facility_name: BELOVED ONES 2

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Narrative:
Continued from pg. LIC It was alleged that the facility staff allowed a foster youth to AWOL, staff did not prevent a foster youth from engaging in inappropriate behaviors and a facility window is in disrepair. Statements obtained from the confidential interviews did not provide sufficient information to corroborate the allegations. The staff that were interviewed stated that the facility is not a lock-down facility. Therefore staff is not allowed to physically prevent residents from leaving. Facility staff stated that residents are verbally encouraged not to go AWOL. The staff stated that law enforcement was called once the foster youth began engaging in inappropriate behaviors in order to de-escalate the situation. The staff stated that the foster youth broke a window and the window was immediately boarded up on the same day. Facility staff called in a work order to have the window repaired the next day. The county social worker stated that the foster youth was in need of a higher level of care and the facility staff did their best. LPA Mundo was unable to get a statement from the foster youth. There was no corroborating information obtained through the interviews and review of records to confirm the allegation. Based on the interviews and records reviewed, the allegations are found Unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the allegations. The following reports were provided to the facility representative: LIC 9099, LIC 9099C, LIC 811, and Appeal Rights. There were no deficiencies cited.

Investigation Findings:
13On 8/27/2021 at 2:25 pm, Licensing Program Analyst (LPA) Jenny Mundo conducted a follow-up complaint inspection with the Short Term Residential Therapeutic Program (STRTP) for the purpose of providing findings for the above complaint allegations. LPA Mundo met with the facility Administrator Crystal Downey. During the course of the investigation, LPA Mundo conducted interviews with 2 facility staff on 5/21/2021 via telephone and a county social worker on 8/26/2021 via telephone (see Confidential Names form LIC 811 dated 8/27/2021). LPA Mundo also reviewed documents on 6/2/2021 and 8/27/2021 including but not limited to the facility's LIC 500 and staff trainings for 2021, Special Incident Reports (SIRs) involving one foster youth for the period of 4/11/2021-5/11/2021, the following documents for one foster youth: current Needs and Service Plan (NSP), current Child and Family Team Meeting (CFTM) minutes, Treatment plan from College Hospital and case notes for 4/11/2021-5/11/2021. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Jenny Mundo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 2FACILITY NUMBER: VISIT DATE: 08/27/2021

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

met_with: Crystal Downey, Administrator


state: CA

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Statements from other interviews revealed that C1 reached out their hand and tapped C2's breast when C2 was passing, and it happened only once. Staff did not see the incident as it occurred very quickly. Statements obtained from the confidential interviews did not provide sufficient information to corroborate the allegation. Based on the information gathered, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that alleged violation occurred, therefore the allegation is unsubstantiated. There were no deficiencies cited during this inspection. An exit interview was conducted. Appeal rights explained and a copy of this report, and Appeal Rights were provided to the facility representative.

Investigation Findings:
13On July 27, 2023, at 11: AM, Licensing Program Analyst (LPA) Karen Suh conducted a follow-up complaint inspection to deliver the finding of an investigation concerning to the allegation above. The LPA met with the representative named above and discussed the finding. The investigation included confidential interviews that consisted of but were not limited to: one client and three staff and C1's therapist on April 6, 2023. The LPA was unable to interview C2 as C2 has been terminated from the facility and where about is unknown. The LPA was unable to contact the County Social Worker (CSW) after several attempts. The LPA reviewed Needs and Services Plans, Treatment Plans, Child and Family Team (CFT) Meetings and Special Incident Report. It was alleged that minors engaged in inappropriate interactions due to lack of supervision: one client touched another client's breast. Staff denied the allegation. On the day of the incident, staff were in the kitchen area sitting at the table and one client (C1) was on the computer and the other client (C2) was in a room. Staff did not see any alleged incident; staff did not see C1 touching C2's breast. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Karen Suh LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 2FACILITY NUMBER: VISIT DATE: 07/27/2023

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

report_type: Complaint Investigation

met_with: Danielle Council, Supervising Facility Manager

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated

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Narrative:
In addition to the interviews conducted, it is important to note the efforts to engage with the reporting party (RP) and neighbors for their statement. On 10/31/23, LPA Martinez emailed the RP seeking a statement regarding the incident under investigation. Despite efforts by LPA Martinez, the reporting party's statement was absent from the investigation. On 10/19/23, LPA Martinez approached the neighbors to discuss the complaint investigation. Despite this attempt, the neighbors declined to provide a statement. On 09/11/23, the department received a complaint alleging that staff did not provide adequate supervision to youth in care. Confidential interviews consistently revealed that staff are always available for supervision. All interviewed staff members (S1, S2, S3), along with C1, reported that staff is available to provide supervision. Additionally, staff members receive ongoing training in handling crises, ensuring they are prepared to handle challenging situations. Daily logs help maintain effective communication among staff. The staff members consistently stated that the youth placed in the facility are always under supervision. The staff interviewed denied the allegation that the facility failed to provide adequate supervision to the youth in their care. Based on the confidential interviews and records reviewed, the allegation against license 157807000 is unsubstantiated. An unsubstantiated determination means the allegation lacks a preponderance of the evidence to prove that the violation occurred. There are no deficiencies to be cited at this time. An exit interview was conducted, and a copy of the signed LIC9099 was provided to the administrator.

Investigation Findings:
13On 01/11/24, Licensing Program Analyst (LPA) Joe Martinez met with Danielle Council, Administrator, to deliver findings for the above complaint. During an investigation into the complaint received by the department, LPA Martinez interviewed three (3) staff members and one (1) youth on 09/13/23. At the time of the inspection the facility only had one youth placed in the home. On 11/06/23, LPA Martinez reviewed records relevant to the investigation. Records included the Needs and Services Plan, Special Incident Reports (SIR), Team Meeting Records, and Daily Program Notes. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Joe Martinez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 2FACILITY NUMBER: VISIT DATE: 01/11/2024

met_with: Danielle Council


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Narrative:
S1 and S2 denied the allegations, asserting that they are both certified in Professional Assault Crisis Training (Pro-Act) and will utilize this training only as a last resort to prevent self-harm among clients or to protect others from harm. S2 additionally noted that all staff members are trained in trauma-informed care and will employ effective communication strategies to de-escalate potential conflicts. S1 and S2 mentioned that physical interventions may include blocking by proximity or guiding clients to a safer location. They also reported an incident that took place on July 12, 2024, involving C1, who, after receiving a phone call informing them of a family member's passing, became emotionally distressed and threw an object at a wall shelf, resulting in its collapse. S1, who was seated in the office adjacent to C1's room, heard the disturbance and went to assess the situation. Upon opening the door, S1 was met with C1's demand to "get the fuck out of her room." S1 observed C1 with their head down on the bed and the shelf on the floor and refusing to engage in conversation. Shortly thereafter, C1 requested a hammer to reattach her bookshelf to the wall. When S1 offered assistance, C1 declined, and since C1 was at baseline, S1 provided the hammer. S1 then positioned themselves at the doorway of C1's room and watched as C1 attempted to rehang the shelf before returning to the office. While at their desk, S1 noticed C1 exit her room and head towards the back door. S1 followed C1, who then threatened to strike S1 with the hammer if not left alone. C1 subsequently used the hammer to damage the outside cameras and continued into the facility to break the cameras located inside. S1 reported that upon entering the facility, she contacted S2, who arrived shortly thereafter to provide assistance. S2 noted that upon their arrival, they observed C1 wielding a hammer and refusing to relinquish it to S1, while also making threats to strike S1 with the hammer. Given the emergency situation and the risk of physical harm, S1 swiftly attempted to secure the hammer from C1, resulting in C1 dropping it on the floor. Subsequently, S2 secured the cooperation of C1 and instructed S1 to retrieve the hammer and place it in the staff office. S2 explained that C1 was held back solely to prevent C1 from accessing the hammer or inflicting harm on another (S1). Upon S1's return from the office, C1 exhibited signs of distress and attempted to reach out to S1; however, C1 lost their balance and fell to the ground, requiring a brief support on C1's arm and shoulder that lasted no longer than forty seconds. S2 then advised S1 to return to the office, while C1 attempted to jump out of the living room window. S2 intervened by grasping C1's hand and pulling C1 back, cautioning C1 about the dangers of attempting to leave the facility without proper attire, as they were only wearing a t-shirt and undergarments. C1 subsequently hurried to their room, expressing a need to smoke, and took a cell phone along with marijuana vape pens, attempting to smoke in the presence of S2. S2 intervened, confiscating the contraband and informing C1 that, due to a court order, possession of a cell phone was prohibited. Subsequently, S2 initiated a dialogue with C1, who disclosed that their behavior was influenced by the recent passing of a family member. At this point, S2 offered assistance, which C1 opted to refuse. Based on information obtained during interviews describing the incident in question, the circumstances involved did not result in the usage of restraints or meet the restraint criteria. Additionally, findings from the investigation indicated that the personnel had received training in Pro-Act and employed the correct techniques when applying restraints. The facility's staff documented the application of restraints and promptly submitted Serious Incident Reports (SIRs) to the relevant agencies. Therefore, based on the information received, the above allegation(s) is determined to be unsubstantiated. Although the allegation(s) may have happened are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the allegations are found to be unsubstantiated. Appeal Rights were provided and discussed with the Foster Family Agency. There are no deficiencies to be cited at this time. An exit interview was conducted and a copy of the report along with the (LIC 811) was left with the STRTP Facility Manager.

Investigation Findings:
13On September 27, 2024, at 12: PM, Licensing Program Analyst (LPA) Winston Moroney conducted a complaint inspection at the above Short-Term Residential Therapeutic Program (STRTP) and met with the Supervising Facility Manager Serina Lindsay. The inspection aimed to deliver the finding(s) regarding the complaint allegation(s). On July 22, 2024, the Community Care Licensing Division of the California Department of Social Services received a complaint from the Centralized Complaint and Information Bureau (CCIB) with the following allegation(s): Staff improperly restrained a minor in care. This LPA conducted the investigation of the above allegation(s) and it consisted of but was not limited to a review of records, including the client's needs and services plans, medical records, and interviews with the two staff members (S1) on 7/31/24, and S2 on 8/6/24. (C1), and (C2) declined to be interviewed, so no statement was obtained from them. (Reference Confidential Names Form LIC 811, dated September 26, 2024). **This is an amended findings report delivered on February 14, 2025*** The Following Allegation(s) were reported: The staff improperly restrained a minor in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Winston Moroney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 2FACILITY NUMBER: VISIT DATE: 09/27/2024

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

met_with: Serina Lindsay - Supervising Facility Manager


raw_content:
Narrative:
There was a statement made that the FM#2 yelled at Ref. #1, "you crazy ass." The LPA received conflicting statements as to whether FM#2 yelled at and called Ref. #1 the name. FM#2 denied yelling at Ref. #1 and calling her the names, indicating that it was the contrary, Ref. #1 did all the yelling and calling names. The investigation revealed that FM#2 required medical assistance and Ref. #1 refused medical assistance. The LPA was unable to obtain sufficient evidence to corroborate the allegations. There was no preponderance of the evidence to substantiate the allegations. So, although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the allegations are unsubstantiated. There are no deficiencies to be cited regarding this allegation. A copy of this complaint was provided to the facility representative.

Investigation Findings:
On August 15, 2025 at 1:20 p.m., Licensing Program Analyst (LPA), Karen McGee, delivered the findings of a complaint investigation involving Client (see Confidential Names, LIC Ref. #1 dated August15, 2025). The LPA met with Facility Manager, Christopher Richardson. On May 5, 2025, Monterey Park Children's Residential Program (MPCRP), received a complaint with the above mentioned allegations. Confidential interviews were conducted that included, but were not limited to: one client Ref. #1 at their temporary placement, the Supervising Facility Manager (SFM) and Administrator via telephone on August 4, 2025 and Facility Manager (FM), Ref. #2 on August 9, 2025. The LPA did not interview Facility Manager Ref. #3. The LPA reviewed Ref.#1's Needs & Services Plan and the incident report. The investigation revealed that Ref. #1yelled at, spat on and physically attacked FM #2 at the facility after becoming upset because the staff followed Ref. #1 when Ref. #1 left the facility without permission. The investigation revealed that FM#2, who was pregnant attempted to block and disengage Ref. #1. FM#2 denied attacking Ref. #1 and Ref. #1 denied that FM#2 attacked them. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Karen McGee LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 2FACILITY NUMBER: VISIT DATE: 08/15/2025

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

met_with: Christopher Richardson


summary: Complaint Investigation - Substantiated - 1 allegation

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Narrative:
cont.# The information revealed that the staff at this STRTP take most of their training in an online database, while other training is taken in person. The topics of training include, but are not limited to, crisis intervention, emergency procedures, trauma-informed care, and regulatory compliance. On 04/24/25, LPA Flores conducted a file review at the STRTP, and it was observed that S1's file did not contain a Cardiopulmonary Resuscitation (CPR) and First Aid Training Certificate. LPA Flores, having considered the evidence provided during the investigation, deemed the allegation substantiated. A citation was issued on licensing report LIC809 dated 4/24/2025 for violation of Interim Licensing Standards (ILS), Version 6: Section 87065.1 (b)(8)(A): (8) Facility manager training is in addition to first aid and CPR training, and other training as required in Section 87095.65. (A) Completion of cardiopulmonary resuscitation (CPR) and first aid training shall be demonstrated by current and valid CPR and first aid cards issued by the American Red Cross, the American Heart Association, a training program approved by the State Emergency Medical Services Authority pursuant to Health and Safety Code Section 1797.191, or from an accredited college or university. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. No further inspection is needed. A copy of this report, appeal rights and LIC811 was provided to the facility representative. Exit interview conducted.

Investigation Findings:
13On August 21, 2025, at 10:40AM, Licensing Program Analyst (LPA) Humberto Flores, conducted a follow-up complaint inspection at Beloved Ones Short Term Therapeutic Program (STRTP) and met with Administrator Jeanne Fletcher. The purpose of the inspection was to deliver the findings for the above complaint allegation. The initial information that generated this complaint investigation stated that staff have not completed the training required at the facility . RP states the training is to ensure staff are equipped to handle resident care, crisis intervention, emergency procedures, trauma-informed care, and regulatory compliance. RP states that despite multiple email notifications sent to staff, no action has been taken to complete the training from Relias. LPA Flores investigated the allegation and conducted interviews with the Reporting Party (RP), Executive Director (ED) and staff. A review of Staff Ref #1 (S1) and Ref #2 (S2) (see Confidential Names form LIC811 dated 08/21/2025), training records were conducted, and copies were made. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Humberto Flores LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 2FACILITY NUMBER: VISIT DATE: 08/21/2025

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

met_with: Administrator, Jeanne Fletcher

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

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Narrative:
On February 15, 2022, at 11:30AM, Humberto Flores, Licensing Program Analyst (LPA), conducted an announced Case Management Inspection at Beloved Ones Short Term Residential Therapeutic Program (STRTP) and met with Desiree Terry. The purpose of the inspection was to verify that the facility meets the requirements for a capacity increase, previously requested, to six (6) children. Currently the facility licensed capacity is one (1) child. LPA Flores inspected the facility and observed that there are 2 beds with mattresses, pillows and bed sheets in room #1, room #2 and room #3. There is a closet in each room with enough space to store clothes and shoes. A copy of the facility sketch was provided upon request. LPA Flores observed that the STRTP meets the requirements to hold a licensed capacity of six (6) children. No further inspection is needed. A copy of this report was provided to the facility representative. Exit interview conducted.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Desiree Terry, Supervisor Facility Manager


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On April 25, 2022, 10:30AM, Licensing Program Analyst (LPAS) Humberto Flores, conducted an unannounced Annual Inspection at Beloved Ones Short Term Therapeutic Residential Treatment (STRTP) and met with Jessica Hatley. LPA Flroes stated the purpose of the inspection to the STRTP representative. During the inspection a copy of the Register of Facility Clients and Personnel Report was provided upon request. The following topics were inspected: PHYSICAL PLANT: A tour of the facility was conducted, along with Jessica Hatley. The License is placed in a prominent place, in the reception are of the facility. Children's foster rights were posted. LPA Flores observed that the facility is clean, safe, sanitary and in good repair. The passageways are unobstructed. There is no swimming pool or body of water. The disinfectants and cleaning solutions were stored away from the kitchen areas, food preparation areas to the children. The food is safe and of the quality and the quantity necessary to meet the needs of the clients. Each meal meets at least 1/3 of the recommended in the USDA Basic Food Group Plan-Daily Food Guide. cont.# Supplies of staples non-perishable foods for one week and perishable foods for two days are maintained in the facility. Medications are locked and accessible only to employees supervising stored medications. The temperature in the rooms that clients occupy are maintained between 68 and 85 degrees (F). The hot water temperature was at 131.7 degrees (F). This is a violation of Interim Licensing Standards (ILS), Section Furniture, Fixtures, Equipment, and Supplies (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). This is a violation of the regulations and the Health and Safety Code that, if not corrected, have a direct and immediate risk to the health, safety or personal rights of those in care. A type A citation was issued. Emergency Intervention Plan: LPA Portillo reviewed the program statement and PROACT instruction manual and identified the training that is provided for all staff. The staff receive on-going training to maintain certification. A monthly log is utilized to document manual restraints. There have been no restraint. cont.# Disaster Preparedness Plan: LPA Flores reviewed the disaster and mass casualty plan and other provisions by reviewing the program statement. The facility conducts monthly fire and emergency evacuation drills. Drills are documented and kept in the facility for at least one year. CLIENT RECORDS: LPA Flores reviewed the one (1) client file records. Needs and services is trauma informed, culturally relevant, and age and developmentally appropriate and identified the child's needs: reason for placement, education, personal care and grooming, ability to manage money, visitation information, mental health services and placement information CORE THERAPEUTIC SERVICES: During the inspection review, LPA Flores was able to see that the facility is providing the Short-Term Therapeutic Program (STRTP) core services and support to the individuals in placement. The facility has trauma informed, culturally relevant, age, and developmentally appropriate. The facility is also providing trauma informed core services through agreements with other agencies. OPERATIONAL REQUIREMENTS: During the inspection review, LPA Flores observed the facility maintained an updated roster of the clients with pertinent information. The facility administrator and manager are the responsible and capable staff for communicating with emergency personnel in the facility. The facility has developed, maintained and implemented written complaint procedures cont.# STAFFING RECORDS: During the inspection review, LPA Humberto inspected two (2) staff files and verified that all facility staff was subject to criminal records review, fingerprinted and cleared DOJ, FBI and CACI, training hours. LPA Flores observed that Staff Ref #2 did not have an educational background in the file. This is a violation of Section Personnel Requirements: (1) The facility manager shall meet one of the following requirements prior to employment: (A) Have a Bachelor of Arts or Sciences degree. This is a violation of the regulations and the Health and Safety Code that, without correction, could become an immediate risk to the health, safety or personal rights of clients, or record keeping violation that would impact the care of clients and/or protection of their resources, or a violation that would impact those services required to meet clients' needs. A type B citation was issued. A search and review of Licensing Information System (LIS) was conducted during the inspection. A total of 5 employees listed in the Personnel Report LIC500, were working at the facility without a prior association to the STRTP. The employees working without a prior association are: S1, S3, S4, S5 and S6. This is a violation of the regulations and the Health and Safety Code that, if not corrected, have a direct and immediate risk to the health, safety or personal rights of those in care. A type A citation was issued and a civil penalty of $100 per day for a maximum of 5 days per each employee was assessed, for a total of $2,500.00. A copy of this report, LIC811s and LIC809D and appeal rights was provided to the STRTP representative. Exit interview conducted.

Deficiencies:
87065: (1)

visit_type: Annual

met_with: Jessica Hatley, Administrator

title: Personnel Requirements


facility_name: BELOVED ONES 3

raw_content:
Narrative:
Confidential statements obtained during the investigation were unable to corroborate the allegations as details obtained provided inconsistencies which did not support the allegations. The county placing agency social worker provided confidential information regarding the client which did not support the allegations. In addition, the client was unable to be interviewed due to being runaway status with her whereabouts unknown. Facility staff denied the allegations. Documentation of pre-placement and placement indicate that Client has a history of running into traffic and putting herself at risk. Records indicate that that crisis intervention was performed during de-escalation and records indicate incidents that took place during placement and services that were provided and not followed by the client. Based on the information gathered, the allegations are unsubstantiated as the preponderance of evidence to prove the allegations was not met although the allegations may have happened or are valid. A copy of this report, Confidential Names Form and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On January 24, 2024, at 11: AM, Licensing Program Analyst (LPA) Claudia Portillo conducted a follow-up inspection to deliver the findings of a complaint investigation concerning the allegation above. LPA Portillo discussed the findings with the facility representative named above. During the course of the investigation, LPA Portillo interviewed the complainant and County Social Worker on 10/13/23, facility staff on 10/20/23 and 1/22/24 (see Confidential Names Form dated January 24, 2024). LPA Portillo reviewed documents including the placing agency service reports, Mental Health Assessment, CFT Notes, Needs and Services Plans, incident reports, and personnel files. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Claudia Portillo LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 3FACILITY NUMBER: VISIT DATE: 01/24/2024

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

met_with: Cory Jackson, Facility Manager


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Investigation Findings:
13On June 25, 2024, at 11: AM, Licensing Program Analyst (LPA) Winston Moroney conducted a complaint inspection at the above Short-Term Residential Therapeutic Program (STRTP) and met with the Facility Manager Cory Jackson. The inspection aimed to deliver the finding(s) regarding the complaint allegation(s). On April 23, 2024, the Community Care Licensing Division of the California Department of Social Services received a complaint from the Centralized Complaint and Information Bureau (CCIB) with the following allegation(s): The facility staff is not arranging transportation for youth as needed. This LPA conducted the investigation of the above allegation(s) and it consisted of but was not limited to a review of records, including the client's needs and services plans, medical records, and interviews with the two staff members (S1) on 5/2/24, S2 on 5/2/24, 1 client (C1) on 5/2/24, and the CSW on 5/22/24. (Reference Confidential Names Form LIC 811, dated June 25, 2024). The Following Allegation(s) were reported: 1. The facility staff is not arranging transportation for youth as needed. Staff members S1 and S2 denied the accusation by clarifying that during the alleged incident, C1 had called from school requesting to be picked up because of feeling unwell. They explained that they received three calls, two of which were distorted with static and cutting in and out, making it challenging to understand the message. On the third call, they identified C1's voice but still struggled to comprehend due to the background noise. S1 was then sent to the school to conduct further investigation. Upon arrival, S1 was informed that C1 was indeed unwell and required assistance returning to the facility. S1 reassured the school that it would be taken care of but had to go back to the facility to get the facility car as personal vehicles were not permitted for client transportation. S1 informed school staff that they would return within fifteen minutes to accompany C1 back to the facility. The information gathered from C1 confirmed the aforementioned and additionally mentioned that they did not encounter any problems with transportation and that it was the only instance. Details obtained from the CSW revealed that during their interactions with C1, no concerns were observed, and C1 did not face any transportation issues. Furthermore, it was disclosed that the facility staff are highly attentive and supportive towards their clients. Therefore, based on the information received, the above allegation(s) is determined to be unsubstantiated. Although the allegation(s) may have happened is are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the allegations are found to be unsubstantiated. Appeal Rights were provided and discussed with the Foster Family Agency. There are no deficiencies to be cited at this time. An exit interview was conducted and a copy of the report along with the (LIC 811) was left with the STRTP Facility Manager. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Winston Moroney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Cory Jackson - Facility Manager


raw_content:
Narrative:
The Following Allegation(s) were reported: It was reported that on April 7, 2025, a staff member (S3) allegedly struck C1 with a shoe on their buttocks and also hit them in the eye after C1 touched a floral decoration that S3 had recently made for the facility. The staff members (S1, S2, S3, S4, and S5) denied these allegations, asserting that all staff are trained in trauma-informed care practices, which emphasize de-escalation, empathy, and non-violent communication. These practices aim to prevent retraumatization and to ensure the emotional and physical safety of clients. Additionally, several staff members indicated that each staff member has undergone Pro-Act training, a comprehensive program that details safe and ethical physical intervention techniques. Such techniques are employed only as a last resort when there is an imminent risk of harm to the client or others, utilizing the least restrictive measures necessary to maintain safety. The staff members stated that no physical intervention was needed or performed during the incident. They maintain that C1 was verbally redirected and that no physical contact took place between S3 and C1. C2 refuted the claim, stating that they have never witnessed or heard of any employee hitting or mistreating any client. C2 emphasized that the staff is highly supportive and offers everything necessary to guarantee success with their program. The statement obtained from C1 did not corroborate the above allegations due to C1 providing contradicting information to various interviewers, including Law Enforcement, Kern County (SSP), and LPA. Additionally, the statement obtained from the Kern County SSP confirmed that they have no objections or concerns regarding the quality of care and supervision provided by the facility staff. Therefore, based on the information received, the above allegation(s) are determined to be unsubstantiated. Although the allegation(s) may have happened are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred; therefore, the allegations are found to be unsubstantiated. Appeal Rights were provided and discussed with the Foster Family Agency. There are no deficiencies to be cited at this time. An exit interview was conducted and a copy of the report along with the (LIC 811) was left with the STRTP Facility Manager.

Investigation Findings:
13On August 8, 2025, at 1: PM, Licensing Program Analyst (LPA) Winston Moroney conducted a complaint inspection at the above Short-Term Residential Therapeutic Program (STRTP) and met with the Facility Manager, Edward Hillman. The inspection aimed to deliver the finding(s) regarding the complaint allegation(s). On April 7, 2025, the Community Care Licensing Division of the California Department of Social Services received a complaint from the Centralized Complaint and Information Bureau (CCIB) with the following allegation(s): The staff hit a minor in care, resulting in bruising; The staff used inappropriate forms of discipline. This LPA conducted the investigation of the above allegation(s) and it consisted of but was not limited to a review of records, including the client's needs and services plans, medical records, SIR's and interviews with the five staff members (S1, S2) on 4/10/25, (S3) on 4/24/25, (S4, S5) on 5/23/25, 2 of 2 clients (C1, C2) on 4/10/25, and the SSP on 1/31/24. Reference Confidential Names Form LIC 811, dated August 8, 2025. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Winston Moroney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 3FACILITY NUMBER: VISIT DATE: 08/08/2025

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

met_with: Edward Hillman - Facility Manager


summary: Facility Evaluation

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Narrative:
On February 15, 2022, Humberto Flores, Licensing Program Analyst (LPA), conducted an announced Case Management Inspection at Beloved Ones Short Term Residential Therapeutic Program (STRTP) and met with Jessica Hatley. The purpose of the inspection was to verify that the facility meets the requirements for a capacity increase, previously requested, to six (6) children. Currently the facility licensed capacity is one (1) child. LPA Flores inspected the facility and observed that there are 2 beds with mattresses, pillows and bed sheets in room #1, room #2 and room #3. There is a closet in each room with enough space to store clothes and shoes. A copy of the facility sketch was provided upon request. LPA Flores observed that the STRTP meets the requirements to hold a licensed capacity of six (6) children. No further inspection is needed. A copy of this report was provided to the facility representative. Exit interview conducted.


summary: Facility Evaluation

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Narrative:
On May 09, 2022, 10:50AM, Licensing Program Analyst (LPAS) Humberto Flores, conducted an unannounced Annual Inspection at Beloved Ones Short Term Therapeutic Residential Treatment (STRTP) and met with Cynthia Bertrand. LPA Flores stated the purpose of the inspection to the STRTP representative. During the inspection a copy of the Register of Facility Clients and Personnel Report was provided upon request. The following topics were inspected: PHYSICAL PLANT: A tour of the facility was conducted, along with Cynthia Bertrand. The License is placed in a prominent place, in the reception are of the facility. Children's foster rights were posted. LPA Flores observed that the facility is clean, safe, sanitary and in good repair. The passageways are unobstructed. There is no swimming pool or body of water. The disinfectants and cleaning solutions were stored away from the kitchen areas, food preparation areas to the children. The food is safe and of the quality and the quantity necessary to meet the needs of the clients. # Each meal meets at least 1/3 of the recommended in the USDA Basic Food Group Plan-Daily Food Guide. Supplies of staples non-perishable foods for one week and perishable foods for two days are maintained in the facility. Currently no client is taking psychotropic medication. The temperature in the rooms that clients occupy are maintained between 68 and 85 degrees (F). The hot water temperature was at 119.7 degrees (F). Emergency Intervention Plan: LPA Flores reviewed the program statement and PROACT instruction manual and identified the training that is provided for all staff. The staff receive on-going training to maintain certification. A monthly log is utilized to document manual restraints. According to the STRTP representative, there has been no restraint. Disaster Preparedness Plan: LPA Flores reviewed the disaster and mass casualty plan and other provisions by reviewing the program statement. The facility conducts monthly fire and emergency evacuation drills. Drills are documented and kept in the facility for at least one year. CLIENT RECORDS: LPA Flores reviewed the one (1) client file records. Needs and services is trauma informed, culturally relevant, and age and developmentally appropriate and identified the child's needs: reason for placement, education, personal care and grooming, ability to manage money, visitation information, mental health services and placement information. # Copy of the Identification Card, Consent Forms for Medical and Dental Treatment. The STRTP representative disclosed that the appointment for the Health Screening is on 5/24/2022 and a Tuberculosis Test will be obtained too. CORE THERAPEUTIC SERVICES: During the inspection review, LPA Flores was able to see that the facility is providing the Short-Term Therapeutic Program (STRTP) core services and support to the individuals in placement. The facility has trauma informed, culturally relevant, age, and developmentally appropriate. The facility is also providing trauma informed core services through agreements with other agencies. OPERATIONAL REQUIREMENTS: During the inspection review, LPA Flores observed the facility maintained an updated roster of the clients with pertinent information. The facility administrator and manager are the responsible and capable staff for communicating with emergency personnel in the facility. The facility has developed, maintained and implemented written complaint procedures STAFFING RECORDS: During the inspection review, LPA Humberto inspected one (1) staff files and verified that all facility staff was subject to criminal records review, fingerprinted and cleared DOJ, FBI and CACI, training hours. # LPA Flores observed that Facility Manager Staff Ref #1 (S1) (see Confidential Names form LIC811 dated 05/09/2022) did not meet the requirements of two years of full-time experience, or its equivalent, working with the population to be served. This is a violation of Interim Licensing Standards (ILS), Section 87065 (f)(1)(B): f) The licensee shall designate at least one facility manager to be present at the facility at all times when one or more children are present: (1) The facility manager shall meet one of the following requirements prior to employment: (B)Two years of full-time experience, or its equivalent, working with the population to be served, or equivalent education or experience, as determined by CDSS. 1. Experience shall be verified as having been performed as a paid or volunteer staff person whose duties required direct supervision and care of the population served. This is a violation of the regulations and the Health and Safety Code that, without correction, could become an immediate risk to the health, safety or personal rights of clients, or record keeping violation that would impact the care of clients and/or protection of their resources, or a violation that would impact those services required to meet clients' needs. A type B citation was issued. # A search and review of Licensing Information System (LIS) was conducted during the inspection. All employees have criminal record clearance with the Department of Justice (DOJ, Federal Bureau of Investigation (FBI) and Child Abuse Central Index (CACI) and are associated to the STRTP in the Licensing Information System (LIS). A copy of this report, LIC811s and LIC809D and appeal rights was provided to the STRTP representative. Exit interview conducted.

met_with: Cynthia Bertrand, Administrator


summary: Facility Evaluation

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Narrative:
On September 22, 2022, at 10:35AM, Humberto Flores, Licensing Program Analyst (LPA), conducted an unannounced Case Management Inspection, at Beloved Ones Short Therapeutic Residential Treatment Program (STRTP) and met with Cynthia Bertrand. The purpose of the inspection was to gather information about the below incident reported via Special Incident Report (SIR). The STRTP reported that on 02/27/2022, Child Ref #1 (C1) (see Confidential Names form LIC811), was transported to a medical facility and diagnosed with Diabetic Ketoacidosis due to not taking any insulin for over 48 hours (hrs). C1 was prescribed, and taking, insulin. LPA Flores investigated the incident and interviewed Cynthia Bertrand and spoke with Thandi Smith over the phone. LPA Flores requested copies from C1's file, and copies were made upon request. The SIRs and statements provided revealed that on 02/25/2022, around 2:29PM, ran away from the facility and went to a friend's house until 02/27/2022 that he was located by facility staff. On 02/25/2022, the STRTP decided to conduct an emergency removal on C1 due to C1's erratic and aggressive behavior. C1 did not return to the STRTP after he was discharged from the medical institution. cont.# No further inspection is needed. A copy of this report and LIC811 was provided to the facility representative. Exit interview conducted.


summary: Facility Evaluation

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Narrative:
On 03/09/23 at 11: AM, Licensing Program Analysts (LPAs) Pamela Silva and Ashley Ruacho conducted an unannounced Annual Inspection at the facility. LPAs met with Cindi Bertrand, Administrator. The facility currently has a provisional Short Term Residential Therapeutic Program (STRTP) license. The STRTP's Mental Health Program Application is pending approval. This STRTP is licensed to serve up to six (6) ambulatory children ages 7-17 years of age. The facility also provides services to non-minor dependents pursuant to W&I Code 16501.1 (C)(1). There is one (1) minor and one (1) non-minor dependent currently in placement. The facility is a single-story home located in a residential area. There are no bodies of water in the premises. LPAs conducted a walk-through of the entire facility. Physical Plant The license, facility sketch, Personal Rights, Emergency Disaster form, Complaints poster, Foster Youth Bill of Rights, Complaints/Grievance policy, emergency phone numbers and menus are posted in a prominent, publicly accessible location in the facility. Disinfectants, cleaning solutions and sharps are kept inaccessible in a locked closet in the hallway. Facility has non-perishable food for at least one week and perishable food for at least two days. Medications are centrally stored in a locked cabinet in the staff office. Smoke and carbon monoxide detectors were tested and in proper working order. Fire extinguishers are fully charged. Room temperatures are maintained at 76 degrees F. The hot water temperature was tested and is within standard range. All sinks, showers and toilets were in working order. No more than 2 children share a bedroom. All beds are in good repair; equipped with good springs, clean mattresses and pillows. Adequate supply of beddings and linens were observed. Emergency exits are free from obstruction. Overall, the facility is clean, safe, sanitary and in good repair. Operations Facility maintains a register of clients and the register is available upon request. The board of directors regularly conduct meetings to review and discuss the STRTP's operation. The facility has developed, maintained and implemented written complaint procedures. Emergency Intervention Documentation of emergency intervention training for staff is on file. The facility maintains a monthly restraint log which will be submitted bi-annually to the Department. According to the Administrator, there have been no manual restraints. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least quarterly for each shift. Facility maintains an emergency and disaster plan, register of clients, Needs and Services Plan for each client, medication records, and contact information for each client's responsible party and physician. Core/Therapeutic Services Facility provides core services and supports to children and non-minor dependents as appropriate or necessary that are trauma informed, culturally relevant, age and developmentally appropriate and include the following: Medi-Cal specialty mental health services; transition support services; educational and physical, behavioral, and mental health supports; activities to support children and non-minor dependents and services to achieve permanency. Client Records LPAs reviewed two (2) client records. Client records are available to the licensing agency to inspect, audit and copy upon demand. Client records contain required information including, but not limited to, consent forms, court orders, needs and services plan, medical assessment; safeguards for cash resources, personal property and valuables; education records; personal rights forms; removal/discipline/complaints form and medication administration records. Staff Records LPAs reviewed two (2) staff records. All staff have been subjected to criminal records review and have been fingerprinted and cleared with DOJ, FBI and CACI. Documentation of the required education and experience requirements are maintained in the personnel file. Documentation of staff training are on file. LPAs interviewed two (2) staff members. LPAs were unable to interview the two (2) clients due to one client's refusal and one client is out on a community day pass. During the inspection, LPAs were informed about a car accident that occurred on 03/07/23. One client was in the car when the accident happened. There were no injuries to the client. The staff driving the vehicle was taken to the hospital and was later discharged. The incident was not reported to the Department. A deficiency citation is being issued, see LIC809D. An exit interview was conducted, and a signed copy of this report, LIC809D, LIC811 and appeal rights were provided to the facility representative..

met_with: Cindi Bertrand


summary: Facility Evaluation

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Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Pamela Silva on March 7, 2024 at 9: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA met with Jeanne Fletcher, Interim Administrator, and inspected the facility inside and out. There are no children currently taking psychotropic medication at the facility. LPA reviewed zero (0) of child's records and three (3) of staff personnel files on site at the facility. LPA reviewed zero (0) of child's psychotropic medications and medication records. LPA interviewed two (2) of staff on site to discuss the facility's policies and procedures of operation. No child interview was conducted during this inspection due to no children is currently taking psychotropic medication. LPA provided a copy of this licensing report to Jeanne Fletcher, Interim Administrator. No deficiencies are being cited at this time. LPA conducted exit interview with the Administrator.

met_with: Jeanne Fletcher


facility_name: BELOVED ONES 4

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Narrative:
The investigation revealed that Ref. #1 was not patient and if Ref. #1 did not get things that Ref. #1 wanted in the moment, the Ref. #1 indicated that they felt disrespected. The CSW indicated that they had no concerns with Ref. #1's care while Ref. #1 resided at the facility. The CSW indicated that weekly meetings were held regarding Ref. #1 and the CSW met with the client once per month. There was no preponderance of the evidence to substantiate the allegations. So, although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the allegations are unsubstantiated. There are no deficiencies to be cited regarding these allegations. A copy of this complaint was provided to the facility representative.

Investigation Findings:
13On February 16, 2024 at 12:45 p.m., Licensing Program Analyst (LPA), Karen McGee delivered the findings of a complaint investigation to the facility. The LPA met with Administrator, Kenny Herrera. On October 19, 2023, the Monterey Park Children's Residential Program (MPCRP), received a complaint with the above mentioned allegations. Confidential interviews were conducted that included, but were not limited to: the Administrator, one client (see Confidential Names, LIC Ref. #1 dated February 16, 2024) was interviewed by LPA Vaishali Singh-Sood at the new placement; one County Social Worker via telephone on February 15, 2024. A second client Ref. #2 declined an interview on February 16, 2024 at the facility. The LPA reviewed the Needs & Services Plan and Incident Reports. The investigation did not reveal evidence to corroborate the allegation. It revealed that another client that was alleged to have lived at the facility never resided at the Beloved Ones 4 facility. The investigation revealed that Ref. #1 did not want to reside at the facility and preferred a location closer to their parent. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Karen McGee LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 4FACILITY NUMBER: VISIT DATE: 02/16/2024

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

met_with: Kenny Herrera


raw_content:
Narrative:
Investigation revealed the following: It was alleged staff hit minor. Staff denied the allegation. Staff stated that one child was having an issue with another child and that child was attempting to assault and destroy property. Staff stated that child was intercepted by staff, but that staff never hit or put hands on child. Staff stated that child expressed concerns that they were getting physically abused in the home or having their property stolen but staff accommodated child by encouraging child to utilize lock and having staff sit in front of child's room to ensure no one entered room without permission. Interview reviewed with children denied the allegation. Children stated they liked the facility and that they either wanted to return or stay at facility. Children expressed no concerns with any staff or people in the facility. Interview conducted with CSW stated they had no concerns with home or children being placed in the home. CSW stated that one child was having issues, but issues presented seemed to be personal and not issues with facility or facility staff. Documents reviewed identified facility and facility staff took all necessary steps to address an issue with a child who was expressing concern with residing in the facility. No documents, medical assessments or statements identified any staff hitting a child. Based on information gathered, although the allegation may have happened or is valid, the preponderance of evidence to prove the allegation was not met, therefore the allegation is unsubstantiated. An exit interview was conducted. A copy of this report Confidential Names Form, and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On February 7, Licensing Program Analyst LPA Winston Moroney made an unannounced visit to the Beloved Ones 4 facility on behalf of LPA Dawn Mahecha to close the above investigation. LPA met with representative and discussed the following findings to investigation. Investigation consisted of the following: On 12/11/ LPA Mahecha met with and interviewed facility manager and Administrator (see confidential names, LIC811 dated 12/11/2024). LPA reviewed one (1) file and obtained the following documents: Current LIC500/ client roster, one staff Proact training certification, policy, and procedure on the use of restraints, one (1) child's current needs and service plan, medical assessment from November and incident reports from November 22 thru December 2, 2024. On 2/5/ LPA interviewed County social worker (CSW) and reviewed statements and interviews conducted with child and additional witnesses. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Winston Moroney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 4FACILITY NUMBER: VISIT DATE: 02/07/2025

met_with: Kenny Herrera - Administrator


raw_content:
Narrative:
During the confidential interviews it was reported by S1 and S2 that clients are treated with dignity and respect. Staff do use the ProAct method to restrain clients when needed, but no one has ever been hurt and staff do not have any personal belonging of any client. Further, that if personal items are held and anytime, it is only for the safety of the clients in care. During confidential interviews with the clients revealed that 2 out of 2 children felt like they were being treated with dignity and respect. 1 out of 2 clients felt staff handled clients a little aggressively during restraining, but also mentioned their arm was already hurting (which had nothing to do with the staff) before the restraint took place. Additionally, 2 out of 2 clients stated that staff only take belongings from clients if they are a danger to themselves or others. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are unsubstantiated. No deficiency cited

Investigation Findings:
13On April 11, 2025 att 1:30pm, Licensing Program Analyst (LPA), Carrie Palmer conducted a follow-up complaint inspection with the above named facility and spoke the administrator. The purpose of the visit is to deliver the findings for the above complaint allegation. During the course of the investigation, LPA Palmer reviewed facility records and conducted investigative interviews with a total of 2 staff on 3/7/25, 1 client on 3/7/25 and 1 client on 3/21/25. (See Form Confidential Names). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Carrie Palmer LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 4FACILITY NUMBER: VISIT DATE: 04/11/2025

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

met_with: Kenny Herrara, Adminstrator


raw_content:
Narrative:
cont.# A review of the Administrator and Facility Managers (FM1), FM#2 (FM2), FM#3 (FM3), FM#4 (FM4) and FM#5 (FM5) (see Confidential Names form LIC811 dated 07/25/2025) training records were conducted, and copies were made. The information revealed that the staff at this STRTP take most of their training in an online database, while other training is taken in person. The topics of training include, but are not limited to, crisis intervention, emergency procedures, trauma-informed care, and regulatory compliance. At the time of the file review FM1 and FM2 did not have a current cardiopulmonary resuscitation and first aid certificate. LPA Flores, having considered the evidence provided during the investigation, deemed the allegation substantiated. A citation was issued on LIC809 dated 4/22/2025 for violation of Interim Licensing Standards (ILS), Version 5: Section 87065.1 (b)(8)(A): (8) Facility manager training is in addition to first aid and CPR training, and other training as required in Section 87095.65. (A) Completion of cardiopulmonary resuscitation (CPR) and first aid training shall be demonstrated by current and valid CPR and first aid cards issued by the American Red Cross, the American Heart Association, a training program approved by the State Emergency Medical Services Authority pursuant to Health and Safety Code Section 1797.191, or from an accredited college or university. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. No further inspection is needed. A copy of this report, appeal rights and LIC811 was provided to the facility representative. Exit interview conducted.

Investigation Findings:
13On July 25, 2025, at 11:55AM, Licensing Program Analyst (LPA) Humberto Flores, conducted a follow-up complaint inspection at Beloved Ones Short Term Therapeutic Program (STRTP) and met with Alexandria Huertas. The purpose of the inspection was to deliver the findings for the above complaint allegation. The initial information that generated this complaint investigation stated that staff have not completed the required trainings at the facility . Reporting Paraty (RP) states the training is to ensure staff are equipped to handle resident care, crisis intervention, emergency procedures, trauma-informed care, and regulatory compliance. RP states that despite multiple email notifications sent to staff, no action has been taken to complete the training from Relias. LPA Flores investigated the allegation and conducted interviews with the Administrator and staff. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Humberto Flores LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 4FACILITY NUMBER: VISIT DATE: 07/25/2025

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

met_with: Facility Manager, Alexandria Huertas


raw_content:
Narrative:
The next allegation was regarding the phone being in disrepair. During confidential interviews, it was reported by staff and clients that there was one phone in disrepair, but there was another phone working to ensure staff are able to conduct business and children are able to use the phone when they need to. Confidential interviews also revealed that the washer/dryer was not working properly, but the agency implemented processes to ensure children's laundry was washed at another facility until the washer/dryers were repaired. It was reported by staff and clients that the washer/dryer are in good repair at this time. The last allegation was regarding files being kept in a secure place. After speaking with S1, S2, S3 and the complainant it was revealed that files are kept in the office, in which the office can be locked. Within the office, the files are kept in a cabinet that has a lock on it. It was also stated that the door of the office is never locked and that the lock on the cabinet door doesn't work. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. No deficiencies cited. A copy of this report was provided to Kenny Herrera, Administrator.

Investigation Findings:
13On July 29, 2025 at 1: PM, Licensing Program Analysts (LPAs) Pamela Silva and Juliet Robles conducted a follow-up complaint inspection with the above named facility on behalf of LPA Carrie Palmer and spoke to Administrator, Kenny Herrera. The purpose of the visit is to deliver the findings for the above complaint allegation. During the course of the investigation, LPA Palmer reviewed facility records and conducted investigative interviews with S1, S2 on 4/11/25 and S3, C1 and the complainant on 7/28/25. (see Confidential Names). During the confidential interviews regarding the allegation of the facility van being in disrepair. It was clarified that the vehicle was not a van, but it was a car, which the facility no longer uses. The car has been replaced with another vehicle which staff and clients state is working properly per S3, S2 and S1. Staff also provided LPA Palmer with invoices to show that the agency has processes in place to repair vehicles in the event that they breakdown. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Pamela Silva LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 4FACILITY NUMBER: VISIT DATE: 07/29/2025

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


raw_content:
Narrative:
The Facility Manager stated that Ref. #1 became triggered after being promised something by the other staff and the staff reneged on the promise. The Facility Manager denied that Ref. #1 attempted to attack the other staff, but verbally threatened to punch the staff after the staff did not provide a trauma-informed environment talking over Ref. #1 and telling Ref. #1 to shut-up. The Facility Manager stated that it did not rise to level of calling law enforcement. The Facility Manager denied that Ref. #1 chased him with a pot and stated that other statements made against Ref. #1 either did not happen on the same date as was told or were exaggerated. The investigation revealed that the staff no longer worked at the facility. There was a statement made that there were no towels at the facility, and Ref. #1 and #2 shared the same towel. At least two staff stated that the Assistant Weekend Administrator went to purchase more towels, while the towels at the facility were being washed. At least two staff denied that the clients shared towels. An interview with Ref. #1 did not reveal an issue with towels. It is determined that there is not sufficient evidence to corroborate the allegation. There was no preponderance of the evidence to substantiate the allegation. So, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated. There are no deficiencies to be cited regarding this allegation. A copy of this complaint was provided to the facility representative.

Investigation Findings:
On August 5, 2025, Licensing Program Analyst (LPA), Karen McGee delivered the findings of the complaint investigation. The LPA met with Administrator, Kenny Herrera. On April 3, 2025, the Monterey Park Children's Residential Program (MPCRP), received a complaint with the above mentioned allegations. Confidential interviews were conducted that included, but were not limited to: two clients (see Confidential Names, LIC Ref. #1 and #2 dated August 5, 2025) at the facility on April 16, 2025, Facility Manager, Ref. #3 via telephone on July 23, 2025, and Floating Weekend Administrator via telephone on July 24, 2025. The LPA reviewed the End of Shift Report (EOSR) for March 30, 2025, 38 out of 111 incident reports and complaints. There was a statement that staff did not report an incident with Ref. #1. The investigation revealed that while there was a situation where Ref. #1 was angry and yelled at a staff and the staff locked themselves in the office, a review of the EOSR written by that staff and other interviews did not reveal an unusual incident that met Interim Licensing Standands or General Licensing Regulations that was required to be reported to Community Care Licensing (CCL). It is not unusual for clients placed in a Short Term Residential Therapeutic Program (STRTP) to become angry or yell. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Karen McGee LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 4FACILITY NUMBER: VISIT DATE: 08/05/2025

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


raw_content:
Narrative:
cont.# The statements obtained and documentation reviewed revealed that on 05/03/2025, S1 transported C1 to her scheduled outing. While at the location, S1 and C1 went into a sport bar and, allegedly, S1 bought at least one drink that contained alcohol. A statement provided during the investigation indicated that S1 drank the alcoholic drink and that on the trip back to the facility, S1 drove through a red traffic light and crossed the middle section of the road. During the investigation, LPA Flores was not provided with enough information to corroborate the allegations. Documentation obtained from S1's file showed that on 05/19/2025, S1 was terminated from the STRTP. LPA Flores, having considered the statements and documentation provided during the investigation, deemed the allegation unsubstantiated due to the lack of evidence to corroborate the allegations. An unsubstantiated finding means that, although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. A copy of this report, LIC811 and appeal rights were provided to the facility representative. Appeal rights explained. Exit interview conducted.

Investigation Findings:
13On Thursday October 2, 2025, at 2:45PM, Licensing Program Analyst (LPA) Humberto Flores, conducted a follow-up complaint inspection at Beloved Ones Short Term Therapeutic Program (STRTP) and met with Administrator, Kenny Herrera. The purpose of the inspection was to deliver the findings for the above complaint allegation. The initial information that generated this complaint investigation stated that on 5/03/25, Staff Ref #1 (S1) (see Confidential Names form LIC811 dated 10/02/2025) had taken Child Ref #1 (C1) to a "sports bar" and ordered an alcoholic drink. The report disclosed that S1 proceeded to drive with C1 in the car back to the facility. The report also disclosed that on the drive home, S1 was sitting at a red light and proceeded to drive and crossed over a middle section of the street. LPA Flores investigated the allegation and interviewed Reporting Party (RP), C1, a witness and other staff from the facility. S1 did not make herself available for an interview. A review of C1's and S1's file was conducted, and copies were made. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Humberto Flores LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 4FACILITY NUMBER: VISIT DATE: 10/02/2025

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

met_with: Administrator, Kenny Herrera


summary: Facility Evaluation

raw_content:
Narrative:
On April 13, Licensing Program Analyst (LPA) Juliet Robles conducted an unannounced visit at the facility at 12: PM and met with Ashley Mac Learn, Administrator and Thandi Smith, Director. The purpose of the inspection was to conduct a Post Licensing inspection of the facility. The facility currently has a provisional Short Term Residential Therapeutic Program (STRTP) license. The STRTP's Mental Health Program Application is pending approval. The STRTP has pending approval from CARF accreditation. This STRTP is licensed to serve one (1) female client 12-17 years of age or Non-Minor Dependents, ambulatory only. This is a one-story home with three (3) bedrooms that two (2) rooms are converted into office and therapy room, two (2) bathrooms, kitchen, living room, dining room, garage, front lawn and backyard. The following was observed by the LPA during the walk through of the facility with the Administrators at 12: PM. PHYSICAL PLANT: LPA observed the license, personal rights, facility sketch, emergency disaster plan, menus, grievance procedures and box. All hazardous items have been properly made inaccessible to areas where client will have access. The medications were stored and locked in a cabinet in the staff office. Cleansers/chemicals and sharps knives are locked and stored in the office. There are three (3) First Aid Kits that are checked and are complete. Supplies of staples non-perishable foods for one week and perishable foods for two days are maintained in the facility. The facility has smoke detectors and carbon monoxide that are in all bedrooms and hallways. The hot water in the client bathroom was measured to be 105 degrees (F). The facility outside grounds was also inspected and it was observed to be free of clutter and debris. Emergency exits were free from obstruction. Operations Facility maintains a current, written plan of operation that meets licensing standards. Facility maintains a register of clients and the register is available upon request. The board of directors regularly conducts meeting to review and discuss the STRTP's operation. Disaster Preparedness Plan Facility maintains a current, written disaster and mass casualty plan of action. Facility conducts disaster drill at least every month. The drills are documented, and the documentation is maintained in the facility for at least a year. Core/Therapeutic Services Facility provides core services and supports to children as appropriate or necessary that are trauma informed, culturally relevant, age and developmentally appropriate. Facility utilizes College Community Services for their treatment and therapies. Client and Staff Records LPA at 2: PM started to review one (1) client record and three (3) staff files. Client record contain required information including, but not limited to, consent forms, court orders, appraisal/needs and services plan, removal/discipline/complaint procedures; medical assessment; safeguards for cash resources, personal property and valuables; education records; personal rights forms; and medication administration records. LPA interviewed one (1) client. All facility staff was subject to criminal records review, fingerprinted and cleared DOJ, FBI and CACI. All staffs signed the Criminal Record Statement and acknowledgement to report Child Abuse. Personnel records are maintained on the licensee, administrator, supervisor and each employee. Documentation of the required education and experience requirements are maintained in the personnel file. LPA interviewed three (3) staffs. Emergency Intervention Plan: Facility utilizes technique of group and individual behavior management like crisis prevention and alternative methods of handling aggressive and assaultive behavior. Staff have trainings on manual restraint if needed to be utilized. On today's inspection, there are no citations assessed during this inspection. LPA was provided with Board Minute Meetings and staffs schedule/personnel report. The facility representative was provided information on where to locate Provider Information Notices (PINs), and Compliance and Regulatory Enforcement (CARE) Tools, for Children's Residential licensees please visit the Program website at www.cdss.ca.gov/inforesources/community-care-licensing/inspection-process. An exit interview was completed and a signed copy of this report with LIC 811 was provided to the facility representative.

met_with: Ashley Mac Learn


facility_name: BELOVED ONES 5

raw_content:
Narrative:
It was alleged that the minor sustained unexplained bruising while in care. During interview, the foster child (FC1) denied having any bruising while living at the facility. FC1 stated he has never been hurt living the facility. FC1 felt safe and comfortable at the facility. Confidential statements obtained during the investigation were unable to corroborate the allegations as there were no statements obtained to support the allegations. Based on the information gathered, the allegations are unsubstantiated as the preponderance of evidence to prove the allegations was not met although the allegations may have happened or is valid. A copy of this report, Confidential Names Form and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On March 30, 2022 at 10: AM, Licensing Program Analyst (LPA) Joshua Rarela conducted a follow-up complaint inspection to deliver the findings of a complaint investigation concerning the allegation above. The complaint was investigated LPA Zeyda Loera. LPA Rarela met and discussed the findings with the facility representative named above. During the course of the investigation, LPA Loera conducted interviews with two staff and three foster children on 1/20/22 (see Confidential Names Form LIC 811 dated March 29, 2022). LPA Loera reviewed documents including the foster child's Needs and Services plan, the foster child's Child and Family Team (CFT) documents, Individualized Care Plan, and staff training record. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Joshua Rarela LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 5FACILITY NUMBER: VISIT DATE: 03/30/2022

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

met_with: Ashley Mclearn, Administrator


raw_content:
Narrative:
Based on the information gathered, although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that an alleged violation occurred, therefore the allegation is unsubstantiated. There were no deficiencies cited during this inspection. An exit interview was conducted. Appeal rights explained and a copy of this report, and Appeal Rights were provided to the facility representative.

Investigation Findings:
13On October 27, 2022 at 5: PM, Licensing Program Analyst (LPA) Karen Suh conducted a follow-up complaint inspection to deliver the findings of an investigation concerning to the allegation above. LPA met with the facility representative named above and discussed the findings. During the investigation, LPA conducted interviews with three clients and four staff on 9/8/22 and 9/23/22. LPA reviewed records on 9/8/22, 9/19/22, and 10/17/22. It was alleged that a client was hit by a staff. In an interview, the client denied the allegation stating that the client was not hit by a staff. The client stated they get fever blisters often. Interview with staff revealed that the client often has fever blisters on their lips, and they would touch and pick on them which they led to bleed and have scab. Staff denied the allegation stating they never hit the client. LPA observed the client with a scab on the right side of the bottom lip and the client stated the scab is from the fever blister. The investigation did not reveal any staff or clients that observed staff hitting Ref. #1 (see Confifential Names dated October 26, 2022). UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Karen Suh LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 5FACILITY NUMBER: VISIT DATE: 10/26/2022

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

met_with: Ray Townsend, Facility Manager


raw_content:
Narrative:
did not observe or see anyone touch anyone inappropriately. Staff denied the allegation and stated that they did not observe or see any unusual behavior or interactions between children. Staff stated that the children were on an outing and playing in the water but that no inappropriate touching was observed. Staff stated that after the outing one child reported having an issue of harassment with another child who resides in a sister location. However, staff stated that children are separate and only see each other at school. Staff stated they have also been working with the school in keeping children separated as they are currently in the same class. Documents reviewed did not identify any incidents with children being inappropriately touched or having any issues. Information obtained did not clearly identify where or when incident happened or occurred or that anyone was present during the alleged interaction. Based on the information gathered, although the allegation may have happened or is valid, the preponderance of evidence to prove the allegation was not met, therefore the allegation is unsubstantiated. An exit interview was conducted. A copy of this report Confidential Names Form and Appeal Rights were provided to the facility representatives. There were no deficiencies cited during this inspection.

Investigation Findings:
13On 12/22/ Licensing Program Analyst (LPA) Dawn Mahecha made an unannounced visit to the Beloved Ones 5 facility to conclude the above identified complaint investigation. LPA met with facility manager and discussed the above identified findings to complaint investigation. Investigation consisted of the following: On 10/12/ LPA met with and interviewed Administrator and five (5) children (See confidential names list, LIC811 dated 10/12/2022). LPA obtained copies of facilities current staff/ client roster, emails to school regarding incidents and follow up, child's Needs and service plan (NSPs) and case notes, SIRs or complaints associated to children touching one another inappropriately. Additionally, LPA interviewed all potential witnesses. Investigation revealed the following: It was alleged that minor was inappropriately touched by another minor while in care. Interviews conducted with children were inconsistent as one child stated they were touched inappropriately by another minor who resides in a different home during an outing. Child stated that minor was harassing them while they played in the water. However, child stated that no staff or other children who live in their home observed or saw in the interaction. The additional four (4) children interviewed stated they UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Dawn Mahecha LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 5FACILITY NUMBER: VISIT DATE: 12/22/2022

met_with: April Thompson, Facility manager


raw_content:
Investigation Findings:
On May 5, 2023 at 2:20 p.m., Licensing Program Analyst (LPA), Karen McGee, delivered the findings of the Complaint Investigation to the facility. The LPA met with Administrator, Jeanne Fletcher. On January 30, 2023, the Monterey Park Children's Residential Program (MPCRP), received a complaint with the above mentioned allegations. Confidential interviews were conducted that included, but were not limited to: the Administrator at the facility on January 20, 2023; client (see Confidential Names, LIC Ref. #1 dated May 5, 2023) at school. The LPA was unable to interview the County Social Worker after several attempts. The LPA reviewed Ref. #1's Needs and Services Plan, and Special Incident Reports. The investigation revealed that Ref. #1 is allowed 30 minutes of video call with a specific family member and there are family members that Ref. #1 is not allowed a call. Ref. #1 is allowed to call other family members. Based on the interview with Ref. #1, Ref. #1 does not have problems using the telephone at the facility and has privacy on occasion. The LPA was unable to corroborate the allegation. There was no preponderance of the evidence to substantiate the allegation. So, although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred, therefore the allegations are unsubstantiated. There are no deficiencies to be cited regarding this allegations. A copy of this complaint was provided to the facility representative. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Karen McGee LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

visit_type: Complaint Investigation


raw_content:
Narrative:
Investigation revealed the following: It was alleged staff are physically abusing minor in care. Staff had similar statements and denied the allegation. Staff stated that they do not hit or pinch children as a form of discipline or for any reason. Staff stated they have never heard children complain nor had any children report any complaints about staff hitting or pinching them. Children had similar statements and denied the allegation. Children stated that they have had no issues with staff, nor have they witnessed any other children having any issues with staff. One child stated that one staff would pinch and hit them a while ago but did not disclose details pertaining to incidents occurring. Child stated that it only happened a couple of times. Child stated that an unknown guy staff was present one time but did not recall the name or details of staff that may have been present or what happened by staff. Additionally, child stated that typically no one has been present when incidents have occurred. Child did not remember if they sustained any marks or bruising from pinching or hitting and stated they felt safe in the home. Documents reviewed identified no issues with the home or children being placed in the home. LPA observed no documentation to support that child was being pinched or hit by staff or that child obtained injury as a cause of a staff member. Information obtained by the county social worker identified inconsistent statements and information on whether an incident with staff and child actually occurred. Although the allegation may have happened or may be true there is not a preponderance of evidence to support that the allegation did or did not happen. Therefore, this complaint is being closed Unsubstantiated. Exit interview was completed, no deficiencies were cited, and a copy of this report was emailed to Brendan Coulon - Regional Administrator for review and signature.

Investigation Findings:
13On 05/24/ Licensing Program Analyst (LPA) Winston Moroney made an unannounced visit to the Beloved Ones 5 facility on behalf of LPA Dawn Mahecha for the purpose of closing the above complaint investigation. LPA met with the facility manager and discussed the above-identified findings. The investigation consisted of the following: On 12/22/ LPA Mahecha met with and interviewed the facility manager (see confidential names, LIC811 dated 12/22/2022). LPA requested copies of facilities current LIC500, client list, recent staff training, and complaints/ special incident reports (SIRs) related to children's interaction with staff where restraints or physical touch was involved within the past two months. Additionally, LPA requested copies of the children's most recent needs and service plans and documented case notes regarding children's behavior within the last two months for the past two months. On 5/21/2023 and 5/22/ LPA interviewed additional witnesses. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Winston Moroney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: BELOVED ONES 5FACILITY NUMBER: VISIT DATE: 06/08/2023

met_with: Brendan Coulon - Regional Administrator