facility_name: MOSAIC OF FRIENDS IV

summary: Facility Evaluation

raw_content:
Narrative:
On January 26, 2022 at 11: AM, Licensing Program Analyst (LPA) Rosslyn Gray arrived at the above facility for the purpose of conducting Annual Required Inspection. LPA met with Facility Manager Gia Griffin, and together a tour of the entire facility. The facility is licensed for 5 developmentally disable children ages 11 through 17 years old, Ambulatory only. Clients are currently placed by Westside; South Central Regional Centers. Currently there a three (3) male NonMinor Dependents (NMD) in placement. LPA observed that there are no bodies on water on the premises. The Licensee confirmed that there are no firearms or dangerous weapons in the facility. The Group Home Overview: This is a two (2) story home located in a residential neighborhood. There is a Living room; Dining room, Kitchen. There is a locked two (2) car garage, currently utilized as a storage and other miscellaneous item. The Hot Water Heater is strapped. There are two (2) vehicle parked outside inspected to be in good operating condition (The vehicles car was checked for tires, headlights, tail lights, turn signals, horn and windshield wipers). Car # Make and Model 2018 BMW; Proof of Insurance (GICO 02/20/2022); Car Registration (Expiration 11/23) and current Driver's License. Car # Make and Model (2018 BMW) Proof of Insurance (Farmers 06/14/2022); Car Registration (Expiration 09/28/2022 and current Driver's License. The Licensee ensured that no smoking is allowed in the vehicles. BEDROOMS: All three (3) bedrooms are equipped with one (1) twin bed, comfortable mattress, linen, blanket and pillows; adequate drawer space and a closet. Bedroom #1: Bedroom #2: Bedroom #3: are all occupied. Bedroom 4: is located on the second floor is not occupied, and it is utilized as a staffing office. Lic Page 1 of BATHROOMS: Bathroom #1 and #2 are located on the 1st floor. All were inspected and found to be clean. LPA test the water temperature, bathroom sinks and ensured that all toilets flushed. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Bathroom #1: located in the hallway between bedroom #1 and bedroom #2. The door is broken, but in operable condition. Bathroom #2: is attached to bedroom #3, it is also accessible through a door located off the laundry area. Living room: Is equipped with a two (2) sofas, a television that is mounted in the wall. A book shelf, a non-operational fireplace with a screen, and a wall furnace heater is operable with recent maintenance. Staff ensured that it is safe and not hot to the touch and that the temperature gage does not exceed 70 degrees. Dining Room Table: Is damaged and is schedule to be replaced. Kitchen: Is equipped with a gas stove/oven, refrigerator/freezer, a microwave, and a dishwasher. The facility has adequate perishable/nonperishable supply of food. Facility staff provide nutritious meals and snacks. Two (2) hot meals are prepared per day. The kitchen trash has a lid cover. All knives, medications, cleaning supplies, and hazardous materials are kept locked and inaccessible to clients in care. There is adequate hygiene and grooming supplies and ample amount of extra clean linen. Laundry room: is located off the kitchen is equipped with a washer and dryer and observed to be in good condition. There is an operable facility telephone readily accessible to clients. LPA observed combined Smoke detector and Carbon Monoxide; tested to be operable. All the prescribed medications; medication logs, files and are locked key in the office on the second floor. The First Aid kit is in the kitchen area cabinet. It has the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. Outdoor Area: The outdoor perimeter front yard, and backyard were inspected and found cleared of debris and hazards materials. The stairways, and open porches are unobstructed. LPA observed a broken wooden gate that leads to the side of the house that is obstructed and does not meet regulations and is schedule to be repaired. LPA observed two (2) missing window screens and one (1) ripped window screen that did not meet regulations are scheduled to be replaced. There were no security bars on the windows. Blinds and drapes from the inside and outside were observed to be in good condition. Report continued on LIC809C 2 of LPA observed utility shut-off valves for gas and water located on side of house. Clients in care are supervised, protected, and are accorded dignity in personal relationships with staff and others. The facility staff ensures that the clients are transported to school and accompany to extracurricular, cultural and personal enrichment activities. The facility met all posting requirements and operates within license capacity and limitations. LPA observed that Licensee ensures that CDC Guidelines are implemented in effort to prevents other from contracting the COVID-19 virus (i.e wash hands with alcohol based, wipes, hand sanitizes and gloves) and signs posted. The Licensee will report changes in the plan of operation affecting service to clients. Client Records: Three (3) clients in care. Staff Records: Three (3) staff. LPA obtained the Facility Profile and Personnel Report and confirmed that the Licensee have required criminal record clearance. DOJ, FBI and Child Abuse Response; which meet qualification. Staff Interviews: LPA conducted a confidential interview with the Licensee Administrator and two (2) other staff. LPA observed deficiencies in the physical plant that did not meet regulations and the facility was cited. LPA's concluded the Annual Required Inspection. An exit interview was conducted, and a copy of this report was left at the at the Licensee on 01/26/2022


state: CA

summary: Facility Evaluation

raw_content:
Narrative:
On February 25, 2022 at 2:15PM, Licensing Program Analyst (LPA) Rosslyn Gray conducted a Plan of Correction (POC) virtual Case Management Inspection at the MOSAIC OF FRIENDS IV Group Home via FaceTime with the facility Administrator on January 26, 2022 an Annual inspection was conducted and the facility was cited for several deficiencies of the physical environment that did not meet regulations. The purpose of conducting the Case Management inspection is to ensure that the deficiencies has been corrected. On this day LPA-Gray observed that the entire kitchen ceiling had been replaced with adequate lighting; the side yard wooden gate was repaired; all damaged window screens were replaced; a new dining table was ordered and was being assembled and the bathroom broken door was replaced. The Licensee complied with the California Code of Regulations, Title Division Six, regulation Cited ILS 84487(f)/ Buildings and Grounds 84487(f) states that "The facility shall be clean, safe, sanitary, and in good repair at all times. There were no deficiencies cited at this time. LPA concluded the inspection, Cleared the POC and a copy of this report will be emailed to the licensee for signature.

report_type: Facility Evaluation

visit_type: Case Management

met_with: ADMINISTRATOR


summary: Facility Evaluation

raw_content:
Narrative:
On June 12, 2022, at 9:30 am Licensing Program Analyst (LPA) Olivia Rosas arrived at Mosaic of Friends IV unannounced for the purpose of conducting a SB Psychotropic Medication Case Management- Medication Inspection Visit. LPA Rosas met with Gia Williams, Administration Lead. Individuals mention in this report are identify on the Confidential Names List (LIC811) dated 07/12/22. LPA Rosas reviewed zero (0) client files and three (3) staff files. LPA Rosas conducted three (3) staff interviews and zero (0) client interview due to clients being Non-Minor Dependent and not meeting criteria for the SB Psychotropic Medication Case Management- Medication Inspection. Currently there are three (3) clients residing in the above facility. This is a two-story home located in a residential area and equipped with three (3) bedrooms, (2) two bathrooms, living room, dining area, kitchen, laundry space, and an attach garage. There are no bodies of water on the premises. Common areas area clean and in good repair. Rooms are fully furnished with beds, and closet space. Outdoor space is free of obstructions. LPA Rosas observed the facility to be clean, safe, sanitary and in good repair. LPA Rosas observed adequate staffing in the facility to provide care and supervision to children in care. LPA Rosas also observed medication to be stored in a cabinet that is kept locked and inaccessible to clients and unauthorized staff members. Exit interview was conducted, and a copy of this report was left at the facility.

met_with: Gia Williams, Administration Lead


summary: Facility Evaluation

raw_content:
Narrative:
On September 29, 2023, Licensing Program Analyst (LPA) C. White arrived at the above location for the purpose of conducting a case management visit to close a complaint received on Mosaic of Friends, Facility # 197603205, located at Esther Ave. Los Angeles, CA. 90064. LPA met with Administrator, Gia Williams LPA was informed by the Administrator, that Mosaic of Friends was closed November 2022 due relocation. An exit interview was conducted, and a copy of this report was left with the Administrator.

met_with: Administrator - Gia Griffin


summary: Facility Evaluation

raw_content:
Narrative:
On December 19, 2023 at 9:30AM, Licensing Program Analyst (LPA) Rosslyn Gray arrived at the above facility for the purpose of conducting Annual Required Inspection. LPA met with Administrator Gia Griffin, who provided a tour of the entire facility. The facility is licensed to provide care a supervision for 5 developmentally disabled children ages 11 through 17 years old, Ambulatory only. Children are currently placed by Westside; South Central Regional Centers. Currently there (3) male NonMinor Dependents (NMD) in placement. LPA observed that there are no bodies on water on the premises. The Licensee confirmed that there are no firearms or dangerous weapons in the facility. The Group Home Overview: This is a two (2) story home located in a residential neighborhood. There is a Living room; Dining room, Kitchen. There is a locked two (2) car garage, currently utilized as a storage and other miscellaneous items. The Hot Water Heater is strapped in a closet inside the garage. There are two (2) vehicle parked outside inspected to be in good operating condition (The vehicles car was checked for tires, headlights, tail lights, turn signals, horn and windshield wipers). Car # Make and Model 2018 BMW; Proof of Insurance (GICO August 1, 2024); Car Registration (Expiration 11/24) and current Driver's License. Car # Make and Model (2018 BMW) Proof of Insurance (Farmers 06/14/2024); Car Registration (Expiration 09/28/2024 and current Driver's License. The Licensee ensured that no smoking is allowed in the vehicles. Bedrooms: All three (3) bedrooms are equipped with one (1) twin bed, comfortable mattress, linen, blankets and pillows; adequate drawer space and a closet. Bedroom #1: Bedroom #2: Bedroom #3: are all occupied. Bedroom 4: is located on the second floor is not occupied, and it is utilized as a staffing office. Lic Page 1 of BATHROOMS: Bathroom #1 and #2 are located on the 1st floor. All were inspected and found to be clean. LPA tested the water temperature, bathroom sinks and ensured that all toilets flushed. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Bathroom #1: located in the hallway between bedroom #1 and bedroom #2. Bathroom #2: is attached to bedroom #3, it is also accessible through a door located off the laundry area. Living room: Is equipped with a one (1) sofa, a television that is mounted in the wall. There are three (3) bookshelves, a non-operational fireplace with a screen, and a wall furnace heater is operable. Staff ensured that it is safe and not hot to the touch and that the temperature gage does not exceed 70 degrees. Dining Room Table: There a four (4) seated dining room table. Kitchen: Is equipped with a 5 burner gas stove/oven, refrigerator/freezer and a microwave. The facility has adequate perishable/nonperishable supply of food. Facility staff provides hot nutritious meals and snacks. Two (2) hot meals are prepared per day. The kitchen trash has a lid cover. All knives, medications, cleaning supplies, and hazardous materials are kept locked and inaccessible to clients in care. There is adequate hygiene and grooming supplies and ample amount of extra clean linen. Laundry room: is located off the kitchen is equipped with a washer and dryer and observed to be in good condition. There is an operable facility telephone readily accessible to children. LPA observed combined Smoke detector and Carbon Monoxide; tested to be operable. All the prescribed medications; medication logs, files and are locked key in the office on the second floor. The First Aid kit is in the kitchen area cabinet. It has the required items inside (age-appropriate, and scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. Outdoor Area: The stairways, and open porches are unobstructed, and the outdoor perimeter is free from hazardous materials. The side yard and back debris is scheduled to cleared by the Gardner within a week. LPA observed two (2) boarded broken windows located at the rear of the living room that view to the backyard of the house, and two (2) cracked boarded windows, one (1) located at rear of the living room, left corner/ bottom rear of the living room (huge picture costumed window), and the second cracked window is located in bedroom #3 that are in the process of being repaired within a week. The Licensee agreed to provide picture of the repairs. Window blinds and drapes from the inside and outside were observed to be in good condition. LPA observed the wooden gate in the back yard to have a cracked slat that does not appear to be a danger to clients in care . Report continued on LIC809C 2 of LPA observed utility shut-off valves for gas and water located on side of house. Clients in care are supervised, protected, and are accorded dignity in personal relationships with staff and others. The facility staff ensures the children are transported to school and accompany to extracurricular, cultural and personal enrichment activities. The facility met all posting requirements and operates within license capacity and limitations. LPA observed Licensee ensures CDC Guidelines are implemented in effort to prevents other from contracting the COVID-19 virus (i.e wash hands with alcohol based, wipes, hand sanitizes and gloves) and signs posted. LPA obtained the Facility Profile, Personnel Report and confirmed all staff have criminal record clearances. DOJ, FBI and Child Abuse Response; which meet qualification. The Licensee will report changes in the plan of operation affecting service to clients. Client Records: LPA reviewed three (3) clients in care records. Staff Records: LPA reviewed three (3) staff records Client Interviews: LPA did not conduct confidential interviews with with the three (3) clients in placement due to the observed cognitive inability and developmentally delays able to be interviewed. Staff Interviews: LPA conducted a confidential interview with three (3) on duty staff. LPA ensured to thoroughly review active staff (i.e Group Home Administrator, the Facility Manager; and Operations Manager. LPA provided a Technical Assistant for the needed repairs to the broken windows, and to clear the debris. LPA's concluded the Annual Required Inspection. There were no deficiencies cited at this time. An exit interview was conducted, and a copy of this report was left at the at facility with Administrator/Gia Griffin the Licensee on 12/19/2023

visit_type: Annual

met_with: Administrator/Gia Griffin


summary: Facility Evaluation

raw_content:
Narrative:
On December 19, 2024 at 10:30AM, Licensing Program Analyst (LPA) Rosslyn Gray arrived at the above facility for the purpose of conducting Annual Required Inspection. A Health and safety risk assessment was conducted upon arriving at the facility. LPA met with Administration Assistant Gia Griffin, who provided a tour of the entire facility. The facility is licensed to provide care a supervision for 5 developmentally disabled children ages 11 through 17 years old, Ambulatory only. Children are currently placed by Westside; South Central Regional Centers. Currently there (3) male NonMinor Dependents (NMD) in placement. LPA observed that there are no bodies on water on the premises. The Licensee confirmed that there are no firearms or dangerous weapons in the facility. The Group Home Overview: This is a two (2) story home located in a residential neighborhood. There is a Living room; Dining room, Kitchen. There is a locked two (2) car garage, currently utilized as a storage and other miscellaneous items. The Hot Water Heater is strapped in a closet inside the garage. There are two (2) vehicle parked outside inspected to be in good operating condition (The vehicles car was checked for tires, headlights, tail lights, turn signals, horn and windshield wipers). Car # Make and Model 2018 BMW; Proof of Insurance (State Farm September 2022- March 22, 2025); Car Registration (Expiration 11/24) and current Driver's License. The Licensee ensured that no smoking is allowed in the vehicles. Bedrooms: All three (3) bedrooms are equipped with one (1) twin bed, comfortable mattress, linen, blankets and pillows; adequate drawer space and a closet. Bedroom #1: Bedroom #2: Bedroom #3: are all occupied. There is a private room located on the second floor. Lic Page 1 of BATHROOMS: Bathroom #1 and #2 are located on the 1st floor. All were inspected and found to be clean. LPA tested the water temperature, bathroom sinks and ensured that all toilets flushed. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Bathroom #1: located in the hallway between bedroom #1 and bedroom #2. Bathroom #2: is attached to bedroom #3, it is also accessible through a door located off the laundry area. Living room: Is equipped with a one (1) sofa, a television that is mounted in the wall. There are three (3) bookshelves, a non-operational fireplace with a screen, and a wall furnace heater is operable. Staff ensured that it is safe and not hot to the touch and that the temperature gage does not exceed 70 degrees. Dining Room Table: There a three (3) seated dining room table. Kitchen: Is equipped with a 5 burner gas stove/oven, refrigerator/freezer and a microwave. The facility has adequate perishable/nonperishable supply of food. Facility staff provides hot nutritious meals and snacks. Two (2) hot meals are prepared per day. The kitchen trash has a lid cover. All knives, medications, cleaning supplies, and hazardous materials are kept locked on the back porch and inaccessible to clients in care. There is adequate hygiene and grooming supplies and ample amount of extra clean linen. Laundry room: is located off the kitchen is equipped with a washer and dryer and observed to be in good condition. There is an operable facility telephone readily accessible to children. LPA observed combined Smoke detector and Carbon Monoxide; tested to be operable. All the prescribed medications; medication logs, files and are locked key in the office on the second floor. The First Aid kit is in the kitchen area cabinet. It has the required items inside (age-appropriate scissors, tweezers, thermometer, and gauzes, antiseptic and First Aid Manual Guide. Outdoor Area: The stairways, and open porches are unobstructed, and the outdoor perimeter is free from hazardous materials. Window blinds and drapes from the inside and outside were observed to be in good condition. Report continued on LIC809C 2 of LPA observed utility shut-off valves for gas and water located on side of house. Clients in care are supervised, protected, and are accorded dignity in personal relationships with staff and others. The facility staff ensures the children are transported to school and accompany to extracurricular, cultural and personal enrichment activities. The facility met all posting requirements and operates within license capacity and limitations. LPA observed Licensee ensures CDC Guidelines are implemented in effort to prevents other from contracting the COVID-19 virus (i.e wash hands with alcohol based, wipes, hand sanitizes and gloves) and signs posted. LPA obtained the Facility Profile, Personnel Report and confirmed all staff have criminal record clearances. DOJ, FBI and Child Abuse Response; which meet qualification. The Licensee will report changes in the plan of operation affecting service to clients. Client Records: LPA reviewed three (3) clients in care records. Client Interviews: LPA did not conduct interview with clients in placement due to all three (3) being nonverbal and developmentally delayed. . Staff Records: LPA reviewed three (3) staff records Staff Interviews: LPA conducted a confidential interview with three (3) on duty staff. LPA concluded the Annual Required Inspection. There were no deficiencies cited at this time. LPA concluded the Annual/Required Inspection on this day 12/19/2024. An exit interview was conducted, and a copy of this report will be provided via email to the Administration Assistant Gia Griffin. LIC-809-C/ Page 3 of 3

met_with: Administration Assistant Gia Griffin


summary: Facility Evaluation

raw_content:
Narrative:
On January 15, 2026, at 9:00 a.m., Licensing Program Analyst (LPA) Cheri Wilkerson made an unannounced visit to Mosaic of Friends IV to complete a required annual inspection for 2026. No one answered the door. LPA Wilkerson left a business card on the screen door. She then attempted to call Mosaic of Friends Inc., but one phone number was disconnected and no one was available to open the door. Gia Griffin later answered another phone number and stated that she could meet at the facility in one hour. LPA Wilkerson left the facility and parked nearby to start report and review the Program Statement. On January 15, 2026, at 9: AM, Licensing Program Analyst (LPA) Cheri Wilkerson arrived at Mosaic of Friends IV for the purpose of conducting an annual/required inspection. LPA met with Licensee, Gia Griffin who granted access and provided a tour of the facility. Staff and 3 client residents. There were clients present at the facility. Individuals mentioned in this report are identified on the Confidential Names List (LIC811) dated 01/15/2026. The facility is licensed to provide care and supervision for 5 developmentally disabled children ages 11 through 17 years old, which are Ambulatory only. The Westside: South Central Regional Center is the agency which placed minors in care. Currently there are three (3) male Nonminor Dependents (NMD) in placement. LPA Wilkerson observed that there are no bodies on water on the premises. The Licensee confirmed that there are no firearms or dangerous weapons in the facility. Continue on page 2 of 3. Home Overview: This is a two (2) story home located in a residential neighborhood. There is a Livingroom, Dining room, Kitchen. There is a locked two (2) car garage, currently utilized as a storage and other miscellaneous items. The Hot Water Heater is strapped in a closet inside the garage. There is one vehicle parked outside inspected to be in good operating condition (The vehicle's car was checked for tires, headlights, taillights, turn signals, horn and windshield wipers). Make and Model 2018 BMW; Proof of Insurance (State Farm September 18, 2025- March 18, 2026); Car Registration (Expiration 11/12/2026) and current Driver's License. The Licensee ensured that no smoking is allowed in the vehicles. Bedrooms: All three (3) bedrooms are equipped with one (1) twin bed, linen, blankets and pillows; adequate drawer space and a closet. Bedroom #1: Bedroom #2: Bedroom #3: are all occupied. There is a private room located on the second floor. BATHROOMS: Bathrooms #1 and #2 are located on the 1st floor. All were inspected and found to be clean. LPA tested the water temperature, bathroom sinks and ensured that all toilets flushed. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Bathroom #1: located in the hallway between bedroom #1 and bedroom #2. Bathroom #2: is attached to bedroom #3, it is also accessible through a door located off the laundry area. Living room: Is equipped with a one (1) sofa, a television that is mounted in the wall. There are three (3) bookshelves, a non-operational fireplace with a covered screen, and a wall furnace operable heater. Staff ensured that it is safe and not hot to touch. The temperature gage does not exceed 70 degrees. Dining Room Table: There are three (3) seats at the dining room table. Kitchen: Is equipped with a 5-burner gas stove/oven, refrigerator/freezer and a microwave. The facility has adequate perishable/non-perishable food items. Facility staff provide hot nutritious meals and snacks. Two (2) hot meals are prepared per day. The kitchen trash has a lid cover. All knives, medications, cleaning supplies, and hazardous materials are kept locked on the back porch and inaccessible to clients in care. Continue of page 3 of 3. There are adequate hygiene and grooming supplies and ample amount of extra clean linen. Laundry room: is located off the kitchen and is equipped with a washer and dryer which was observed to be in good condition. There is an operable facility telephone readily accessible to children. LPA observed combined Smoke detector and Carbon Monoxide; tested to be operable. All the prescribed medications; medication logs, and files are locked in the office on the second floor. The First Aid kit is fully stocked in the kitchen cabinet. It has the required items and First Aid Manual Guide. Outdoor Area: The stairways, and open porches are unobstructed, and the outdoor perimeter is free from hazardous materials. Windows and drapes were observed to be in good condition. LPA observed utility shut-off valves for gas and water located on side of house. The facility staff ensures the children are transported to school and extracurricular activities. The facility meets all posting requirements and operates within license capacity and limitations. Client Records: LPA reviewed three (3) clients in care records. Client Interviews: LPA did not conduct interviews. Minor in placement are non-verbal and developmentally delayed. . Staff Records: LPA reviewed three (3) staff records Staff Interviews: LPA conducted a confidential interview with three (3) on duty staff. S1, S2, and S3. LPA concluded the Annual Required Inspection. There were no deficiencies cited at this time. LPA concluded the Annual/Required Inspection on this day 01/15/2026. LPA Wilkerson will follow up on age requirements of clients and finalize this report and require another signature.An exit interview was conducted, and a copy of this report will be provided via email to the Administrator, Gia Griffin Williams at Mosaicoffriends2@gmail.com. End of report.

met_with: Gia Griffin Williams


facility_name: MOUNTAIN VALLEY CHILD AND FAMILY-NEVADA CITY RANCH

summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Staff schedules show the facility is planned for minimum staffing ratios as outlined in the Interim Licensing Standards. Incident reports show several restraints requiring three to five staff; staff involved can be assigned from different homes located on the ranch. Incident reports also show a rise in incidents for the months of April and May with over thirty incidents reported to CCL for April; each incident involves one to five staff. Based on the information provided during interviews and gathered from documentation, it is determined the preponderance of evidence had been met therefore the allegation that facility is understaffed is substantiated. The Agency is cited under Section Cited CCR 84065.5(c) If a child requires special care and supervision because of age, behavior or other factors, the number of on-duty direct care staff shall be increased. An exit interview was conducted and a copy of this report was provided to Rene van der Meer - Program Manager via email.

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

report_type: Complaint Investigation

met_with: Rene van der Meer - Program Manager

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Danielle Walker-Flores conducted a complaint investigation inspection met with Kamiko Lucas - Administrator to discuss the findings of the complaint investigation. LPA Danielle Walker-Flores conducted the complaint investigation. On 10/08/ LPA interviewed witness (W1, see confidential names titled 03/04/22), reviewed video footage of the incident, conducted a file review and obtained documentation at the facility. The following documents were collected and reviewed during the investigation; foster child's intake information, Needs and Service plans, incident reports, discharge report and Mountain Valley investigative summary. LPA interviewed reporting party on 01/27/21. LPA interviewed client and witness (W2) on 02/08/22. LPA interviewed staff (S1) on 02/15/22. The complaint alleges staff physically abused minor. There was an incident involving staff and client that occurred on 09/02/21 when client threw a can of olives which hit staff in the face. The video shows staff stumbling back and client pushing staff into a hallway where the cameras did not reach. Complaint alleges staff hit minor while out of the view of cameras. Statements in interviews indicate the client then proceeded to choke staff. Statements were reviewed from staff who responded to the incident or observed the client after the incident. S1, S2, S3, S4 and the nurse who treated both staff and client involved submitted written statements. Statements regarding physical abuse were inconsistent during interviews. Based on interviews and documentation the preponderance of evidence has not been met, therefore the allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Exit interview conducted and appeal rights provided. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Daniel Allmon LICENSING EVALUATOR NAME: Danielle Walker LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Kamiko Lucas - Administrator

complaint_status: unsubstantiated


raw_content:
Narrative:
Interviews were inconsistent regarding staff making inappropriate comments to minors. One staff member admitted to making a comment regarding how a minor is currently at the ranch because their previous education setting was unsuccessful, but the minor misinterpreted the comment as if they were there due to being "unsuccessful." Staff tried to apologize and explain that is not what was meant by the comment. Two clients made vague references to staff at the facility being mean and judgmental. One client contradicted those statements, reporting staff were "overly helpful" and supportive. Records reviewed did not provide additional information about this allegation. Based on LPM's interviews and LPA's records reviews, although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove the violation did, or did not, occur. Therefore, the allegation is UNSUBSTANTIATED. A signed copy of this LIC 9099 and 9099C report was provided to the facility along with appeal rights.

Investigation Findings:
13Licensing Program Analyst (LPA) Misty Valenica and Licensing Program Manager (LPM) Hillary Hall arrived unannounced at the facility on this date for the purpose of delivering findings for the complaint investigation. LPA and LPM met with Rene Vandermeer, Administrator. LPM Hillary Hall opened the investigtion with the facility on 10/17/2023 and interviewed one staff and three clients. LPA Misty Valencia reviewed relevant records from the facility including: Ranch Direct Care Staff Roster, Occupancy Chart, 24 hour notification form (incident form), two 2014R Physical Intervention Report (PIR), Serious Incident Reports, and four Needs and Services Plan. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Hillary Hall LICENSING EVALUATOR NAME: Misty Valencia 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 25-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CHICO - RESIDENTIAL, COHASSET RD., STE. FACILITY NAME: MOUNTAIN VALLEY CHILD AND FAMILY-NEVADA CITY RANCHFACILITY NUMBER: VISIT DATE: 01/05/2024

met_with: Rene Vandermeer, Administrator


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Continued from Based on LPA's interviews which were conducted, and records reviewed, although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove the violation did, or did not, occur. Therefore, the allegation is UNSUBSTANTIATED. A signed copy of this LIC-9099 report, the LIC-9099C, and appeal rights were provided to the facility. An exit interview was conducted.

Investigation Findings:
13Licensing Program Analyst (LPA) Aleza Ruiz arrived unannounced at the facility on this date for the purpose of delivering findings for the complaint investigation.LPA met with Tim Dykes, Mental Health Supervisor. LPA Aleza Ruiz conducted the complaint investigation. LPA initiated the investigation with the facility on 10/11/2024 and met with Rene Vander Meer, Administrator and conducted a Health and Safety Inspection. During the course of the investigation, LPA interviewed one program administrator and four additional facility staff. LPA reviewed records including: Placement roster, maintenance records, staff roster, staff contact list and photos Regarding the allegation the facility did not repair damaged walls, three staff members denied this, one staff member stated walls are partially fixed. LPA observed water damage on the wall in a photo however maintenance verified the damaged portion of the wall had been replaced timely. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Hillary Hall LICENSING EVALUATOR NAME: Aleza Ruiz 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 25-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CHICO - RESIDENTIAL, COHASSET RD., STE. FACILITY NAME: MOUNTAIN VALLEY CHILD AND FAMILY-NEVADA CITY RANCHFACILITY NUMBER: VISIT DATE: 01/03/2025

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

met_with: Tim Dykes, Mental Health Supervisor


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Continued from Based on LPA's observations, interviews which were conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be Substantiated. Citation is being issued for violating Title 22, Division Section 80087(a) A signed copy of this LIC-9099 report, the LIC-9099C, and LIC-9099D were provided to the facility. An exit interview was conducted. Appeal rights were provided.

Investigation Findings:
13Licensing Program Analyst (LPA) Aleza Ruiz arrived unannounced at the facility on this date for the purpose of delivering findings for the complaint investigation. LPA met with Tim Dykes, Mental Health Supervisor. LPA Aleza Ruiz conducted the complaint investigation. LPA initiated the investigation with the facility on 10/11/2024 and met with Rene Vander Meer, Administrator and conducted a Health and Safety Inspection. During the course of the investigation, LPA interviewed one Program Administrator and four additional staff. LPA reviewed records including: Placement roster, maintenance records, staff roster, staff contact list and photos. Regarding the allegation the facility did not ensure laundering equipment was in good repair, three staff members denied this, two staff members agreed with this. LPA reviewed photos of the washer that showed grime inside of the washer. The facility has several washers, records indicate one washer was replaced however the washer that had been replaced was not the washer in the photo that contained grime within it . During inspection of the washer room, LPA was unable to view the inside of the washers in use and witnessed a new washer that was recently installed, this washer was also in use at the time of the inspection. Continued on 9099C SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Hillary Hall LICENSING EVALUATOR NAME: Aleza Ruiz 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 25-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CHICO - RESIDENTIAL, COHASSET RD., STE. FACILITY NAME: MOUNTAIN VALLEY CHILD AND FAMILY-NEVADA CITY RANCHFACILITY NUMBER: VISIT DATE: 01/03/2025

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


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Danielle Walker-Flores arrived at the agency to conduct a case management inspection regarding an incident. Community Care Licensing was notified that foster child FC1 (see confidential names list titled 05/14/21) sustained a head laceration during an altercation with staff S1 on 05/10/2021. FC1 was taken to the emergency room and S1 was suspended immediately pending investigation. LPA reviewed video clip, interviewed Administrator, interviewed clients, and reviewed personnel file. Personnel documentation was unavailable during inspection. Program Manager agreed to send the requested documentation via email. Further information is needed to complete this case management.

met_with: Rene Van Der Meer - Program Manager


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Danielle Walker-Flores arrived at the agency on today's date to conduct a case management inspection regarding an incident that occurred on 08/11/21. During a basketball game, clients C1 and C2 (see confidential names list titled 09/02/21) were involved in an altercation which resulted in C1 choking C2 until C2 became discolored. C2 was taken to the Emergency Room where it was determined no structural damaged occurred. A safety plan was implemented which included C2 being moved to a different home. LPA interviewed two staff involved and C2. LPA determined staff responded appropriately. No deficiencies cited.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Danielle Walker-Flores arrived at the agency on today's date to conduct a case management inspection regarding an incident that occurred on 09/30/21. Client C1 (see confidential names titled 09/30/21) was attacking C2 with a skateboard which prompted staff to restrain C1. After the restraint, C1 complained of arm pain and was taken to the Emergency Room where he was diagnosed with a bruised wrist. LPA reviewed files and interviewed three staff and client. LPA also reviewed video footage of the restraint. It was determined that C1 had broken his arm a few months back which could have led to his arm being sore after the restraint. Agency has met with C1's treatment team and developed a safety plan around restraints and early interventions. Agency is going to revisit the treatment plan and meet with staff during weekly meetings and update staff through clinician's orders. No deficiency cited. An exit interview was conducted and a copy of this report provided via email.

met_with: Michelle Bonner - Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On 2.10. Licensing Program Analyst (LPA) Jennifer Baca arrived at the facility for the purpose of conducting a pre-licensing visit. LPA met with Misty Jackson. LPa introduced herself and explained the reason for the visit. LPA was given a tour of the facility both inside and out. The house has 6 bedrooms and 3 bath. There are currently four residents placed at the facility. LPA observed three days of perishable food and seven days of non- perishable food.. LPA observed working smoke detectors through out the facility. LPA observed working smoke detectors. The facility has a back trailer on the property that is used for Therapy and staff. There is a barn on the property for maintenance tools which is always locked. there were no deficiencies at todays inspection. a copy of this report was left with Misty Jackson Program Manager

visit_type: Prelicensing

met_with: Misty Jackson, Program Manager


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced Post Licensing inspection at the facility. When LPA first arrived, all clients were at the Mountain Valley Gerber facility with all staff. Due to escalations from the clients and an AWOL at the time and staff who have called in, no staff were able to come to Bar Du to assist LPA with the inspection at the time. A Facility Manager would be arriving to work at 10: AM who would be able to assist LPA. Facility Manager (FM) De'jana Crockett arrived to assist LPA with the inspection at 10: AM. LPA and FM conducted a walk-through of the facility and LPA observed: four client rooms in clean/orderly condition, two client bathrooms with working toilets, sinks, and showers. Client's water sources measured at 108.8 degrees Fahrenheit, which is within the required range of 105 degrees Fahrenheit and 120 degrees Fahrenheit. There were no sources of water dedicated to extreme heat. The carbon monoxide detector and smoke detector were operational. There was an adequate amount of food for the required amount of time, both perishable and non-perishable foods. Items to make today's scheduled dinner were present in the facility. There was an adequate amount of silverware, dishware, and cooking items. The facility has a dishwasher, however it does not work, so they do clean the dishes appropriately with dish soap. There were extra bedding items, hygiene supplies, and personal items. All medications and cleaning supplies were locked and inaccessible to clients as required. The license and personal rights were posted as required. The staff office was locked and inaccessible to clients. The First Aid Kits met all requirements. The outdoor activity space met all requirements. There is a swing-set outside which had the required safety material underneath. The swing-set was anchored to the ground as required. There were no deficiencies regarding the physical plant/walk-through. LPA reviewed the facility's Operations, Emergency Interventions, and Disaster Plans and found: The facility is conducting emergency drills as required. There was a client roster with clients' names, DOBs, Authorized Representative, and Medical Provider information. There is an Emergency Action Plan, however it does not meet the requirements. The facility did not have a copy of their Program Statement/Plan of Operation at the facility. The facility has a valid fire clearance. Board Meeting minutes were not obtained by the time LPA left the facility. There were partial client files at the facility which had clients' face sheets, consent forms, discipline policy, complaint procedures, foster youth bill of rights, emergency transfer procedures, immunization record, and medical benefits card. However, complete files are only maintained electronically, which there is no access to at the facility. No staff working physically in the facility have access to complete client files. There are some staff records kept at the facility, however these only consist of: supervision check-ins, Memos of Understanding (things that need to be worked on), Topics of Concern (write-ups), Performance Evaluations, and Topics of Merit (recognition for positive work). Complete staff files are also electronic and inaccessible at the facility. The Restraint Log is also digital only at not available at the moment. LPA called Administrator Kamiko Lucas to arrange for LPA to come to the Administrative Office to review electronic files. Before LPA left, Kamiko informed LPA that the Administrative Office is prepared for LPA to come tomorrow. LPA could not complete this inspection on this date, and will have to complete it at the Administrative Office located at Bradshaw Rd., Sacramento, CA 95827 on another date. LPA issued two Technical Violation advisory notes and one Technical Assistance advisory note, which are not citations. An exit interview was conducted with FM and a copy of this report was left with her.

met_with: De'jana Crockett


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an announced Post Licensing inspection at the Administration Office located at Bradshaw Rd., Sacramento, CA 95827 and met with Nurse Dominique Stephens, HR Director Michelle Millhous, Clinician Jenn Potts, Senior Program Director (SPD) Kamiko Lucas who assisted with the inspection. LPA was sent the past year's worth of restraint logs after LPA left the facility yesterday. LPA reviewed them and found the facility is documenting the restraints. LPA reviewed four electronic client files with the assistance of Nurse Dominique Stephens, Therapist Jenn Potts, and HR Director Michelle Milhous (HR). LPA found there were the appropriate consents, including psychiatric medical consents. There were records of Mental Health Services being received by clients, which included their diagnoses and goals and objectives. All clients had separate Psychotropic Medication Administration Records as required for all their psychotropic mediations, with all required information. Two clients out of four have had a wellness exam as required, however only one has received a TB test or assessment as required. There have been issues with out of County insurances, however, one client is from Stockton, which is not unreasonable to drive to to take the client to a doctor's appointment. That client was placed in June 2023, and now has a doctor's appointment scheduled for October 2023. Three out of four clients have a record of vaccinations, and the fourth client does not as their parent has not sent it to the facility, despite the facility requesting it multiple times. The two clients who received a wellness appointment had paperwork from those visits that did not satisfy the requirements and were missing multiple required elements on them. LPA showed Nurse where to access CCL's LIC 602 form, which has all the required information on it. LPA recommended the nurse have the doctors fill that form out during wellness exams in the future. In the event a medical provider refuses to fill out a form, LPA is advising the facility document their efforts. LPA found that one out of four clients had initial Needs and Services Plans. All clients have been placed longer than 30 days. However, there is no specific deadline for when to complete an initial NSP by in the regulations for Group Homes. A best-practice is completing it within 30 days of placement. LPA advised Therapist to complete them as soon as she can, and she agreed. LPA received the Board Meeting minutes for the last four quarters and found the Board is meeting as required. No clients had an Admission Agreement, and the facility stated they had never been asked for that for client placed through school or Managed Care. A bedroom sharing compatibility assessment is not documented for any clients who share bedrooms. SPD Kamiko Lucas stated that she, the assigned clinician, and the assigned house supervisor do this, however it is not documented. Regarding fingerprint clearances, only one staff is still In-Process on Mountain Valley Bar Du's old STRTP License. One staff's determination has been closed. CCL has held the old license open to allow In-Process fingerprints on the old license to go through and be able to transfer to the new Group Home license. HR agreed that the staff can be reprinted under the new license. LPA will the close out the old license HR agreed. HR also informed LPA that they do not have access to the new license in Guardian to be able to transfer associations to the new license. LPA witnessed this on HR's Guardian page; only the old Bar Du license was available. LPA advised HR to inform Guardian of this to have it addressed. Currently the agency is fingerprinting new hires under the Gerber license and will transfer the associations to the Bar Du Group Home license when they have access. LPA informed HR that those new staff cannot work at the Bar Du location until they are associated/transferred to Bar Du. HR agreed. All staff LPA reviewed on this date were associated as required. LPA reviewed five staff files, including one Administrator, one Clinician, one Facility Manager, and two staff. LPA found: The Facility Manager met experience/education requirements, however the dates of employment were missing from one of the reference checks. LPA and HR were able to find in the application the dates worked. LPA observed the facility has a Facility Manager Training which meets requirements, however there was no evidence that any Facility Manager has taken it. There was no evidence of a Prudent Parent Standards training being given to staff who would be able to apply that to day-to-day decisions surrounding the clients. LPA observed that all staff received their TB tests, and Health Evaluation visits as required. All staff reviewed have received Emergency Intervention Training. All staff files have job descriptions, records of fingerprint clearances, training records, education or experience records if required, and records of first aid/CPR. On this date, the facility is being cited for a violation of the California Code of Regulations Title 22, Division 6, Chapter 5, Sections: 84065(d)(3), 84068.1(b)(4)(A), 80069(a), and 84069.1(a). LPA is issuing three Technical Violation Advisory Notes, which are not citations. LPA was unable to complete this inspection on this date. LPA will return to the facility on another date to complete medication review, cash resources review, and to interview staff and clients. An exit interview was conducted with SPD and HR. A copy of this report and appeal rights was left with them.

met_with: Dominique Stephens, Michelle Millhous, Jenn Potts, Kamiko Lucas


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced Post Licensing Continuation inspection at the facility and met with Facility Manager (FM) De'jana Crockett who assisted with the inspection. LPA reviewed client cash resources and client medications. LPA found that all medications are kept under triple lock in the staff office, where they are inaccessible to clients. All medications were accounted for and had a corresponding Psychotropic or Standard Medication Administration Record, which were filled out as required. LPA found that all clients are receiving an allowance as required and the facility is keeping a record of each client's deposits and withdrawls, with a running balance. Three out of four clients' cash records were up to date. FM updated the fourth client's during this inspection. LPA interviewed two clients and two staff. LPA found that staff receive training, and generally know about abuse reporting in that it needs to be reported. However, one staff did not know the process of self-reporting a Suspected Child Abuse Report (SCAR) to CPS and Law Enforcement as necessary. LPA explained the process of doing so to that staff, and where to find the form. During interviews with clients LPA learned that it is possible that staff sometimes do not respond in the most trauma-informed ways during escalations, and should remember in-the-moment that this is a therapeutic environment where staff need to be the calm party to help process crises. Otherwise, LPA found that clients receive three meals a day and snack, outings, allowance, phone access, school, life-skills classes, and other activities. The Post Licensing is concluded. An exit interview was conducted with FM and a copy of this report was left with her.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced case management inspection at the facility to gather more information about multiple incidents of self-harm over the course of the past two months. LPA met with Facility Manager De'jana Crockett, who assisted with the inspection. LPA and FM conducted a walk-through of the facility and LPA observed there were no paper towels in either client bathroom, which FM did put in there during this inspection. Also during the inspection, one of the smoke detectors started beeping, so LPA advised FM to have the battery changed. LPA also advised that C1's rat tail comb, which is in their hygiene basket, only be given to C1 while supervised due to their self-harming propensity with similar objects. FM removed the comb from C1's basket and it will be used under supervision. LPA interviewed FM for this case management. LPA requested the following: - Clinician's behavior contracts for C1 and C2. - Sign in and sign out sheet of personal items. - C1's Needs and Services Plans from time of placement in May 2023, to present. - Hospital paperwork from each time C1 went to the hospital/ER/Urgent Care for self-harm behavior. Further information is needed in order to resolve this case management. An exit interview was conducted with FM and a copy of this report and confidential names list were provided to her.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an unannounced case management inspection at the facility to gather more information and interview clients about multiple incidents of self-harm that have occurred. LPA met with Facility Manager De'jana Crockett, who assisted with the inspection. The date the Case Management was originally opened is 2/9/2024. LPA and FM conducted a walk-through of the facility and LPA observed no deficiencies. When LPA first arrived at the facility LPA met with Administrator Kamiko Lucas who informed LPA that multiple children LPA came to speak with have been discharged and are not present, one of which was discharged today. LPA collected parent contact information from Administrator for those children. LPA collected other client and staff information from FM as well. LPA collected November NSP for C1, and C1's 30-Day Notice. LPA was unable to interview the involved clients on this date due to them having been discharged. LPA requested: 1. All of C1's Child and Family Team (CFT) Notes - (Therapist and FM stated this is the Individualized Education Plan (IEP)), due to all clients being placed through school districts). 2. All of C1's safety plans. 3. C1's NSP. Further information is needed to resolve this case management. An exit interview was conducted with FM and a copy of this report was provided to her.

met_with: Dejana Crockett


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess made an announced case management inspection at the facility to interview a staff about multiple incidents of self-harm that have occurred. LPA met with staff Victoria Vaiaoga who assisted with the inspection. The date the Case Management was originally opened is 2/9/2024. LPA interviewed staff for this Case Management. Further information is needed to resolve this case management. An exit interview was conducted with Facility Manager De'jana Crockett and a copy of this report was provided to her.

met_with: Victoria Vaiaoga


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Alyssa Burgess and Licensing Program Manager (LPM) Jodean Hall made an unannounced case management inspection at the facility and met with Facility Manager (FM) De'jana Crockett, who assisted with the inspection. CCL received three Incident Reports from the facility dated 5/13/2024, 5/17/2024, and 5/20/2024 concerning two different clients C1 and C2 (see confidential names list dated 6/26/2024), in which LPA is investigating. On today's date LPA and LPM requested access to a staff file (S1) however, it was not accessible to staff or LPA and LPM. FM called Administrator Misty Jackson to see about getting access, however the HR personnel left the office at 2: PM due to an emergency, and no other individuals have access. Administrator stated she will provide the staff file to LPA by tomorrow 6/27/2024. This was addressed in the other LIC 809 dated 6/26/2024. There was also no facility manager present when LPA and LPM arrived. There were two clients being supervised by a staff who has been an employee at the facility for one month or less. Another staff was present on the grounds, however was not present in the facility. That staff was hired about 7 months ago. Neither staff had knowledge about licensing or how to get information. FM did return during this inspection and assisted LPA and LPM. This was addressed in the other LIC 809 dated 6/26/2024. LPA and LPM requested the following client documentation: 1. All CFTs or IEPs for C1 and C2, hospital paperwork for self-harm ingestion incidents dated above for C1 and C2, NSPs since placement for C1 and C2, all safety plans created for C1 and C2, and any behavioral contracts for C1 and C2. This will be submitted to CCL by tomorrow, 6/26/2024. Collected: 1. One Treatment plan for C3 implemented 5/30/2023 which did not change within 6 months and was signed on 11/8/2023. 2. One Treatment plan for C1 implemented 7/21/2023 which did not change within 6 months and was signed on 6/12/2024. 3. One Treatment plan for C2 4. 12 months of Clinician's orders for C3, excluding the medication side-effects section. 5. 12 months of Clinician's orders for C1. 6. Two Clinician's orders for C2. LPA conducted and exit interview with FM and a copy of this report was provided to her.


facility_name: MOUNTAIN VALLEY CHILD SERVICES, INC

summary: Facility Evaluation

raw_content:
Narrative:
On 8/11/2025 at 11: AM, Licensing Program Analyst (LPA) Aleza Ruiz and Licensing Program Manager (LPM) Hillary Hall conducted an in person office meeting with Kamiko Lucas, Senior Program Director and Daniel Petrie, Chief Executive Officer. The purpose of the meeting was to convert the Mountain Valley Gerber STRTP to Mountain Valley Gerber Group Home by conducting the Component II meeting. LPA Ruiz explained the purpose of the meeting. Documents discussed during time of meeting were the following: LIC LIC LIC 401a LIC LIC 403a LIC LIC Program Statement- Policy and Procedures discussed during time of meeting were the following Job Descriptions Medical/Dental Visitation Rules and Policy House Rules Complaints and Grievances The Applicant has stated they will do the following and submit updated Program Statement and requested documentation by 9/15/2025. Program Statement: Applicant will submit to LPA Ruiz when it has been updated. To be updated by 9/15/ LPA Ruiz will do the following: Pre-licensing inspection scheduled for 9/25/2025: Will continue to follow up with the Applicant throughout the application/licensing process. A copy of this report was provided to the Applicant.

met_with: Kamiko Lucas,Senior Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On 10/27/25 at 2: PM, Licensing Program Analyst, (LPA) Aleza Ruiz conducted a Pre-Licensing inspection at the Mountain Valley Gerber facility. LPA Ruiz met with Kamiko Lucas, Senior Program Director. The facility will be licensed to care for 6 ambulatory children ages 10-20 years. LPA toured the facility inside and outside. The facility property has a total of 4 buildings; one being a portable that houses the nursing station and 2 other staff offices, second being a greenhouse, third being a bran where animals and tools are kept to tend to the land and animals (horses, chickens, rabbits and pigs), lastly a one-story home consisting of 4 bedrooms, 1 bathroom used for only staff, 1 bathroom used for staff and clients and 1 bathroom used by clients only. There were also 2 staff offices, one kitchen area, one dining area, one classroom, one therapist office and one entertainment area. There is also a swingset and gazebo in the backyard along with a built-in barbecue pit and garden in the front yard. The room temperature was comfortable, and no odor was detected. LPA was unable to complete the inspection due to the facility staff being unable to open a total of 3 locked areas on the property. LPA to continue inspection on 11/03/2025. No staff interviews were conducted. A copy of this report was left with the Licensee.

met_with: Kamiko Lucas, Senior Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On 11/03/25 at 11: AM, Licensing Program Analyst, (LPA) Aleza Ruiz continued the Pre-Licensing inspection at the Mountain Valley Gerber facility that began on 10/27/2025. LPA Ruiz met with Kamiko Lucas, Senior Program Director and Misty Jackson, Program Manager. LPA was able to observe all areas that were locked on the facility property and successfully complete the Pre-Licensing Inspection. No staff interviews were conducted. A copy of this report was left with the Licensee.


facility_name: MUIR WOOD-AUBERRY ROAD

summary: Complaint Investigation - Unsubstantiated - 1 deficiency

raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Reyna Martinez conducted a complaint inspection and met with Scott Sowle, Program Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegations. The Department has investigated the complaint alleging Staff are exposing minors to inappropriate material; Staff are engaging in inappropriate behavior; Staff are not providing adequate care and supervision; and Staff do not provide adequate food service. LPA conducted interviews and obtained documentation. There were inconsistencies in the confidential interviews. Although the allegations may have happened or is valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was provided to Scott Sowle, Program Administrator-CEO. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Reyna Martinez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE This is an official report of an unannounced visit/investigation of a complaint received in our office on 07/19/2024 and conducted by Evaluator Reyna Martinez PUBLICCOMPLAINT CONTROL NUMBER: 24-CR- FACILITY NAME:MUIR WOOD-AUBERRY ROADFACILITY NUMBER: ADMINISTRATOR:SCOTT SOWLEFACILITY TYPE: ADDRESS: AUBERRY ROADTELEPHONE: (310) 903- CITY:CLOVISSTATE: CAZIP CODE: CAPACITY:6CENSUS: 0DATE: 09/25/ UNANNOUNCEDTIME BEGAN: 02: PM MET WITH:Scott SowleTIME COMPLETED:03: PM 9Unqualified staff are providing care and supervision INVESTIGATION FINDINGS: 13On the above date, Licensing Program Analyst (LPA) Reyna Martinez conducted a complaint inspection and met with Scott Sowle, Program Administrator-CEO. The purpose of the inspection was to deliver the findings for the above complaint allegation. Based on interviews it was determined that staff have not met the required training requirements and are providing care and supervision to the clients in care. Based on the LPA's observations, confidential interviews and records review which were conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be substantiated. A deficiency is being cited for the California Code of Regulations (CCR) Section 84065(i)(2) Personnel Requirements. A copy of the report and Appeal Rights was provided to Scott Sowle, Program Administrator-CEO. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Reyna Martinez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE FACILITY NAME: MUIR WOOD-AUBERRY ROADFACILITY NUMBER: 107207237

Deficiencies:
84065: (2)	Sixteen hours of training shall be completed by new child care staff  within 90 days of hire.

met_with: Scott Sowle

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


summary: Facility Evaluation

raw_content:
Narrative:
On June 23, Licensing Program Analyst (LPA) Wayne Aoki travelled to Muir Wood-Auberry Road to conduct the Component II interview. LPA was met by facility Chief Executive Officer/Administrator, Scott Sowle. LPA discussed the following with the Mr. Sowle: Forms that the facility uses and will continue to use. Corporate organization - Including chain of command and roles of staff Written plans, policies or procedures that was submitted with the application. Administrator/Director qualifications and duties. Finances of the facility (CCL currently is waiting for the financial verification from their financial institute. Muir Wood currently operates 10 licensed facilities (64 beds) in California. Mr. Sowle informed this LPA that he will be the Administrator for Muir Wood - Auberry Road when the facility is licensed, Mr. Sowle indicated that all 10 facilities that are licensed have specific Administrators/Facility Managers assigned to each facility. Mr. Sowle will be residing in the area until Kerry Figeuroa is certified as an Administrator. Ms. Figeuroa is scheduled to take the Administrator's test on June 28, 2023. A copy of this report was provided to Mr. Sowle.


summary: Facility Evaluation

raw_content:
Narrative:
On June 23, 2023, Licensing Program Analyst (LPA) Wayne Aoki travelled to the facility listed above to conduct a pre-licensing and Component III inspection. The applicant submitted an application on 4/7/2023. The Program Statement has been reviewed and approved as meeting regulatory requirements. LPA met with Chief Executive Officer/Administrator, Scott Sowle. 1. Facility grounds inspected. Grounds are clean and free from observable hazard. The facility has a swimming pool that is properly fenced with a self closing/latching gate that opens away from the pool. Facility has a separate building housing a classroom and gym. 2. Adequate indoor activity space and materials observed, and outdoor activity space was observed. 3. Chemicals were appropriately locked 4. Procedures for Locked and centrally stored medications observed. 6. Adequate storage space observed. 7. Individual beds in good repair observed. A supply of extra linens available for bed changes. 8. The house has 3 bedrooms, double occupancy, located on a single floor. Bedrooms are accommodating of all required furnishings. 9. Adequate food storage space observed. Facility will add appropriate supply of foods upon placement of youth in the home. A supply of nonperishable foods were observed on this date. 10. Sample menu posted. 11. All appropriate forms posted within client view. 12. Dining room equipped with large table and chairs accommodating of all clients. 13. Facility has three restrooms for client use, one for staff use, all are operable Hot water measured 117 degrees on this date. Applicant has personnel associated through Guardian. Administrator has been fingerprint cleared. Prior to initial license approval, all staff must be fingerprint cleared and associated to the facility. Prior to accepting clients for care, the facility shall ensure that all personnel who will have client contact are cleared and associated. Discussed Guardian process with the facility. Discussed with the facility the process for changing the facility Administrator. The following documents are required: 1. LIC 308 (Designation of Facility Responsibility) designating new administrator. 2. Current Personnel Record for new Administrator. 3. Verification of Education and/or experience for new administrator. 4. Copy of current administrator certificate. 5. Current (within one year) health screening and TB test. 6. Board Resolution granting administrative responsibility to the new administrator. 7. Fingerprint association transfer request (if the Administrator is not already associated to the facility) 8. Exception request (if the Administrator does not specifically meet regulatory requirements, i.e. experience is in a facility with a capacity of six or fewer). Discussed Incident reporting. An initial report for all reportable incidents is to be made by the next working day to CCLFresnoIncidents@dss.ca.gov. A full report is to be remitted within 7 days and may also be made to the incident reporting email. The currently assigned analyst for the facility will be Wayne Aoki. Wayne.Aoki@dss.ca.gov or at (559) 978-9486. The facility will be approved for initial licensure, pending verification of guardian clearance and association for the Licensee and Administrator and Financial Verification for the facility.. Initial license will be issued on a provisional basis, expiring one year from effective date. License will be valid for up to 6 male and/or female youth ages 12 through 17.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On May 29, Licensing Program Analysts (LPAs) Angelica Borja and Briana Placencia conducted an unannounced Post Licensing inspection at the facility. LPAs met with Rosie Samarjian. An inspection of the facility was conducted and the following was observed: LPAs reviewed four client files. LPAs interviewed two clients, LPAs interviewed one staff. The facility was inspected indoors and outdoors. Hot water temperature measured at 105.0 degrees. LPAs observed at least one week supply of nonperishable and at least a five day supply of perishable foods. Individual beds were observed with appropriate clean linens and are in good repair. Cleaning chemicals inaccessible to clients. The facility is maintained at 71 degrees. All facility smoke and carbon monoxide detectors appear to be in appropriate working order, fire extinguisher is properly charged and was last serviced in January 2024. LPAs reviewed the outcome of post licensing thus far. LPAs will need to return at a later day to complete the post licensing. LPAs advised Administrator that Licensing is requesting an in person informal meeting next week to discuss concerns addressed at this post licensing inspection. Medications centrally stored and locked. Per Licensee, there are no weapons at the facility. Three deficiencies are being issued for today's findings. A copy of this report and appeal rights was left at the facility.

Deficiencies:
84072(d): Personal Rights

(d) The licensee shall ensure that each child, regardless of whether the child is in foster care, is accorded the personal rights specified in Welfare and Institutions Code section 16001.9, as applicable. In addition, the licensee shall ensure that each child is accorded the following personal rights

met_with: Rosie Samarjian


summary: Facility Evaluation

raw_content:
Narrative:
On June 21, Licensing Program Analysts (LPAs) Angelica Borja and Briana Placencia conducted a continued Post Licensing inspection at the facility. LPAs met with Rosie Samarjian. An inspection of the facility was conducted and the following was observed: LPAs reviewed six staff files. LPAs interviewed three clients, LPAs interviewed four staff. The facility was inspected indoors and outdoors. LPAs observed at least one week supply of nonperishable and at least a five day supply of perishable foods. Individual beds were observed with appropriate clean linens and are in good repair. Cleaning chemicals inaccessible to clients. All facility smoke and carbon monoxide detectors appear to be in appropriate working order, fire extinguisher is properly charged and was last serviced in January 2024. LPA's observed fire clearance that was completed on 05/18/23. Medications centrally stored and locked. Per Licensee, there are no weapons at the facility. Two deficiencies are being issued for today's findings. A copy of this report and appeal rights was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On July 31, 2024, Licensing Program Analysts (LPAs) Reyna Martinez and Angelica Borja conducted an unannounced Annual/Required inspection at the facility. LPAs met with Jessica Beutler. Appropriate staff/client ratios were verified during this inspection. Staff files and staff training's were reviewed. 5 records of clients were reviewed. Emergency intervention plan reviewed. Staff and Client files did not meet all regulatory requirements. Additional follow up required for annual inspection to complete physical plant inspection, review operations, and review disaster preparedness. Deficiencies were cited on today's visit on the attached LIC 809-D Page. A copy of this report was left at the facility, along with appeal rights.

met_with: Jessica Beutler, Care Coordinator Manager


summary: Facility Evaluation

raw_content:
Narrative:
On August 15, 2024, Licensing Program Analysts (LPAs) Angelica Borja and Reyna Martinez conducted an unannounced Annual/Required inspection at the facility. The purpose of the inspection was to continue the annual inspection. LPAs met with Jessica Beutler. Centrally stored medications are maintained in a locked closet in a locked cabinet. Sharps and Toxic chemicals are kept locked. The facility has a written emergency disaster plan. All facility smoke detectors and carbon monoxide were tested and appear to be in appropriate working order, fire extinguisher is properly charged and was last serviced August 1, 2024. Individual beds were observed with appropriate clean linens and are in good repair. The facility is Joint Commission Accredited through February 5, 2025. There is at least one-week supply of nonperishable and a two-day supply of perishable foods. The facility is maintained at 71 degrees. Hot water temperature measures 110 degrees. No firearms or weapons are allowed in the facility. 1 pool gated and locked. Appropriate staff/client ratios were verified during this inspection. The facility employs Care Coordinator Manager, Therapist, Clinical Director, Registered Nurse, Care Coordinators, Operations Manager, Outreach Manager, Chef, and Facilities Manager. 3 staff interviewed, 2 clients interviewed, and 4 clients refused to be interviewed. Deficiencies were cited on today's visit on the attached LIC 809-D Page. A copy of this report was left at the facility, along with appeal rights.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, LPAs (Licensing Program Analysts) Danny Macias and Leslie Inouye conducted a case management inspection at the above agency. The purpose of the inspection was to address reporting requirements for the facility. LPAs met with and discussed Reporting Requirements and 84061(i) Reporting Requirements with Chief Operating Officer (COO) Bryan Bowen. A technical assistance for section Reporting Requirements and 84061(i) Reporting Requirements is issued on this date. A copy of this report was left with Bryan Bowen at the conclusion.

met_with: Bryan Bowen


facility_name: MUIR WOOD-AUBERRY WEST

summary: Facility Evaluation

raw_content:
Narrative:
On the date above Licensing Program Analyst, Les Inouye met with Scott Sowle and Bryan Bowen. The meeting was to receive the corrections form the last review. Forms from Section A requested were submitted. Part 1 documents and Part Program Description were submitted. All documents will be review to current licensing standards and the licensee will be notified if any further updates or correction are needed or the the information Meets Standards. A discussion on the current status of programs and applications in the state and area was discussed. Current processes and reviews for state wide applications were discussed along with the purpose and goals of Muir Wood and the services they provide. LPA, will review the entire application and notify the licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On the date above Licensing Program Analyst, Les Inouye met with Scott Sowle and Brent Bowers. The meeting was to review the corrections form the list returned 10/16/24. An updated Program Statement will be submitted and the licensee will be notified if any further updates or correction are needed or the information Meets Standards. Applicant has requested an extension of the submission date which has been granted. LPA, will review the entire application and notify the licensee.

met_with: Scott Sowle and Brent Bowers


summary: Facility Evaluation

raw_content:
Narrative:
On the date above Licensing Program Analyst, Les Inouye met with Scott Sowle and Brent Bowers The meeting was to receive the corrections form the last review. All Part 1 documents and Part Program Description were submitted. All documents will be review to current licensing standards and the licensee will be notified if any further updates or correction are needed or the information Meets Standards. Applicant will be notified if any corrections can be completed section by section to expedite a complete review. If a facility pre licensing visit can be scheduled Licensing Program Analyst, Danny Macias will be contacted to schedule with the facility. LPA, will review the entire application and notify the licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On May 5, 2025, Licensing Program Analysts (LPAs) Danny Macias and Leslie Inouye travelled to Muir Wood Auberry West to conduct a pre-licensing inspection. LPAs met with Chief Operating Officer (COO) Bryan Bowen. A physical plant inspection was completed and included the following checks. Adequate indoor and outdoor activity space and materials observed. The facility is maintained at 68 degrees. All facility smoke detectors are in appropriate working order, fire extinguisher is properly charged and serviced in April 2025. Facility maintains an adequate supply of perishable and non-perishable foods. All required forms are posted. Medications will be locked and centrally stored. Individual beds were observed in all bedrooms. There are no bodies of water on the property. Per COO, no firearms or weapons are in the facility. There are no pets at the facility. LPAs discussed two areas in the back yard requiring clean-up. The facility is having the gardening staff perform clean-up in the following 2 weeks. LPAs left a copy of this report with COO at the conclusion.


summary: Facility Evaluation

raw_content:
Narrative:
A Case Management visit was conducted to discuss the Program Statement revisions. Bryan has reviews to be completed and is in the process of review and submission. A review is expected to be submitted by 5/16/25. If any questions or clarifications are needed Bryan will contact LPA Les Inouye.

met_with: Bryan Bowan


facility_name: MUIR WOOD - AUBERRY SOUTH

raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Reyna Martinez conducted a complaint inspection and met with Scott Sowle, Program Administrator-CEO. The purpose of the inspection was to deliver the findings for the above complaint allegations. The Department has investigated the complaint alleging Staff are exposing minors to inappropriate material; Staff are engaging in inappropriate behavior; Staff are not providing adequate care and supervision; and Staff do not provide adequate food service. LPA conducted interviews and obtained documentation. There were inconsistencies in the confidential interviews. Although the allegations may have happened or is valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was provided to Scott Sowle, Program Administrator-CEO. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Reyna Martinez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE This is an official report of an unannounced visit/investigation of a complaint received in our office on 07/22/2024 and conducted by Evaluator Reyna Martinez PUBLICCOMPLAINT CONTROL NUMBER: 24-CR- FACILITY NAME:MUIR WOOD - AUBERRY SOUTHFACILITY NUMBER: ADMINISTRATOR:SOWLE, SCOTTFACILITY TYPE: ADDRESS: AUBERRY ROADTELEPHONE: (310) 903- CITY:CLOVISSTATE: CAZIP CODE: CAPACITY:6CENSUS: 0DATE: 09/25/ UNANNOUNCEDTIME BEGAN: 02: PM MET WITH:Scott SowleTIME COMPLETED:03: PM 9Unqualified staff are providing care and supervision INVESTIGATION FINDINGS: 13On the above date, Licensing Program Analyst (LPA) Reyna Martinez conducted a complaint inspection and met with Scott Sowle, Program Administrator-CEO. The purpose of the inspection was to deliver the findings for the above complaint allegation. Based on interviews it was determined that staff have not met the required training requirements and are providing care and supervision to the clients in care. Based on the LPA's observations, confidential interviews and records review which were conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be substantiated. A deficiency is being cited for the California Code of Regulations (CCR) Section 84065(i)(2) Personnel Requirements. A copy of the report and Appeal Rights was provided to Scott Sowle, Program Administrator-CEO. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Reyna Martinez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE FACILITY NAME: MUIR WOOD - AUBERRY SOUTHFACILITY NUMBER: 107207243

Deficiencies:
84065: (2)	Sixteen hours of training shall be completed by new child care staff  within 90 days of hire.


summary: Facility Evaluation

raw_content:
Narrative:
On October 9, Licensing Program Analyst (LPA) Wayne Aoki travelled to Muir Wood - Auberry South to conduct the Component II interview. LPA was met by facility Chief Executive Officer/Administrator, Scott Sowle. LPA discussed the following with the Mr. Sowle: Forms that the facility uses and will continue to use. Corporate organization - Including chain of command and roles of staff Written plans, policies or procedures that was submitted with the application. Administrator/Director qualifications and duties. Muir Wood currently operates 13 licensed facilities (82 beds) in California. Mr. Sowle informed this LPA that he will be the Administrator for Muir Wood - Auberry South when the facility is licensed, Mr. Sowle indicated that all 13 facilities that are licensed have specific Administrators/Facility Managers assigned to each facility. Mr. Sowle will continue with Administrative duties until Rosie Samarjian receives her Administrator's Certificate. 1. Facility grounds inspected. Grounds are clean and free from observable hazard. The facility has a swimming pool that is properly fenced with a self closing/latching gate that opens away from the pool. 2. Adequate indoor activity space and materials observed, and outdoor activity space was observed. 3. Chemicals were appropriately locked 4. Procedures for Locked and centrally stored medications observed. 6. Adequate storage space observed. 7. Individual beds in good repair observed. A supply of extra linens available for bed changes. 8. The house has 3 bedrooms, double occupancy, located on a single floor. Bedrooms are accommodating of all required furnishings. 9. Adequate food storage space observed. Facility will add appropriate supply of foods upon placement of youth in the home. A supply of nonperishable foods were observed on this date. 10. Sample menu posted. 11. All appropriate forms posted within client view. 12. Dining room equipped with large table and chairs accommodating of all clients. 13. Facility has three restrooms for client use, one for staff use, all are operable Hot water measured 117 degrees on this date. Applicant has personnel associated through Guardian. Administrator has been fingerprint cleared. Prior to initial license approval, all staff must be fingerprint cleared and associated to the facility. Prior to accepting clients for care, the facility shall ensure that all personnel who will have client contact are cleared and associated. Discussed Guardian process with the facility. Discussed with the facility the process for changing the facility Administrator. The following documents are required: 1. LIC 308 (Designation of Facility Responsibility) designating new administrator. 2. Current Personnel Record for new Administrator. 3. Verification of Education and/or experience for new administrator. 4. Copy of current administrator certificate. 5. Current (within one year) health screening and TB test. 6. Board Resolution granting administrative responsibility to the new administrator. 7. Fingerprint association transfer request (if the Administrator is not already associated to the facility) 8. Exception request (if the Administrator does not specifically meet regulatory requirements, i.e. experience is in a facility with a capacity of six or fewer). Discussed Incident reporting. An initial report for all reportable incidents is to be made by the next working day to CCLFresnoIncidents@dss.ca.gov. A full report is to be remitted within 7 days and may also be made to the incident reporting email. The currently assigned analyst for the facility will be Wayne Aoki. Wayne.Aoki@dss.ca.gov or at (559) 978-9486. The facility will be approved for initial Licensure, pending verification of guardian clearance and association for the Licensee and Administrator. Initial license will be issued on a provisional basis, expiring one year from effective date. License will be valid for up to 6 male and/or female youth ages 12 through 17. A copy of this report was provided to Mr. Sowle.


summary: Facility Evaluation

raw_content:
Narrative:
On this date Licensing Program Analyst's (LPA) Les Inouye and Danny Macias made a Case Management -POC visit for the purpose of clearing a citation dated 09/06/24 for Buildings and Grounds 80087(a). LPA's met with Jessica Beutler. The citation was previously amended from a Type A to a Type B which has been previously documented. POC information has been sent and received by CCL and verified on todays visit. Deficiency cleared.

met_with: Jessica Beutler


summary: Facility Evaluation

raw_content:
Narrative:
On December 6, 2024, Licensing Program Analysts (LPAs) Danny Macias and Melissa Renovato conducted an unannounced required two year inspection at Muir Wood Auberry South Group Home located in Clovis CA. LPAs met with Care Coordinator Manager Jessica Beutler. A physical plant inspection was completed and included the following checks. Adequate indoor and outdoor activity space and materials observed. The facility is maintained at 70 degrees. All facility smoke detectors are in appropriate working order, fire extinguisher is properly charged and serviced in October, 2024. Facility maintains an adequate supply of perishable and non-perishable foods. All required forms are posted. Due to time constraints, LPAs will complete inspection at a later date. A copy of this report was left at the facility.

met_with: Jessica Beutler, Lydia Franco


summary: Facility Evaluation

raw_content:
Narrative:
On December 10, 2024, Licensing Program Analysts (LPAs) Danny Macias and Melissa Renovato continued a required annual inspection at Muir Wood Auberry South Group Home located in Clovis CA. LPAs met with Operations Manager Lydia Franco (S2.) A physical plant inspection was completed and included the following checks. Adequate indoor and outdoor activity space and materials observed. The facility is maintained at 70 degrees. All facility smoke detectors are in appropriate working order, fire extinguisher is properly charged and serviced in October, 2024. Facility maintains an adequate supply of perishable and non-perishable foods. All required forms are posted. Medications are locked and centrally stored. Individual beds were observed. Per S2, no firearms or weapons are in the facility. There are no pets at the facility. LPAs observed swimming pool to be in compliance with licensing regulations. LPAs reviewed 6 client files, and 5 staff files. LPAs interviewed 2 staff and 2 clients. LPAs discussed repairs needed for the facility van. The van is currently in a repair shop. The facility is currently using another facility's vehicle owned by the same licensee. LPAs discussed the facility's food preparation process. The facility prepares meals off-site and transports them at meal times. Deficiencies are on the attached pages. LPAs requested that the licensee update the following forms within the following 2 weeks: LIC308, LIC309, LIC500 and Emergency Disaster Plan. LPAs left a copy of this report and Appeal Rights with S2.


summary: Facility Evaluation

narrative: On the above date, LPAs (Licensing Program Analysts) Danny Macias and Leslie Inouye conducted a case management inspection at the above agency. The purpose of the inspection was to address reporting requirements for the facility. LPAs met with and discussed Reporting Requirements and 84061(i) Reporting Requirements with Chief Operating Officer (COO) Bryan Bowen. A technical assistance for section Reporting Requirements and 84061(i) Reporting Requirements is issued on this date. A copy of this report was left with Bryan Bowen at the conclusion.


summary: Facility Evaluation

raw_content:
Narrative:
On May 23, 2025, an informal office conference was held at the Fresno Children's Residential Program, Fresno Office. Present with Community Care Licensing are Regional Manager Nelson Martinez, Licensing Program Manager Tamara Melikian and Licensing Program Analyst Danny Macias. Present with Muir Wood Auberry Road is Chief Operating Officer (COO) Bryan Bowen and Director of Compliance (DC) Misty Mejia. The purpose of the conference is to address incident reporting, update of the administrator, and the program statement updates. Facility will be training group home staff on incident reporting and implementing a process to submit incident reports in a timely manner. Facility will submit remaining incident reports to LPA in the coming weeks. In addition, the services of the Technical Support Program was offered and the licensee is interested in this referral being completed for them. Facility will provide LPA an update for the administrator of record and updates to the organization will be forwarded by the licensee within the next week. Facility will submit latest revisions and updates to the program statement in the coming weeks. A copy of this report was left with COO Bryan Bowen.


summary: Facility Evaluation

raw_content:
Narrative:
On June 5, 2025, Licensing Program Analyst Danny Macias conducted a case management inspection at the above agency and met with Operations Manager (OM) Lydia Franco. The purpose of the inspection is to follow up on an incident that occurred on 5-26-25 in which C1 (see LIC811 dated 6-5-25) disclosed inappropriate touching by a male staff member at a previous placement. LPA gathered additional details on the incident (see 812). The staff member that C1 disclosed the incident to was not available to be interviewed on this date. The minor was not available to be interviewed on this date and is no longer a resident of the facility. A copy of this report was left with Lydia Franco at the conclusion.

met_with: Lydia Franco


facility_name: MUIR WOOD - BRADLEY RANCH

summary: Facility Evaluation

raw_content:
Narrative:
On 12/05/2023 at 2: PM, Licensing Program Analyst (LPA) Sarah Lo and Licensing Program Manager (LPM) Jennifer Smith conducted a Component II meeting via Microsoft Teams with Applicant (CEO) Scott Sowle. Also present were Chief Compliance Officer Brent Bower, Care Coordinator Manager Melissa Gaviria, Care Coordinator Manager Jeff Denison, and Operations Manager Ashley Mitchell. The Administrator for this facility will be Jeff Denison. During the meeting the following was discussed: *Background and experience with group homes. *An overview of the program applicant is offering. *The structure for the program. *Program and services. *Neighborhood complaint procedure. *Pool on property will not be used by any staff or clients. *Administrator's qualification. After the review of the application and program statement, LPA and LPM have determined the following missing documents or documents that need to be revised. The documents are to be submitted by 12/13/2023: *Need a copy of administrator's college degree. *Group Home Administrator 40-hour training certificate, health screening, TB clearance, first aid/CPR certification. (Continued on LIC 809c) *Administrative Organization (LIC 309) for board member Chris Laitala needs to have an updated address with the suite number. *Board of Director or Governing Body Statement (LIC 9165) for board member Chris Laitala needs to have an updated address with the suite number. *Personnel Report (LIC 500) needs to be updated to show the name of the Administrator and work hours. *Job description for all positions at the facility. A pre-licensing visit and component III has been scheduled for 12/14/2023. An exit interview was conducted. A copy of this report and the appeal rights were emailed to Applicant Scott Sowle for original signature and a copy will be placed in the facility file.

met_with: Administrator, Scott Sowle