toddler bed. It will sleep two family members Bedroom #3, The master bedroom was furnished with a king-sized bed. It sleeps applicant and spouse. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Kitchen appliances were in a working order.Sharp knives are locked and inaccessible and stored in a locked box in the upper kitchen cabinet. The medication will be locked in a medication box in the hallway cabinet. Cleansers/chemicals are locked and stored in the lower cabinet (kitchen) and lower cabinet (bathroom) and hallway cabinet. There were no guns or weapons as stated by licensee. Food was properly stored. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items and it is kept in kitchen cabinet. A Fire extinguisher was observed outside apartment doorway. . The Facility Sketch, Emergency Disaster Plan, visitation policy, and Personal Rights were posted. There are no deficiencies to be cited at this time.

met_with: Jackson Inima


state: CA

facility_name: PERPETUA SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 05/29/25, at 8: AM, Licensing Program Analyst (LPA) Gilbert Marquez met with Jackson Inima, LIcensee, for the purpose of conducting an annual inspection of the facility. The Facility is licensed to serve two ambulatory children. The current census is zero. The home resides in an apartment complex with multiple units, and the apartment is a second floor unit. The front door opens to the living room which is adjacent to the dining and kitchen area. The balcony is located next to the dinning area. The hallway connects two bathrooms and 3 bedrooms. Bedroom #1, was furnished with two twin beds. It is for two residents and has ample storage space and had all required bed linens. Bedroom #2 and #3 are for the Licensee and his family. Currently only his grandson and adult daughter reside in the home. Cient bedroom is arranged so that no more than two children share the room, and there is one child per bed. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Sharp knives are locked and inaccessible and stored in a locked box in the upper kitchen cabinet. The medication will be locked in a medication box in the hallway cabinet. Cleansers/chemicals are locked and stored in the lower cabinet (kitchen) and lower cabinet (bathroom) and hallway cabinet. Hot water temperature measured at 105.8 degrees Fahrenheit, which is in the regulatory range of 105 to 120 degrees Fahrenheit. There were no guns or weapons as stated by licensee. Food was properly stored. Trash cans for storage of solid waste have tight fitting lids. First Aid kit was accessible with all required items. A Fire extinguisher was observed outside apartment doorway. Jackon was the only interview that was done (S1). No deficiencies cited during today's inspection. An exit interview was conducted, and a copy of this report along with LIC Confidential Names List was provided to Licensee Jackson Inima. A copy of this report will be placed in the facility file.

report_type: Facility Evaluation

visit_type: Annual

met_with: Jackson Inima, Licensee


facility_name: PHAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On September 18, 2025, at 10:30AM, Licensing Program Analyst (LPA) Rachel Vanegas met with Phamily Home Small Family Home Applicant, Mia Pham, at the Riverside Children's Residential Regional Office for the purpose of conducting a Component II meeting. LPA discussed corrections and revisions needed for the Program Statement. The following is a summary of the corrections and revisions discussed and requested. These revisions are due by close of business on October 3, 2025. Section A Documents A1. Application (LIC 200) Please review and revise #7, it requests the facility email address and you listed a physical address. Please review and revise #13 to ensure alignment with the capacity being requested. A2. Applicant Information (LIC 215) Please provide training certificates to reflect applicable training requirements for qualifications and experience verification. A3. Designation of Facility Responsibility (LIC 308) Please review and revise this document, "To be hired" is not needed. A9. Budget Information (LIC 420): Please review and revise. The income listed does not match the total income provided. A10. Personnel Report (LIC 500) Please review and revise to account for care and supervision for 24hrs a day, 7 days a week. **** A11. Personnel Record (LIC 501) Please provide training certificates to reflect applicable training requirements for qualifications and experience verification. A12. Health Screening Report - Facility Personnel (LIC 503): Please provide a health screening and tuberculosis test screening results dated within one year. A14. Emergency Disaster Plan (LIC 610C) Section I: Please review and revise "Caregiver" to "Licensee". Section IV: Please provide signed authorization letters for the use of relocation sites from the agency or business owners, including their name and job title. A15. Facility Sketch (LIC 999) All windows and doors must be identified on the sketch of the facility. Indicate exit routes by number as shown on the LIC 610C Emergency Disaster Plan Please include identification of camera locations (inside and outside of the home) Section B Documents B7. Facility Program Description Please clearly state placement source(s) for clients intended for your program Please review and revise Page 2. It is currently a duplicate page. Program Methods Please review and revise references to Specialized Health Care Needs (Pg. 6) Please review and clarify client population intended for your program (Pg. 6) Health Related Services Please review and clarify how you will notify authorized representatives, etc. for health related emergencies (Pg. 7) Please provide timeframes for reporting requirements of incident reporting (Pg. 7) **** Telephone Please review and revise responsible party for long distance calling charges (Pg. 7) Medication Procedures Please review and clarify #12 to identify staff frequency for audits to be conducted (Pg. 9) Please review and revise responsible party for cost of medications. (Pg. 9) Please review and clarify #17 to include documentation to be used to track medication administration (LIC 622A and/or LIC 622B) (Pg. 10) Describe where first aid supplies and a current edition of a first aid manual approved by the American Red Cross, the American Medical Association or a state or federal health agency will be stored. Describe how psychotropic medication shall only be used in accordance with the written directions of the physician prescribing the medication and in accordance with authorization requirements specified in Sections 369.5(a)(1) and 739.5(a)(1) of the Welfare and Institutions Code and Section 83070(b)(11). Please include a statement that there can be temporary administration of psychotropic medication authorized on the JV220(A) Physician's Statement while the JV223 is pending Describe how the facility will obtain a copy of the current court order, or written authorization of the child's parent or guardian, for each psychotropic medication, as defined in Section 84001(p)(4). Describe the use of Psychotropic Medication Administration Records (PMAR LIC 622B). A separate log for each psychotropic medication prescribed to the child documenting all the following in Title 22 83070(12). Provide a statement that medication errors will need to be reported and documented to CCL, per reporting requirements. Provide a statement that any medication refusal by a client is considered a "Special Incident" and a report will be sent to Community Care Licensing. Transportation The licensee and their staff are prohibited from smoking a tobacco product, or permitting any person from smoking a tobacco product in a motor vehicle that is regularly used to transport children, regardless of when the children are present. This prohibition applies when the motor vehicle is moving or at rest. **** Incident Procedures Each facility shall provide a procedure (approved by the licensing agency for immediate response to incidents and complaints). Timeframes including how to submit a grievance/complaint, who responds, the timeframe, how the outcome is documented, where is the procedures documented. Abuse Reporting Procedures Please review and revise reference to Adult & Elder Abuse to reflect Child Abuse (Pg. 13) Please review and revise reporting notifications to align with Community Care Licensing (CCL) reporting requirements Please review and revise CCL Office information listed from Child Care to Children's Residential Program Rules of Discipline/Personal Rights Please include a section for Grounds for dismissal/relocation/removal from placement. Describe how the child and authorized representative will sign the personal rights form at intake and each time a new right has been added (Pg. 14) Please state how you will provide a copy of the discipline policy and describe how the child will sign the form. (Pg. 14) Children's Complaint and Grievance Procedure Please include the complaint hotline phone number and information (Pg. 15) Admission Policies Please review and revise reference to Regional Center, Medically Fragile, and Clients with Special Health Care Needs (Pg. 21) Please identify source of placement for clients for your program Describe the sign-in and sign-out procedures. Child's Records Please include the Health Screening including Tuberculosis Screening Results as documentation included in the client file (Pg. 22) **** Please review and revise Needs and Services Plan to be completed "within 30 days of placement" (Pg. 23) Please include signatures for the Needs and Services Plan are to be obtained from the client and authorized representative (Pg. 23) Discharge Criteria Please include information regarding placement termination and discharge policy Sample Menu Please review and revise meal times identified on this menu to align with the meal times identified on Page 3 (Pg. 28) Admission Agreement Please remove reference to eviction Please revise Personal Rights acknowledgment from LIC 610C to LIC 613B Please review and include information regarding Camera Uses and Locations in accordance with Children's Residential Program Provider Information Notice 24- LPA Vanegas conducted an exit interview and a copy of this report along with the signed LIC 281C, Care Tools Pre-licensing form, and Children's Residential Program Provider Information Notice 24-09 were reviewed and provided to the applicant, Mia Pham.

met_with: Applicant - Mia Pham


summary: Facility Evaluation

raw_content:
Narrative:
On December 9, 2025 at 09: AM, Licensing Program Analyst (LPA) Val Wilson arrived at Phamily Home Small Family Home (SFH) to conduct a pre-licensing inspection. LPA met with Applicant - Mia Pham who led a tour of the home at 9: AM. The home was toured both inside and out with the applicant. Currently there are no clients in placement. Applicant denies there are any firearms in the SFH and none were observed during LPA inspection. The home is a two-story building with three bedrooms, three bathrooms, and an attached garage. The entry way has the following posted: Emergency Disaster Plan (LIC 610), Personal Rights, Grievance procedures, Complaint Hotline, CPR and First Aid card, and Facility Sketch. Applicant will add a sign-in log, confidential grievance drop area, and visitation policies in the entry way. The fire extinguisher is stored in the front entry way and was observed to be charged and inspected by the fire department. There is a half bathroom downstairs with a sink and toilet. Wi-Fi is available and the router is in the garage. The kitchen, living room and dining room are an open concept. The cordless telephone is stored in the kitchen on the counter. The kitchen sink water temperature is 108.5 degrees Fahrenheit. The refrigerator is set at 33 degrees Fahrenheit and the freezer is at 0 degrees Fahrenheit. There was adequate food storage and food storage space. LPA observed a two-day supply of perishable and a seven-day supply of non-perishable food. The menu is posted on the side of the refrigerator. A repair is needed to the cracked slider door in the kitchen and the disconnected exhaust vent above the microwave. There is a complete first aid kit that is kept in the kitchen area. The locked medication box and the sharps container is kept in the kitchen area. There is a covered trash can, dishwasher, microwave, and stove/oven in working condition in the kitchen area. *Continued on page two* *Continued from page one* There is a motion sensor in the living room, and door chimes on the door from the kitchen to the garage, the kitchen slider door, and the breezeway in to the side garage door. The fireplace located in the living room has a metal curtain, glass accordion style doors, and a brick hearth. The functioning fire alarm is hardwired throughout the home and is located upstairs and downstairs. There is a functioning carbon monoxide detector on the first floor in the kitchen area, and a second functioning carbon monoxide detector upstairs in the hallway. The two-car garage is used for storage and contains the water heater. The backyard has a covered patio and there is an unlocked gated door to exit to the front yard. There is no pool or accessible body of water at the home at the time of this inspection. The backyard where clients will have access to play is fenced. Upstairs, there is a full Jack and Jill style bathroom between bedrooms 1 and 2 that has double sink, a shower, and a toilet. The upstairs master bedroom has a double sink, a shower tub, and a toilet. Bedroom 1 and bedroom 2 each have a full-size bed with a mattress pad, top and bottom sheets, a comforter, and pillows. There is a 2-drawer dresser and a large closet in bedroom 1 and 2 that has adequate overhead lighting. The client's bedroom is arranged so that no more than one client will be in the room. No room commonly used for other purposes is used as a bedroom and no bedroom serves as a passageway to another room. There is a laundry room upstairs leading to the locked master bedroom/office. The applicant resides in the master bedroom/office and is the only adult residing in the home. The client and staff files will be located in a locked storage area in the office area. Money will be kept in a locked cabinet in the master bedroom office area. Applicant will also acquire activities for the children to use for indoor and outdoor play. The home has four security cameras located on the outside perimeter of the home (door bell and two views of the backyard, and one of the driveway; indoor cameras do not record audio). The locked closet at the entry way has a monitor for the SFH to observe the views from each of the outdoor cameras. The applicant will acquire a device to access the gas shut off located at the right side of the home. The electric panel is located next to the gas meter. The water meter and shut off is on the sidewalk in front of the home. *Continued on page three* *Continued from page two* The following corrections need to be made: Final revisions to program statement. Applicant will add a sign in log, confidential grievance drop area, and visitation policies in the entry way. Repairs needed to the cracked slider door in the kitchen and the disconnected exhaust vent above the microwave. Applicant will also acquire activities for the children to use for indoor and outdoor play. An exit interview was conducted and a copy of this report and appeal rights were reviewed and provided to the applicant, Mia Pham. Application will be forwarded to the Licensing Program Manager for Licensing upon receipt and confirmation of corrections made to the Program Statement and noted corrections being received.

visit_type: Prelicensing

met_with: Mia Pham


summary: Facility Evaluation

raw_content:
Narrative:
On October 26, 2022, at 9:10 am, Licensing Program Analyst (LPA) Linda Haynes and Licensing Program Manager (LPM) Cheraki Davis met with applicant Phrasiah Mwaniki on this date for a Component II. LPA and LPM requested the following additional documentation from applicant a letter from Canyon Springs stating duties of applicant and a resume. A pre-licensing visit has been scheduled with applicant for November 14, 2022. Exit interviewed conducted. A copy of this report was given and explained to applicant Phrasiah Mwaniki.

met_with: Phrasiah Mwaniki


summary: Facility Evaluation

raw_content:
Narrative:
On November 14, at 1: PM, Licensing Program Analyst (LPA) Linda Haynes and Licensing Program Manager (LPM) Cheraki Davis began a pre-licensing inspection for Phrasiah Small Family Home license. LPA and LPM met with applicant Phrasiah Mwaniki who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients placed in the home. The applicant is applying to serve two clients ages 3 to 17. The home is a one story building with four bedrooms and two bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed, will sleep the licensee, and has a master bathroom. · Bedroom #2 (Guest) had one queen bed; was vacant and will not be used for clients. · Bedroom #3 (Client's) was vacant, had two twin-sized beds. It will sleep two clients. · Bedroom #4 (Guest) had one queen size bed, was vacant and will not be used for clients. · A great room/living room, kitchen, dining area, two bathrooms, an attached two car garage, a laundry room, storage closet, and the backyard. The Client's bedroom was arranged so that no more than two clients will share the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector in every bedroom and a carbon monoxide / smoke detector located in the hallway. The four smoke detectors and the carbon monoxide / smoke detector were checked, and they were working properly. The home's central air conditioning module was in the side yard. The home's tankless water heater was located inside the garage. Inside the facility there was no fireplace. The home has an installed sprinkler system. The appliances were in working order. : The client's files will be locked inside a locked cabinet. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A proper storage of all food was discussed. A trash can for storage of solid waste did not have a tight-fitting lid and was located in a kitchen cabinet. The hot water in the Master Bathroom measured to be 105 degrees Fahrenheit. The client bathroom also had a trash can with a working lid. The water temperature of the client bathroom was observed to be 106.3 degrees Fahrenheit. The home's First Aid kit was accessible the first aid kit was missing the first aid manual and thermometer and located in the pantry. A fire extinguisher was present in the home and located in the pantry. It was observed to be properly charged but needs to be inspected by the fire department. Applicant stated there were no weapons/firearms in the home. LPA and LPM observed there was no swimming pool. The backyard where clients will have access to play was completely fenced. The following deficiencies were observed: The client's beds need a fitted and plat sheet placed on them. The medication and vitamins were not stored in a locked cabinet. The required forms needed prior to operation, were not posted at the time of this inspection. The lock on the side gate needs to be change so that it can be used as a fire exit. The First Aid Kit was missing the first aid manual and thermometer. The fire extinguisher needs to be checked by the fire department. The kitchen trash can need to have a tight fitting lid. The request for a license will be forwarded to Licensing Program Manager for final approval once the Plan of Corrections are cleared. An exit interview was conducted. A copy of this report was provided to Phrasiah Mwaniki.


summary: Facility Evaluation

raw_content:
Narrative:
On January 18, 2024 at 12: PM, Licensing Program Analyst (LPA) Linda Haynes began an annual inspection for Phrasiah Small Family Home. LPA met with Licensee Phrasiah Mwaniki who led a tour of the home. The facility was toured both inside and out with the Licensee. There were no clients in placement at time of inspection. The home is a one story building with four bedrooms and 2 bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed sleeps the applicant · Bedroom #2 (Client's) was vacant has two twin beds; it will sleep two client's. · Bedroom #3 (Daughters) it sleeps the daughter. · Bedroom #4 (guest) it will sleep a guest. · A great room/living room, kitchen, dining area, 2 bathrooms, laundry room, a two car garage and the backyard. The Client's bedrooms were arranged so that no more than two client will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector / Carbon Monoxide Detector in every bedroom. The six smoke detectors / Carbon Monoxide Detectors were checked, and they were working properly. There is no pool or other body of water present. The backyard where clients have access to play was fenced. An exit interview was conducted. A copy of this report and appeal rights was provided to Phrasiah Mwaniki.


summary: Facility Evaluation

raw_content:
Narrative:
On May 12, 2025 at 10: AM, Licensing Program Analyst (LPA) Maya Chavez began an annual inspection for Phrasiah Small Family Home. LPA met with Licensee Phrasiah Mwaniki who led a tour of the home. The facility was toured both inside and out with the Licensee. There were no clients in placement at time of inspection. The home is a one story building with four bedrooms and 2 bathrooms which are set up as follows: · Bedroom #1 (Master) has one bed sleeps the Licensee. · Bedroom #2 (Client's) was vacant has two twin beds, closet storage, and dressers underneath the bed; it will sleep two client's. · Bedroom #3 (Daughters) it sleeps the daughter. · Bedroom #4 (guest) it will sleep a guest. · A great room/living room, kitchen, dining area, 2 bathrooms, laundry room, a two car garage and the backyard. The Client's bedrooms were arranged so that no more than two clients will be in the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke/Carbon Monoxide detector in every bedroom. The six smoke/Carbon Monoxide detectors were checked, and were working properly. There is no pool or other body of water present. The backyard where clients have access to play was fenced. An exit interview was conducted. A copy of this report was provided to Licensee, Phrasiah Mwaniki.

met_with: Licensee- Phrasiah Mwaniki


facility_name: PINOLE VALLEY RESIDENTIAL CARE FACILITY

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On 11/20/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a visit to the home regarding the above allegations. LPA met with Licensee Robin Ann Prior and informed of the purpose of the visit. Based on confidential interviews, observations, and record review, it was found that there were reports of bruising and poor diapering and hygiene care provided to the resident in care. However, there were also reports, including from the assigned social worker and the investigating CPS worker, that there had been no observations nor concerns of abuse or neglect in the home. LPA's observations included that the licensee had a large supply of diapers, and the resident in care did not have a strong odor or noticeabe signs of poor hygiene. Lastly, multiple reports observed bruising to be likely from leg supports rather than abuse. Although the allegations may have happened or are valid, based on LPA's observations and interviews, there is not a preponderance of the evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Licensee Robin Ann Prior, whose signature on this form confirms receipt. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lidia Tinoco LICENSING EVALUATOR NAME: Mariah Hawkins 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

report_type: Complaint Investigation

met_with: Licensee Robin Ann Prior

complaint_status: unsubstantiated


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

met_with: Licensee Robin Prior


raw_content:
Investigation Findings:
13On 12/12/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a complaint investigation visit. LPA met with Licensee Robin Prior and informed of the purpose of the visit. Based on confidential observations, interviews, and record review, it could not be confirmed that the licensee's conduct presents a risk to the client in care. Interviews with multiple parties who oversee the care of the client in care reflect that there have been no reports or observations of suspected abuse of the client. Multiple interviews reflect observations of the licensee providing good care to the client. During LPA's observation of the client, LPA did not observe marks, injuries, or other indicators of abuse. Although the allegation may have happened or is valid, based on LPA's observations and interviews, there is not a preponderance of the evidence to prove the alleged violation did or did not occur. Therefore, the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report and the licensee's appeal rights were provided to Licensee Robin Prior, whose signature on this form confirms receipt. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins 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


summary: Facility Evaluation

raw_content:
Narrative:
On November 03, Licensing Program Analyst (LPA) Isabel Mendoza made an unannounced Annual/Required inspection of the facility. LPA met with Administrator, Robin Ann Prior and informed her the purpose of the visit. The facility only has one client in care who was at school and arrived around 2:30PM. LPA was unable to interview the youth because the youth is non-verbal however (C1) (please refer to LIC 811, for confidential names dated 11/3/21) appeared to be in good spirit. LPA toured the interior and exterior of the home. The facility physical plant consists of six bedrooms total; four upstairs, two downstairs. There are two and one half bathrooms; two full bathrooms upstairs, and a half a bathroom downstairs. The kitchen is fully stocked with 7-day non-perishable and 2-day perishable. Per Ann, there are no firearms on the premises. The facility is free of mess and is sanitary. There are no bodies of water, hazards, or obstructions on the grounds. The smoke detectors were tested and are functioning. License and sketch are visibly posted. Medications are stored in a locked cabinet in the entrance area. Chemicals are stored in a locked cabinet in the garage. The first aid kit is stored in the medication cabinet and is fully stocked. The room and water temperatures were maintained within safe, comfortable, and permitted ranges at F and F, respectively. LPA Mendoza inspected (C1's) medication currently (C1) is only taking over the counter medication. Upon Administrator request, LPA left a copy of LIC 622A and LIC 622B so the administrator has them on file. LPA Mendoza reviewed one client file and one staff file. Both files had all required items. LPA advised the Administrator to keep both client and staff files organized because [Please refer to LIC 809-C for continuation page.] the Administrator having all required documents in different binders or folders. LPA Mendoza left a copy of Small Family Home Check list so the Administrator knows what to keep filed together for CCL's next inspection. No deficiencies were cited during todays inspection. An exit interview was conducted and a copy of the report was left at facility.

met_with: Robin Prior- Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On May 31, 2022 at 10: AM Licensing Program Analyst (LPA) Lisette Valenzuela and Licensing Program Manager (LPM) Isabel Mendoza made an unannounced Annual/Required inspection of the facility. LPA Valenzuela and LPM Mendoza arrived at 10: AM and met with Administrator, Robin Ann Prior and informed her the purpose of the visit. At 10: AM the Administrator let us in to conduct the inspection. The facility only has one client in care who was at the home during the visit. LPA was unable to interview the youth because the youth is non-verbal however (C1) (please refer to LIC 811, for confidential names dated 5/31/22) appeared to be in good spirit. LPA toured the interior and exterior of the home. The facility physical plant consists of six bedrooms total; four upstairs, two downstairs. There are two and one half bathrooms; two full bathrooms upstairs, and a half a bathroom downstairs. The kitchen is fully stocked with 7-day non-perishable and 2-day perishable. Per Ann, there are no firearms on the premises. The facility is clean and in good repair. There are no bodies of water, hazards, or obstructions on the grounds. The smoke detectors were tested and are functioning. License and sketch are visibly posted. Chemicals are stored in a locked cabinet in the garage. The first aid kit is stored in the medication cabinet and is fully stocked. The room and water temperatures were maintained within safe, comfortable, and permitted ranges at F and F, respectively. At 11: AM LPA Valenzuela and LPM Mendoza reviewed one staff file and the Administrator does not have a valid First Aid/CPR certificate. The Administrator confirmed that they do not have an updated certificate. All other items were complete. LPA and LPM reviewed one client files and all required items were complete. Youth is currently in the process of getting adopted by Administrator. The Administrator will notify CCL once finalized. Per Administrator the facility will continue to operate as a Small Family Home, even after the adoption. Please refer to LIC 809-C for continuation. Facility cited for violation of California Code of Regulations, Title Division Six, regulation 83075(1): Health Related Services. Two technical violations were issued during todays inspection. An exit interview was conducted and a copy of the report will be emailed and mailed to the Administrator.

met_with: Robin Prior


summary: Facility Evaluation

raw_content:
Narrative:
**Update on 7/6/ LPA Valenzuela had to amend this LIC 809 to be able to open the CareTools** On 05/24/ Licensing Program Analyst (LPA) Lisette Valenzuela made an unannounced Annual/Required inspection of the facility. LPA Valenzuela arrived at the facility at 11:20AM. LPA Valenzuela met with Administrator, Robin Ann Prior and informed her the purpose of the visit. Administrator Robin Ann Prior informed LPA Valenzuela she was not feeling well and did not feel comfortable. Administrator also let LPA Valenzuela know C1 was sick as well. Administrator states C1 and her caught the flu. Due to this, the Annual will be postponed and LPA Valenzuela will be coming back at a later date. Exit interview was conducted. Report was signed and a copy of report was left at the facility with Administrator Robin Ann Prior.

met_with: Robin Ann Prior - Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On July 6, 2023 at 10:30AM Licensing Program Analyst (LPA) Lisette Valenzuela made an unannounced continuation of the Annual/Required inspection of the facility. LPA Valenzuela arrived at the facility at 10:30AM and contacted the Administrator, Robin Ann Prior via cell phone. At 11:10AM the Administrator opened the door and LPA Valenzuela let Administrator know of the purpose of the inspection. Administrator let LPA Valenzuela inside the facility to conduct the inspection. The facility only has one client in care who was at the home during the visit. LPA Valenzuela was unable to interview C1 (refer to LIC 811) because the C1 is non-verbal. Based on the observations of LPA Valenzuela C1 appeared to be in good spirits. One staff (S1) was interviewed. LPA Valenzuela conducted a walk through of the interior and exterior of the home. The facility license is posted in a prominent location as well as the facility sketch. The facility physical plant consists of six bedrooms total. Four rooms upstairs, two downstairs. There are two and one half bathrooms; two full bathrooms upstairs, and a half a bathroom downstairs. The kitchen is fully stocked with 7-day non-perishable and 2-day perishable. The facility is in good repair and clean. Administrator let LPA Valenzuela know there are no firearms at the home. There are no bodies of water at facility. The first aid kit is stored in a prominent location. The water temperatures are within a safe and permitted range at 47. C. The facility is clean and in good repair. No obstructions were observed on the grounds or blocking emergency exits. The smoke detectors were tested and are functioning. LPA Valenzuela reviewed one (1) client file. All required items were complete. LPA Valenzuela reviewed one (1) staff binder and all required paperwork were complete. LPA Valenzuela reviewed a valid First Aid CPR Certificate for Administrator. Youth is currently in the process of getting adopted by Administrator. The Administrator will notify CCL once finalized. No Title 22 deficiencies were cited. Exit interview was conducted and a copy of the report was left at the facility with the Administrator Robin Ann Prior.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On 5/31/24, Licensing Program Analyst (LPA) Mariah Hawkins conducted a required annual inspection. LPA met with Licensee Robin Prior and informed of the purpose of the visit. LPA toured the facility site and observed the environment to be in sanitary condition and free of safety hazards. Sharps and chemicals are stored where inaccessible to the resident in care. Furnishings are arranged to leave enough space for the resident's wheelchair. Food is stored approrpriately and in a supply to meet the nutritional needs of the resident in care. LPA inspected caregiver records and observed that caregiver has a background clearance, valid first aid certification, and relevant care instruction to meet the resident's care needs. LPA inspected resident records and observed current care plans, medical records, and contacts for the full care team and important agencies. Using the CARE Inspection Tool, no deficiencies were found during today's inspection. An exit interview was conducted, and a copy of this report was left with Licensee.


summary: Facility Evaluation

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Narrative:
On 5/18/2026 at 11: AM Licensing Program Analyst (LPA) Cole Oliver conducted a required annual inspection. LPA Oliver met with Licensee Robin Prior and informed them of the purpose of the visit. The CARE Inspection Tool was utilized to complete the inspection. During the visit, LPA verified that all staff listed had background clearances, as reflected in Guardian. No clients have been placed in care since last year May 2025. (Refer to LIC812) Licensee informed LPA Oliver that Licensee sustained an injury last year May 2025 and is currently recovering. LPA and Licensee discussed the future of the facility license. LPA Oliver toured the home and found it to be in good repair. There were no open bodies of water. The backyard was in good repair and clean. No files were reviewed at the time of the visit. LPA conducted one (1) confidential interview. No deficiencies were found. An exit interview was conducted, and a copy of this report was provided to Licensee.

met_with: Administrator Robin Prior


facility_name: POSTONS SMALL FAMILY HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Confidential interviews and record review provided conflicting reports regarding both allegations. Confidential interviews denied RP1 cussed at C1 and denied that RP1 did not treat C1 with dignity or respect. Confidential interviews confirmed that RP1 does occasionally raise RP1s voice to gain C1's attention but denied ever doing so in a manner that was disrespectful or demeaning. Conflicting information obtained stated that C1 was cussed at and was disrespected by RP1. Confidential interviews and record review could not confirm or dispute the allegations. Based on record review and confidential interviews the allegations alleging resource parent speaks to minor in an inappropriate manner and resource parent does not treat minor with dignity or respect may have occurred, however they are not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of the report was provided along with appeal rights to Licensee, Kahadda Poston.

Investigation Findings:
13On October 30, 2025 at 9:15am Licensing Program Analyst (LPA), Matthew Dorantes met with Postons Small Family Home Licensee, Kahadda Poston, to deliver the findings for the above stated allegations. A Health and safety inspection of the facility was conducted on September 17, 2025, and no immediate hazards were observed. The investigation included interviews with one foster children [Foster Child #1 (C1)], three resource parents [Resource Parent #1 (RP1) - Resource Parent #3 (RP3)], and one county social worker [CSW1]. In addition, county records and facility records were reviewed. On September 14, 2025, Community Care Licensing (CCL) received an allegation alleging resource parent speaks to minor in an inappropriate manner and resource parent does not treat minor with dignity or respect. Specifically, it was reported that RP1 cusses at C1 and RP1 does not treat C1 right, which no further information was provided. ***Next page continued on LIC 9099-C*** UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Nicole Strickland LICENSING EVALUATOR NAME: Matthew Dorantes 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 61-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: POSTONS SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 10/30/2025

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

met_with: Kahadda Poston


summary: Facility Evaluation

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Narrative:
On Tuesday April 12, 2022, at 3: PM Licensing Program Analyst (LPA) Linda Haynes conducted a pre licensing inspection of the facility. At time of inspection LPA met with applicant Kahadda Postons. The facility was toured inside and out with applicant Kahadda Postons. The home is a two-story residence with three bedrooms and three bathrooms. Bedroom # 1 is upstairs and furnished with two twin beds Bedroom # 2 is upstairs and furnished with one queen bed and is a guest bedroom. Bedroom # 3 is upstairs and furnished with one king bed and is the master bedroom. Bedrooms are arranged so that no more than two clients are in a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. Hot water in bathroom number one measured to be 122.6 and bathroom number two 127. Bathroom number three is the master bathroom and the clients will not have access to it. All hazardous items have been properly made inaccessible to areas where clients will have access. The medications will be stored in a locked cabinet in the kitchen. Cleansers/chemicals are stored in a locked cabinet in the laundry room. Sharp knives are inaccessible and stored in a locked cabinet in kitchen. The First Aid Kit is located in the kitchen and contained all required supplies. The facility's smoke detectors in each bedroom were checked and were operable. The carbon monoxide detector was located in the hallway upstairs by the bedrooms and is operable. There are no guns or weapons in the facility as stated by applicant Kahadda Postons. The following required posted items will be made accessible to clients: Grievance Procedures, Personal Rights, and Visitation policies. () The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is no pool or other body of water. There was one technical advisory observed during today's visit. The applicant will be scheduled for a Component III prior to licensure. The request of License will be forwarded to Licensing Program Manager for final approval. Exit interview conducted and a copy of this report was discussed and provided to applicant Kahadda Postons on this date.

met_with: Kahadda Postons


summary: Facility Evaluation

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Narrative:
On Monday July 31, 2023, at 3: PM Licensing Program Analyst (LPA) Linda Haynes conducted an annual inspection of the facility. At time of inspection LPA met with Licensee Kahadda Poston. The facility was toured inside and out with Licensee Kahadda Poston. The home is a two story home with 3 bedrooms and 3 bathrooms. There are no clients in placement. Bedroom # 1 has two twin beds and sleeps two clients. Bedroom # 2 has one king bed and sleeps Licensee's parents. Bedroom # 3 is the master bedroom and sleeps the Licensee. Bedrooms are arranged so that no more than two clients are in a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. Hot water in bathroom number one measured to be 112.3 degrees Fahrenheit. Bathroom number two and the master bathroom and are under construction so LPA could not measure water temperature. All hazardous items have been properly made inaccessible to areas where clients will have access. The medications are stored in a locked closet in the hallway. Cleaners/chemicals are stored in the locked closet in the hallway. Sharp knives are inaccessible and stored in a locked cabinet in the hallway. The First Aid Kit is located in the kitchen and contained all required supplies. The facility's smoke detectors / carbon monoxide detectors in each bedroom were checked and were operable. There are no weapons at the facility as stated by Licensee Kahadda Poston. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is no pool or other body of water at the facility. Exit interview conducted and a copy of this report was discussed and provided to Licensee Kahadda Poston on this date.


summary: Facility Evaluation

raw_content:
Narrative:
On December 05, 2024 at 10: AM, Licensing Program Analyst (LPA) Sarah Lo conducted an annual inspection of the facility. At time of inspection LPA met with Licensee Kahadda Poston. The facility was toured inside and out with Licensee Kahadda Poston. The home is a two-story residence with four bedrooms and three bathrooms. The home is set up as follows: · Bedroom #1 - Home office, no client is allowed · Bedroom #2 - Two twin bed; utilized by C1 · Bedroom #3 - One queen bed; utilized by Licensee · Bedroom #4 - Master suite w/ full bath and one bed; utilized by Licensee's parents. Bedrooms are arranged so that no more than two clients are in a room, and there is one client per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate shelf and closet space for client's belongings. The bathroom was clean and in good repair. The hot water temperature in the client's bathroom was measured to be 115 degrees and the clients have access to the bathroom downstairs in the home and the hot water temperature was measured to be 116.2 degrees. All hazardous items have been properly made inaccessible to areas where clients will have access. The fireplace is properly locked and a key is needed to operate. Proper storage of all food was noted and trash cans for storage of solid waste have tight fitting lids. The medications were stored and locked inside of the refrigerator. Cleansers/chemicals are stored in a locked closet in the kitchen cabinet. Sharp knives are inaccessible and stored in a locked cabinet in the kitchen cabinet. The First Aid Kit is located in the kitchen and contained all required supplies; an emergency kit is located inside the garage. There is no guns or weapons as stated by the Licensee. The garage is used for storage and not accessible to the clients. The facility's smoke detectors in each bedroom were checked and were operable. The carbon monoxide detector is located in the hallway upstairs are operable. LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients as well. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Visitation policies, and current menu. The facility outside grounds was also inspected and it was observed to be clean and well maintained. The backyard is completely fenced and free of hazards. Emergency exits were free from obstruction. There is no pool or other body of water. LPA reviewed one of one client files during the inspection and it contained all required documents. LPA reviewed six of six staff files during the inspection and and they contained documents included criminal background clearance, current CPR/First Aid certificates, training certificates, drivers licenses, employment applications, etc. One Staff interview with Licensee was conducted. One of one client was not available to be interviewed. LPA will attempt to interview client at their school. Based on the facility inspection and file reviews on this date, there are no deficiencies found at this time. A copy of this report was reviewed and given to Licensee, Kahadda Posten.

met_with: Licensee, Kahadda Poston


facility_name: POURING LOVE SMALL FAMILY HOME

summary: Facility Evaluation

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Narrative:
A Component II meeting was conducted at the Monterey Park Children's Residential Regional Office. Licensing Program Analyst (LPA). Angelina Garibaldo and Licensing Program Manager (LPM) met with Applicant, Antranel Marshall. The purpose of Component II was to discuss concerns of the applicant and revisions to Program Statement. The following forms need to be revised: LIC Budget Information LIC Facility Sketch (floor plan) LIC Local Fire Dept (LPA Garibaldo will follow up). Areas of Program Statement requiring revisions or clarifications: Admission/Assessment/Discharge Policies and Procedures Ages that will licensee will accept. Rules of Discipline/Personal Rights Transportation Administrator/Licensee Qualifications Video Cameras Revisions are due back to LPA Garibaldo by: November 3,2025. An exit interview was conducted and a copy of this report LIC809 was given to the applicant along with resources.

met_with: Antranel Marshall- Applicant


summary: Facility Evaluation

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Narrative:
On November 12, 2025, at 9: AM, Licensing Program Analyst (LPA), Angelina Garibaldo conducted an announced pre-licensing inspection at Pouring Love Small Family Home (SFH). LPA met with licensee Antranel Marshall and toured the home. Physical Plant This SFH is in a quiet residential community. The SFH consists of bedrooms (4) bedrooms, (2) bathrooms, kitchen, Livingroom, and a backyard. Overall, LPA observed the home back yard to be sanitary and in excellent condition. Passageways are free from obstruction. Fire extinguishers, smoke and carbon monoxide were tested and in working order. Fixtures, Furniture, Equipment, and Supplies The home has toilets and wash basins for clients' use. Client bedroom one and two were observed to be clean, orderly, and contained two twin-sized beds in room one and one full bed in room two. LPAs observed clean pillows, bed sheets and blankets. The client's bedroom has an adequate closet and drawer space to accommodate the client's clothing and personal belongings. Knives are kept in a locked drawer in the kitchen and cleaning supplies in a locked laundry closet. A Heath Related Services and Record Keeping The medications will be stored in a locked cabinet in primary bedroom. First aid kit was available for review, located in kitchen cabinet. Client and staff files will be kept in locked file cabinet in the Livingroom. Prior to being licensed the following are still pending: Proof of training Final Plan of Operation submitted to LPA. Completion of Component III

met_with: ANTRANEL MARSHALL- Applicant


summary: Facility Evaluation

raw_content:
Narrative:
A Component III meeting was conducted at the Monterey Park Children's Residential Regional Office. Licensing Program Analyst (LPA). Angelina Garibaldo and met with Applicant, Antranel Marshall. The purpose of Component III meeting was to familiarize the applicant with the Small Family Home (SFH) Rules and Regulation, best practices, prepare the applicants on how to maintain and operate their facility and provide information to avoid potential problem areas. A copy of the SFH Component III handout and Forms for use in Children's Residential Facilities was provided to applicant. Prior to being licensed the following are still pending: Required training for applicant and Certificates Program Statement requiring revisions: Staff initial training Staff annual training An exit interview was conducted and a copy of this report LIC809 was given to the applicant along with resources.


summary: Facility Evaluation

raw_content:
Narrative:
On February 12, 2026, Licensing Program Analyst (LPA) Angelina Garibaldo conducted an unannounced inspection at the Small Family Home (SFH) facility and met with the licensee Antranel Marshall. The purpose of the inspection was to conduct a post licensing visit. This SFH is licensed to serve 4 ambulatory clients who have health disabilities, developmental disabilities and physical disabilities aged 0-17. There are currently no children in care. Physical Plan This facility is located in a quiet residential community. The facility consists of bedrooms (3) bedrooms, a den, (2) bathrooms, kitchen, living room, a 2-car garage, and a backyard. The bedrooms are ready for future placement and in compliance with all regulations. An exit interview was conducted, and a signed copy of this report was provided to the facility representative along with LIC 809 report. No deficiencies were cited.

met_with: Antranel Marshall, Licensee


facility_name: POWELL SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 10/28/21 at 9: AM Licensing Program Analysts (LPAs) Robin Sullivan and Shawndra Miles conducted an unannounced required annual inspection. LPAs met with Powell Family Home Administrators. Currently one foster child is placed in the home. The Family has four adopted children and two guardianship teens. Four children were present during the inspection. One client file was reviewed and observed current and complete. The Administrators have current CPR and 1st aid certification. Criminal record clearances were reviewed and the facility is in compliance with this requirement. LPAs observed an adequate supply of perishable and nonperishable food. Medications are stored and locked in a designated medication room. Cleaning supplies are stored inside the locked medication room. The fire extinguisher is current and smoke detectors and carbon monoxide detectors are in working order. There are five bedrooms in the home, four are double occupancy rooms; three bedrooms have 2 children and one bedroom has one youth. The master bedroom is occupied by the Administrators. LPAs observed the facility to be clean and hazard free both inside and outside of the home. The pool is fenced as per regulation requirements. LPAs provided LIC 308 and LIC 610C for facility to update. LPA reviewed and discussed emergency disaster planning, and fire safety with the Administrator. No Title 22 deficiencies were cited. The home continues to meet the regulatory requirements. A copy of this report was emailed to Mrs. Powell.

met_with: Powell Small Family Home Administrators


summary: Facility Evaluation

raw_content:
Narrative:
On November 1, 2022, Licensing Program Analyst (LPA) Jessica Caplinger conducted an unannounced inspection to the facility for the purpose of the required annual inspection. LPA met with Heather Powell, administrator (AD), and a walk through was conducted. The home currently has no placements in care. The Family has three adopted children and three guardianship teens. Four children were present during the inspection and LPA was informed that two children were at school. Two staff files were reviewed. The Administrators have current CPR and 1st aid certification. Criminal record clearances were reviewed and the facility is in compliance with this requirement. LPA observed the home to be clean, safe and sanitary. LPA discussed compliance for food and medication with AD to ensure the facility will be in compliance when a youth is placed in care. The backyard is clean and has adequate space. Cleaning supplies and hazardous materials are locked and would be inaccessible to clients. The water temperature was tested and is in compliance. Fire extinguisher was observed and is maintained; smoke detectors and carbon monoxide were tested and observed in working condition. All bedrooms of the home are equipped with adequate linens and clothing for clients. All required Licensing forms are posted and were observed during inspection including the Personal Rights Poster and License. There are no firearms on the property. The above ground pool was observed with a locked fence surrounding it and keeping it inaccessible to clients. Staff and client files are kept secure in the office. There are five bedrooms in the home, four are double occupancy rooms; two bedrooms are occupied with two youth each and two bedrooms have one youth each. AD informed LPA that if a placement was accepted, they would be placed in the single occupied rooms The master bedroom is occupied by the Administrators. Continued on 809-C LIC 500 was observed current and has no changes since last inspection. LIC 610 is current and posted. A review of licensing information system was done on 10/31/22 indicating that all staff associated to the facility had DOJ, FBI and Child Abuse Index Check clearances. AD's adult child is pending clearance and LPA will follow up on this status. The home currently has only the two administrators as staff and has four other cleared persons to be used as back up care in an emergency. LPA interviewed one administrator. CARE Tools completed. The following domains were completed: Physical Plant, Operations, Special Health Care Needs, and Staffing. LPA reviewed and discussed emergency disaster planning, and fire safety with the Administrator. No deficiencies were observed during inspection. The home continues to meet the regulatory requirements. A copy of this report was emailed to Mrs. Powell.

met_with: Heather Powell; Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an unannounced Annual inspection on 10/4/23 at 10:30am. During the inspection LPA met with Heather Powell, Licensee, who assisted with the inspection. LPA Stidman conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection present in the facility is both licensees ,six family members ranging from ages 8-21. and no clients were present. Number of staff interviewed 2__ LPA observed # _5_bedrooms, # _3__bathrooms. LPA observed the facility has a pool next to the driveway that is fenced, locked and contains a few inches of water due to being drained for the season. LPA observed the facility has a travel trailer in the driveway. LPA inspected and/or reviewed the following: Posting of license_yes__ Personal Rights_yes_ Disinfectants/Cleaning solutions inaccessible_yes Refrigerator Temperature at or below 45 degrees F _is_45 degrees Freezer Temperature at or below 0 degrees_yes Nonperishable Foods one week and fresh perishable foods two days minimum_N/A Menu present and posted_N/A Working telephone yes Carbon monoxide detectors yes_Smoke Detector yes_ First Aid Kit fully stocked yes_ Common Room available yes_ Dining area (enough seating, furniture good condition, not broke or damaged) yes_ Medication centrally stored, locked/inaccessible yes Office (locked and privacy) _N/A_ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F 113.5 degrees_ Fire Extinguisher purchased July 2023_. Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _yes_ Soap and Paper towels _N/A Laundry Facilities available_yes Bedrooms-required linen and furnishings __N/A Motor Vehicle properly maintained, lights, tires, registration/insurance and working seat belts_N/A_ Facility free of vermin _yes_Disaster and mass casualty plan updated and available_yes Quarterly Drills conducted and documented yes Disaster preparedness supplies verified _N/A___Number of Staff files reviewed _two_Criminal record clearances verified _two_First Aid Certificate_yes No Clients files reviewed as no clients are in placement, Heather Powell, Licensee has current training for providing SCHN. The following items were reviewed for compliance in the regional office prior to the facility inspection: Annual fees, Emergency Disaster Plan (per H&S Code 1565), and Personnel Roster, Facility Sketch, LIC 500, LIC 610C and LIC 308. An exit interview was conducted and a copy of this report was left with Heather Powell, Licensee. No violations were observed. No citations given at the time of the inspection.

met_with: Heather Powell, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On December 18, 2024 at 10: AM Licensing Program Analyst (LPA) Angelique Hill, made an unannounced annual inspection. During the inspection LPA Hill met with Heather Powell, Licensee who assisted with the inspection. LPA Hill conducted a walk-through of the facility inside and out. Present in the facility is both licensees ,two family members ranging from ages 8-21. and one client was present. Number of staff interviewed 2_. LPA observed # _5_bedrooms, # _3__ bathrooms. LPA observed the facility has a pool next to the driveway that is fenced, locked and contains no water due to being drained for the season. LPA Hill inspected and/or reviewed the following: I. Physical Plant Posting of license__x_ Personal Rights__x_ Disinfectants/Cleaning solutions inaccessible _x_ Refrigerator Temperature at or below 45 degrees F __x__ Freezer Temperature at or below 0 degrees __x__ Nonperishable Foods one week and fresh perishable foods two days minimum__x__ Menu present and posted __x__ Working telephone __x_ Carbon monoxide detectors ____x_ Smoke Detector __x__ First Aid Kit fully stocked _x__ Common Room available __x__ Dining area (enough seating, furniture good condition, not broke or damaged) ___x___ Medication centrally stored, locked/inaccessible __x___ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F_x__ Fire Extinguisher purchased October Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature __x__ Soap and Paper towels _x__ Laundry Facilities(available, work assign dates) __x__. Bedrooms-required linen and furnishings __x_ Locked Facilities (open locked storage area/building/sheds) __yes__ Bedroom (required bedding/furniture, furniture in good repair) __yes__ Disaster and mass casualty plan updated and available _yes Quarterly Drills conducted and documented yes Disaster preparedness supplies verified _N/A__ Number of Staff files reviewed _two_ Criminal record clearances verified _two_First Aid Certificate _yes. One Client file was reviewed. Heather Powell, Licensee has current training for providing SCHN.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
Licensing Program Analyst (LPA) Jean Stidman made an unannounced Annual inspection on 10/22/25 at 10am During the inspection LPA met with Heather Powell Licensee, who assisted with the inspection. LPA conducted a walk-through of the facility inside and out. Facility staff-client ratio at time of inspection one staff, no clients were present. The licensee has two minor children, one adopted, and one guardianship adult living in the home. The licensee had one adult in the home helping with the licensees children. Number of staff interviewed one LPA observed #5 bedrooms, #3 bathrooms LPA inspected and/or reviewed the following:Posting of license_X_ Personal Rights__X___ Disinfectants/Cleaning solutions inaccessible__X___Refrigerator Temperature at or below 45 degrees F 41 degrees Freezer Temperature at or below 0 degrees_2 degrees F Working telephone __X_ Carbon monoxide detectors __X_Smoke Detector _X__ First Aid Kit fully stocked_X__ Common Room available__X__ Dining area (enough seating, furniture good condition, not broke or damaged) __X_ Medication centrally stored, locked/inaccessible _X_ Hot Water between 105-120 degree F (Properly labeled if over 125 degree F__119 degrees_ Fire Extinguishers purchased 10/10/25. Toilets wash basin, bath and shower fixtures in good repair/no leaks/hot water temperature _x Laundry Facilities(available) __X___ Facility free of vermin _X__ Bedroom (required bedding/furniture, furniture in good repair) __X___ Operations Complaint Procedures For Youth Posted _X__ Disaster Preparedness Disaster and mass casualty plan updated and available __X__ Quarterly Drills conducted and documented_x_ _Staffing Number of Staff files reviewed _two Criminal record clearances verified _two_ First Aid Certificate_two__ Facility citation violation of California Code of Regulations, Title 22, Division 6, Chapter 1, Article 03, Regulation 80019(e) Criminal Record Clearance due missing Criminal Record clearances for one 18 year old and one 19 year old living in the home. The following items were reviewed for compliance: Annual fees, Criminal Record Clearances, Facility Sketch, LIC500 and LIC610C. An exit interview was conducted and a copy of this report was left with Heather Powell Licensee

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: Heather Powell Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On February 18, 2025, at AM, a Component II Office Visit was held to discuss the application received for Power and Change Home Care located at W. Compton Blvd. A Compton, CA Attending Component II were the following individuals: Casper Andrews, Applicant, Erika Butler, Licensing Program Analyst, and JoAunne Griffin, Licensing Program Manager. The purpose of this Component II meeting was to review and discuss the incomplete application and Program Statement and to resolve any outstanding concerns that may have existed. The following incomplete application forms were discussed at the meeting: Section A Documents Application (LIC 200) Applicant Information (LIC 215) Surety Bond (LIC 402) 4. Budget Information (LIC 420) Continued on C 5. Personnel Report (LIC 500) 6. Personnel Record (LIC 501) 7. Emergency Disaster Plan (LIC 610C) Program Statement Applicant needs to revise the Program Statement and place each section under the tab sections. The Applicant was advised of the following revision and/or corrections needed to the application and/or Program Statement: Revisions are due by March 11, 2025. Email revisions to erika.butler@dss.ca.gov. The Applicant's fingerprints and fire inspection are pending. Pre Licensing visit scheduled for March 24, 2025 at 9:00 am. A copy of this report was provided to the Applicant, Casper Andrews.

met_with: Casper Andrews


summary: Facility Evaluation

raw_content:
Narrative:
On March 24, 2025, at 10: AM Licensing Program Analyst (LPA) Erika Butler, arrived at Power and Change Small Family Home for the purpose of conducting a Pre-Licensing Inspection. LPA met with Applicant Casper Andrews who granted access to the home and together a tour of the interior and exterior home was conducted. Home is apart of a commercial multi-use property. LPA entered the home through the commercial property, through the laundry room to gain entrance to the residential property. There are two other units on the grounds of this property. One unit is vacant, and the other unit will be vacant on the April 26, 2025. The Applicant states once tenant leaves, the units will remain vacant while licensed. The home is set up as follows: This is a three bedroom, two bathroom home located in a commercial area. The home consists of a living room, kitchen, laundry space, and backyard area, Living room: is equipped with mounted TV, sectional couch, 2 ottomans, fireplace that is not covered. Dining room: is equipped with a table with four chairs. Kitchen: is equipped with a refrigerator/freezer, a four burner gas stove (two burners were operational at the time of the inspection), and microwave. Sharp knives will be kept inaccessible in applicants locked bedroom. LPA observed a covered trash can. LPA observed ample and non-perishable food items. The Applicant will ensure that three nutritious meals and snacks will be provided to the clients. Exit signs are located at the front door and bedroom #2 door. 809 continued on page 1 of Bedroom #1: Applicants bedroom is equipped with full size bed with drawers dresser, adequate closet space, television, adequate lighting, and window. Window has bars and no bar release. Bedroom #2: Client's bedroom is equipped with full bed, dresser, adequate closet space, adequate lighting, window with bars and no bar release, and exit door that leads outside will remain locked. Bedroom #3: Client's bedroom is equipped with full bed, drawers, adequate closet space, lighting, and windows. Sliding door that leads outside is currently blocked by a piece of wood. Bathroom: Bathroom #1 is located in Applicant's bedroom, and bathroom #2 is located in the hallway. Bathtub was observed to be rusted and not clean. Vehicle: The Applicant will use a GMC Sierra will be used to transport clients. Insurance is valid from February 10, 2025 - August 10, 2025. The vehicle was observed to be in good condition. The home's temperature is maintained by central air/heating. LPA observed one fully charged fire extinguisher which is located in the kitchen. Extra linens will be stored in the cabinet in the hall. The smoke alarm and carbon monoxide detectors were tested and found to be in working order. First Aid kit was missing thermometer. The Applicant will purchase a lock box for refrigerated medication. Disinfectants and cleaning solutions are kept in Applicant's bedroom that will remain locked and inaccessible to children in care. LPA advised Applicant to ensure the following when children are in placement: Children are accorded personal rights and the corresponding form is in their file. Children are supported and encouraged to participate in extracurricular activities. Children are allowed and encouraged to contact the licensing agency, in confidence, without threats or punishment for making complaints. Children are accorded dignity in personal relationships with others in the home. Applicant acknowledges abuse reporting requirements. Applicant will ensure grievance process, Disaster Plan, discipline policies and procedures will be posted in dining room area. Report continued on LIC 809C. (Page 2 of 3) LPA observed cameras in the living room, kitchen, side of the home, the alley which leads to the backyard entrance of the home, and a camera in the front of the home. During the inspection, 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. Applicant informed that the following corrections will need to be made. Lighter needs to be removed from kitchen drawer. Bathtub needs to be cleaned in bathroom #2. Applicant will purchase extra cutlery for the home. Applicant will fix the handle for the shower in bathroom #2. Applicant will place a covering over the fireplace in the living room. Applicant will purchase a lock box for refrigerated medication. Applicant will purchase a thermometer for the First Aid Kit. Applicant will fix the 2 burners on the stove Applicant will purchase a foot operator release for window guard. The Fire Department will come out to complete the inspection of the home. Applicant will have the cell phone fixed for children in care use. Applicant will purchase an alarm, and lock for the sliding door in bedroom #2. Applicant will clean the kitchen stove. Applicant's fingerprints are pending. An exit interview was conducted. A copy of report will be emailed to Applicant Casper Andrews.


summary: Facility Evaluation

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Narrative:
On April 15, 2025, at 9: AM Licensing Program Analyst (LPA) Erika Butler arrived at Power and Change Home Care for the purpose of conducting a follow-up Pre-Licensing Inspection. The following corrections were made: Lighter has removed from kitchen drawer. Bathtub has been glazed in bathroom #2. Applicant purchased extra cutlery for the home. Applicant tightened the handle for the shower in bathroom #2. Applicant will place a more sturdy covering over the fireplace in the living room. Applicant purchased a lock box for refrigerated medication. Applicant will purchase a thermometer for the First Aid Kit. Applicant will email LPA Butler a picture of the thermometer. Applicant will fix the 2 burners on the stove Applicant removed the bars off the windows. The Fire Department will come out to complete the inspection of the home. Applicant will have the cell phone fixed for children in care use. Applicant will email LPA Butler a picture of the phone. Applicant purchased an alarm, and lock for the sliding door in bedroom #2. Applicant will clean the kitchen stove. Applicant's fingerprints are cleared. Applicant has changed the set-up of the home: Bedroom #1: vacant bedroom is equipped with 2 full size bed with drawers dresser, adequate closet space, television, adequate lighting, and window. Bedroom #2: applicant's bedroom is equipped with full bed, dresser, adequate closet space, adequate lighting, and exit door that leads outside will remain locked. Bedroom #3: vacant bedroom is equipped with full bed, drawers, adequate closet space, lighting, and windows. Sliding door that leads outside is currently blocked by a piece of wood. Component III is scheduled for April 29 @ 9:00 via Teams. An exit interview was conducted. A copy of report will be emailed to Applicant Casper Andrews.


summary: Facility Evaluation

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On April 25, 2025, at 9: AM Licensing Program Analyst (LPA) Erika Butler arrived at Power and Change Home Care for the purpose of conducting a follow-up Pre-Licensing Inspection. The following corrections were made: Applicant placed mesh covering over the fireplace in the living room. Applicant purchased a thermometer for the First Aid Kit. Applicant fixed the two burners on the stove. The Fire Department will come out to complete the inspection of the home after the City of Compton has approved the additional office added to the commercial side of the property. Applicant had the cell phone fixed for client's in care to use. Applicant will remove the coin operated washer and dryer this weekend and replace with non-coin operated washer and dryer. Applicant will update the Program Statement to state that camera's are on the property. An exit interview was conducted. A copy of report will be emailed to Applicant Casper Andrews.


summary: Facility Evaluation

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On September 2, 2025, at 9: AM Licensing Program Analyst (LPA) Erika Butler-Williams, Licensing Program Manager (LPM) Eenrique Hernandez, and Regional Manager (RM) Bernice Karnsrithong arrived at Power and Change Home Care for the purpose of conducting a follow-up Pre-Licensing Inspection. The following corrections need to be made: LIC 200 (to verify the address of the facility, to verify if the 2025 unit #s is on the deed and verify if 2023 is on the deed also). Tub in bathroom #1 needs to be changed or turned into a shower. Window blinds throughout the home need to be changed. Door knobs in throughout the home need to be changed. Main entryway door knob of the home needs to be changed. Stairway access to the entry of the home needs to be fixed. The concrete wall behind the trash bin outside needs to be fixed. The outside gate needs to be repaired. The metal that's on the ground through the entry way from the alley needs to be removed. Applicant will update the Program Statement to state that camera's are on the property. All corrections need to be completed by September 23, 2025. An exit interview was conducted. A copy of report will be emailed to Applicant Casper Andrews.

met_with: Casper Andrews, Applicant


facility_name: PRAISE HOME AND CARE

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****Continued from LIC 9099**** A confidential interview stated that a report was filed with the County about the bruises that were on FC1's body and a report was filed with CCL a short time later. Another confidential interview stated the level of care was being met. Based on confidential interviews the allegations LIC did not report FC1's injury to the county as necessary and FC1 sustained bruises while at the trampoline park or residential park are unsubstantiated. The allegations may have happened or be valid, but there is not a preponderance of evidence to prove that the alleged violations occurred. An exit interview was conducted. A copy of this report, LIC 811, and appeal rights were explained and given to Nelson Chiedu.

Investigation Findings:
On January 10, 2025, at 1: PM, Licensing Program Analyst (LPA) Karen Beal met with Licensee Nelson Chiedu to deliver the investigative findings for the above-stated allegations. On November 1, 2024, at 10: AM, LPA initiated the investigation at Praise Home and Care Small Family Home (SFH) and obtained pertinent documents from the facility files. LPA interviewed the licensee (LIC), Foster Child 1 (FC1), County Social Worker (CSW), and Out of Home Investigator (OHI). On October 24, 2024, Community Care Licensing (CCL) received a complaint that foster parent did not report an incident involving minor in care as necessary and Minor sustained an unexplained injury while in care. Specifically, it was alleged the LIC did not report the injury immediately to the County Social Worker (CSW) and the Foster Child 1 (FC1) received bruises while at the trampoline park and a residential park. R- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: PRAISE HOME AND CAREFACILITY NUMBER: VISIT DATE: 01/10/2025

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

met_with: Nelson Chiedu, Licensee


summary: Facility Evaluation

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On May 24, 2024, Licensing Program Analyst (LPA) Rafael Enriquez met with applicant Nelson Chiedu for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the notification of incomplete application (LIC 184), Letter of Application Revisions, and additional correspondence to assist with the revisions needed to the application. Copy of this report was emailed to applicant and a signed copy will be placed in the facility file.

met_with: Applicant Nelson Chiedu


summary: Facility Evaluation

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On July 03, 2024, at 9: AM, Licensing Program Analyst (LPA) Rafael Enriquez began a pre-licensing inspection and component III for Praise Home and Care Small Family Home for an initial license. LPA met with applicant Nelson Chiedu who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no children placed in the home. The applicant was approved to serve three ambulatory children ages 0 to 17. The home is a two-story building with four bedrooms and three bathrooms which is set up as follows: Downstairs: There was a formal living room, dining room, living room, kitchen, a storage room, a bathroom, three car garage, backyard, and a laundry room. Upstairs: Bedroom #1 sleeps one child, has a bunk bed with two full sized beds. It sleeps the applicant's daughter. Bedroom #2 will sleep two foster children, has two twin sized beds. It was vacant. Bedroom #3 will sleep one foster child, has one twin sized bed. It was vacant. Bedroom #4 sleeps the applicant and his spouse, has a California King bed, has a bathroom and a walk-in closet. There was a bathroom, and hallway cabinets. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked, and they were working properly. Telephone service and appliances were in working order. All hazardous items have been properly made inaccessible to areas where clients/children will have access. Sharp knives and sharp objects were locked in a cabinet in the kitchen. Cleansers/chemicals were inaccessible and stored in laundry room in a locked cabinet. There was adequate food storage space and a supply of three days of perishable foods and a week of non-perishable food. A proper storage of all food was discussed. Trash cans for storage of solid waste had tight fitting lids. The water temperature was observed to be at 117.5 degrees. First Aid kit was accessible with all required items, and it was in the upstairs hallway cabinet. A Fire extinguisher was observed and properly charged. The fireplace was in the living room area, and it was properly screened. All the appropriate forms were posted in view of facility clients. As stated by applicant, there were no weapons/firearms and there were no pools or other bodies of water. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request for licensure will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to applicant Nelson Chiedu.

met_with: Applicant- Nelson Chiedu


summary: Facility Evaluation

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On September 06, 2024, at 12: PM, Licensing Program Analyst (LPA) Rafael Enriquez began a post-licensing inspection for Praise Home and Care Small Family Home. LPA met with licensee Nelson Chiedu who led a tour of the home. The facility was toured both inside and out with the licensee. Currently there is one child placed in the home. The licensee was approved to serve three ambulatory children ages 0 to 17. The home is a two-story building with four bedrooms and three bathrooms which is set up as follows: Downstairs: There was a formal living room, dining room, living room, kitchen, a storage room, a bathroom, three car garage, backyard, and a laundry room. Upstairs: Bedroom #1 sleeps one child, has a bunk bed with two full sized beds. It sleeps the applicant's daughter. Bedroom #2 will sleep two foster children, has two twin sized beds. It sleep one foster child. Bedroom #3 will sleep one foster child, has one twin sized bed. It was vacant. Bedroom #4 sleeps the licensee and his spouse, has a California King bed, has a bathroom and a walk-in closet. There was a bathroom, and hallway cabinets. The small family home is operating within capacity/limitation, is clean, safe, sanitary and in good repair, the outdoor area is free of safety hazards, no pool, or other bodies of water on premise. The SFH has adequate supply of perishable and nonperishable foods, chemicals are locked in the laundry room, knives are locked in a kitchen cabinet. The water temperature was measures at 117.5 degrees. Medications are stored in a locked kitchen cabinet, the disaster plan, personal rights, and other documentation are properly posted, smoke detectors are operable/tested. There are no firearms or dangerous weapons per licensee. First aid kit is maintained, and complete First Aid certifications are current and in expire 2/2026. All adults subject to background checks are cleared. There are no deficiencies to be cited at this time. An exit interview was conducted. A copy of this report was provided to licensee Nelson Chiedu.

met_with: Licensee- Nelson Chiedu


summary: Facility Evaluation

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On April 17th, 2026, Licensing Program Analyst (LPA) Cynthia Ramos arrived at Praise Home and Care Small Family Home (SFH) for the purpose of conducting a required annual inspection. LPA met with licensee Nelson Chiedu who led a tour of the home. The facility was toured both inside and out with the licensee. Currently there are no clients in placement at the home at this time. The home is approved for 3 clients. The home is a two-story building with four bedrooms and three bathrooms which was set up as follows: Upon entering the home, there was a formal living room, dining table. Next to the kitchen, there was a family room with television and property covered fireplace. There was also a restroom, closet and two car garage in the downstairs of the home. In the upstairs of the home there was Bedroom #1 which contained a queen size bed and twin size bed, this room is vacant for future placement. Bedroom #2 has two twin sized beds and adequate closet and bedding; this room is vacant for future placement. Bedroom #3 had two twin size beds and sleeps Licensee's son and daughter. Bedroom #4 sleeps the licensee and spouse, has a king bed, bathroom and a walk-in closet. In the hallway, there was a full bathroom and additional cabinet space. Continued on the Next Page... There were no pool, or other bodies of water on the premise. The SFH has adequate supply of perishable and nonperishable foods, chemicals are locked in the laundry room, and knives are locked in a kitchen cabinet. The water temperature was measured at 128 degrees Fahrenheit (please refer to LIC D) Medications were stored in kitchen cabinet, however there was not a lock (please refer to LIC 809D). The disaster plan, personal rights, and other documentation are properly posted. The smoke detectors/carbon monoxide were tested and were working properly. Per Licensee there are no firearms or dangerous weapons at the home at this time. LPA observed first aid kit was missing required items. Based on today's inspection, the facility is being cited for (3) Type B deficiencies under California Code of Regulations (CCR) for small family homes: 80075(k)(1), 80088(e)(1) and 80087(a). Refer to LIC 809-D for additional details. An exit interview was conducted. A copy of this report was provided to licensee Nelson Chiedu.

met_with: Licensee, Nelson Caleb Chiedu


facility_name: PRESTON SMALL FAMILY HOME

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C1 which caused a bruise to C1's arm. Confidential interviews and record review provided conflicting information regarding the four allegations. Confidential interviews reported due to a prior incident C1 had been having behavior issues both at the facility and school that both the facility and CSW wanted to address with the school prior to C1 returning to school. These behaviors including eloping from school and facility and self-harming behaviors. Confidential interviews reported C1 was informed of the meeting and wanted to attend school anyway which led to C1 attempting to engage in self-harming behaviors and then eloping from the facility. Confidential interviews and record review could not confirm or dispute the reason C1 was not allowed to go to school or if C1 was restrained to deny C1 from eloping the facility to go to school. Confidential interviews and record review were unable to confirm or dispute C1 was handled in a rough manner and/or injured when staff attempted to stop C1 from self-harming and/or eloping from the facility. Based on record review and confidential interviews the allegation(s) alleging staff caused injury to child (C1) in care, staff restrained child (C1) while in care, staff handled child (C1) in a rough manner and staff did not allow child (C1) to go to school, may or may not have occurred, however it is not supported or proven by the evidence. Therefore, the allegations is unsubstantiated at this time. An exit interview was conducted, and a copy of the report was provided along with appeal rights to Preston Small Family Home House Manager, Tabatha Pendleton.

Investigation Findings:
13On August 2, 2023, at 11: AM, Licensing Program Analyst (LPA), Nicole Strickland met with Preston Small Family Home House Manager, Tabatha Pendleton, to deliver the finding for the above stated allegations. A Health and safety inspection of the facility was conducted on 8/18/2022 and no immediate hazards were observed. The investigation included interviews with Administrator (ADM), three staff (Staff #1 [S1], Staff #2 [S2], Staff #3 [S3]), three of four residents (Child #1 [C1], Child #2 [C2], Child #4 [C4]), and Riverside County Social Worker (CSW). In addition, facility records, county records, were reviewed. On August 11, 2022, Community Care Licensing (CCL) received four allegations alleging staff caused injury to child (C1) in care, staff restrained child (C1) while in care, staff handled child (C1) in a rough manner and staff did not allow child (C1) to go to school. Specifically, it was reported C1 was not allowed to go to school, was attempting to leave the facility without permission and was denied the ability to leave by staff restraining UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Nicole Strickland 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: PRESTON SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 08/02/2023

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

met_with: Tabatha Pendleton


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During investigation, confidential interviews stated that FC1 would pee on people such as FC1's therapist. Another confidential interview stated if FC1 peed the bed, there was always supervision so staff would wake FC1 up to use the restroom. Additionally, confidential interviews stated that when clients would act out, staff would use verbal de-escalation or in serious cases, use Crisis Prevention Intervention (CPI) holds. Furthermore, confidential interviews went on to say that the house mainly has tile and only a few little area rugs. Based on confidential interviews and a review of pertinent documents, the allegations that facility staff inappropriately handled foster child while in care may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted. A copy of this report, LIC 811 and appeal rights were explained and given to Licensee Zenobia Groves.

Investigation Findings:
13On 07/19/2024, at 1: PM, Licensing Program Analyst (LPA) Maryjane Perez and Licensing Program Manager (LPM) Abdoulaye Traore conducted an unannounced visit to Preston Small Family Home (SFH) and met with Licensee (LS) Zenobia Groves to deliver the investigative finding for the allegation listed above. On October 11, 2023, Licensing Program Analyst (LPA) Babatunde Aborchie met with House Manager (HM) and conducted a health and safety inspection. LPA observed no safety hazards at this time. In addition, LPA B. Aborchie interviewed facility Staff 1, 2, & 3 (S1, S2, S3). Lpa B. Aborchie also obtained documents pertinent to the investigation. Furthermore, LPA M. Perez and Licensing Program Manager (LPM) Abdoulaye Traore interviewed current HM, S1, & S2 to obtain more information. On 10/04/2023, Community Care Licensing received an allegation that facility staff inappropriately handled foster child while in care. It was reported that when foster child 1 (FC1) urinated on the grounds of the home, "they" (foster mother and other adults in the home) would press FC1's face into the urine-soaked carpet. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: MaryJane Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE CRP RO, MAIN ST., SUITE FACILITY NAME: PRESTON SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 07/19/2024

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

met_with: Licensee- Zenobia Groves


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Regarding the allegation that facility operated out of ratio, it was specifically alleged that several times there was only one staff working. During investigation, confidential interviews stated that each client has at minimum 1 on 1 coverage but most of the time, the facility provides additional staffing. The confidential interview added that coverage depends on the approved client's ratios. LPA reviewed facility personnel report to ensure, the facility was following the ratio requirement according to the placement agreement. LPA was unable to gather additional information at this time. In regard to the allegation that facility staff handled youth in a rough manner, it was specifically alleged that staff grab C1 to stop C1 from hitting staff. Confidential interviews stated that staff do not grab clients. The confidential interviews continued stating that staff will try and de-escalate the behavior or redirect them. LPA was unable to gather additional information due clients refusing to be interviewed. Concerning the allegation that facility staff threw objects at youth, it was specified alleged that a human sized bear and ice was thrown at C1. Confidential interviews denied that any staff had thrown ice or a human sized bear at C1. Additionally, the confidential interviews disclosed that C1 did have a human sized bear in C1's room but C1 never pays attention to it. LPA was unable to gather additional information. LPA was unable to interview C1 due to being non-verbal. Regarding the allegation that facility staff squirted youth with water, it was specifically alleged that staff squirted water at C1 with a water gun. During investigation, confidential interviews denied that staff has squirted C1 with a water gun. Additional confidential witnesses stated such scenario was not observed at the facility. LPA was unable to gather additional information. In regard to the allegation that youth sustained unexplained bruising in care, it was specifically alleged that bruises were observed on C1 that might have caused by staff. Confidential interviews stated that no bruises were observed on C1 recently. It was added that C1 tends to self-harm, and C1 sometimes wears a helmet and arm covers to avoid C1 from biting themselves. LPA was unable to gather additional information. Concerning the allegation that facility staff did not intervene when youth hit another youth, it was specified alleged that C1 was observed beating C2. Confidential interviews denied that C1 beat C2. It was added that staff will keep them away from each other do to they can be unpredictable. Additionally confidential interviews stated that staff will redirect clients from each other so that they don't hurt each other. LPA was unable to gather additional information. Finally, it was reported that facility staff smoked inside the facility in the presence of youth. It was specified that staff was smoking inside the house near the youths. Confidential Interviews denied that staff smoke in the house or around the house. It was added that the staff that smoke walk down thew street on their breaks to smoke. LPA was unable to gather additional information. Based on confidential interviews, the allegations that that facility operated out of ratio, facility staff handled C1 in a rough manner, facility staff threw objects at C1, facility staff squirted C1 with water, C1 sustained unexplained bruising in care, facility staff did not intervene when youth hit another youth and facility staff smoked inside the facility in the presence of youth may have occurred, however, there was not a preponderance of evidence to support or deny the allegations. Therefore, the above allegations are unsubstantiated at this time. An exit interview was conducted, and a copy of this report along with the appeal right were reviewed and provided to facility representative.

Investigation Findings:
13On August 12, 2024, Licensing Program Analysts (LPAs) Rafael Enriquez and MaryJane Perez arrived at Preston Small Family Home (SFM) and met with Assistant Administrator Reginald Groves to deliver the finding for the allegations stated above involving the SFM's staff and clients (C1, C2, C3, and C4) as listed on the Confidential Names List (LIC 811) dated August 12, 2024. On April 25, 2024, LPA Enriquez initiated the investigation at the SFH and obtained pertinent documents. Additionally, LPA conducted a safety inspection of the SFH, no immediate health and safety hazards were observed. During the inspection, LPA interviewed S1, S2, S3 and S4. LPA was not able to interview C1 and C2 due to being non-verbal, and C3 and C4 refused to be interviewed. On March 27, 2024, Community Care Licensing (CCL) received a complaint alleging that facility operated out of ratio, facility staff handled youth in a rough manner, facility staff threw objects at youth, facility staff squirted youth with water, youth sustained unexplained bruising in care, facility staff did not intervene when youth hit another youth and facility staff smoked inside the facility in the presence of youth. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Rafael Enriquez 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: PRESTON SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 08/12/2024

met_with: Administrator - Reginald Groves