summary: Facility Evaluation

raw_content:
Narrative:
On June 21, 2022 at 9:15am, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted a case management inspection at the facility and met Cynthia Briscoe, Administrator. The inspection is a continuation of the case management initiated by LPA last 6/14/22 to check the Emergency Intervention Training of all the staff of the facility. During today's inspection, three (3) staff were found without current Emergency Intervention Training and seven (7) staff (see LIC Confidential Names List) have current training however the previous training certificates dated 5/14/21 expired before they had the new training last 06/10/22. Per ILS 87095.65 (a) (1) All new and existing staff who use or participate in emergency interventions, as well as the facility administrator and the administrator's designee must complete the training. One deficiency citation and one Technical Advisory (TA), Technical Violation is issued. An exit interview was conducted and a copy of the LIC 809, LIC 809D, LIC 811 and TA were provided to the administrator.


state: CA

facility_name: CAMRY GROUP HOME II

summary: Facility Evaluation

raw_content:
Narrative:
On 12/28/22 at 4: PM, Licensing Program Analyst (LPA) Christopher Larios conducted a case management inspection to the Short Term Residential Therapeutic Program (STRTP). During the inspection LPA Larios met with Administrator Cynthia Briscoe. The purpose of the inspection was to issue citations for deficiencies observed while conducting an assignment regarding facility staff using restraint on a client. Confidential interviews conducted by LPA Larios revealed staff restrained a client in a prone position on the floor. While on the floor, staff placed a hand on the client's back-neck area. Witnesses reported staff positioned themselves over the client using their weight to support the restraint. In addition, LPA Larios obtained a copy of the law enforcement contact report, LIC 624-LE written by the staff and reviewed by an administrator. The SIR does not state a restraint was used. A review of the law enforcement report revealed staff informed police the client presented with aggressive behaviors which required staff to use restraint. Facility cited for violation of STRTP Interim Licensing Standards Article 06, 87095.01(a)(1)(A) Emergency Intervention Prohibitions & 87095.61(a) Documentation and Reporting Requirements. Confidential interviews conducted support staff used a prohibited emergency intervention technique by placing their weight over a client while using a restraint. In addition, record review revealed the facility failed to report manual restraint was used during the incident. A copy of this report, LIC9099D, appeals rights and LIC811 dated 12/28/22 were given to the above-mentioned facility representative.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Cynthia Briscoe


summary: Facility Evaluation

raw_content:
Narrative:
On July 24, 2024, at 9:30am, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an unannounced case management inspection to the facility and met Administrator, Tanerrah Powell. The purpose of the inspection is to follow-up on the Special Incident Reports (SIRs) received by the Department late. The incident reports were regarding clients runaway and facility's law enforcement contacts dated 06/30/24 and 07/02/24 received on 07/05/24, involving client (C1) and 07/13/24 and 07/15/24 received on 07/18/24 involving client (C2). Per Administrator Powell, she was on leave when the incidents happened and confirmed that there were no prior emails sent to the Department prior to 07/05/24 and 07/18/ SIRs relating to the subject incidents. Per Section Reporting Requirements, upon the occurrence of reportable incidents, a report shall be made to the licensing agency within the agency's next working day during its normal business hours. Reporting Requirements: Upon the occurrence, during the operation of the facility, of any of the events specified in (1) ... a report shall be made to the licensing agency within the agency's next working day during its normal business hours. In addition, a written report containing the information specified in (2) ...shall be submitted to the licensing agency within seven days following the occurrence of such event. Based on the above information, a deficiency citation was issued. An exit interview was conducted and a copy of the LIC 809, LIC 809D, and LIC 811 were provided to Administrator Powell.

met_with: Tanerrah Powell


facility_name: CANYON OAKS YOUTH CENTER

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13On 8/12/22 at 12: PM, Licensing Program Analysts (LPA) Alyssa Ng and George Karkazis conducted a complaint inspection with Canyon Oaks and spoke with Victoria Valencia, Administrator. The purpose of the inspection was to deliver the findings for the above complaint allegation. During confidential interviews with clients, one client stated they drank alcohol in the facility and tossed it in the garbage. Later that day, staff found the empty bottle and removed it from the premises. After reviewing the incident report dated 02/01/22, three small alcohol bottles were confiscated from clients and the trash bin. Based on LPA's interview with Administrator and record review(s), the preponderance of evidence standard has been met, therefore the above allegation, minor has access to alcohol in care is found to be SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6 & Chapter 1: 80078(a): Responsibility for Providing Care and Supervision. See attached LIC9099D for details. An exit interview was conducted, appeal rights provided and discussed, and a copy of this report was given to Victoria Valencia, Administrator. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng 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 CCLD Regional Office, TRAEGER AVE., SUITE This is an official report of an unannounced visit/investigation of a complaint received in our office on 04/01/2022 and conducted by Evaluator Alyssa Ng COMPLAINT CONTROL NUMBER: 14-CR- FACILITY NAME:CANYON OAKS YOUTH CENTERFACILITY NUMBER: ADMINISTRATOR:VICTORIA VALENCIAFACILITY TYPE: ADDRESS: EDMONDS ROADTELEPHONE: (650) 839- CITY:REDWOOD CITYSTATE: CAZIP CODE: CAPACITY:12CENSUS: 7DATE: 08/12/ UNANNOUNCEDTIME BEGAN: 12: PM MET WITH:Carrie StaffordTIME COMPLETED:01: PM Minor(s) sexually abused while in care. INVESTIGATION FINDINGS: 13On 8/12/22 at 1: PM, Licensing Program Analysts (LPA) Alyssa Ng and George Karkazis conducted a complaint inspection with Canyon Oaks and spoke with Carrie Stafford, Program Director. The purpose of the inspection was to deliver the findings for the above complaint allegation. The allegation, "minor(s) sexually abused while in care," was investigated by Community Care Licensing's (CCL's) Investigations Branch (IB) and assigned to Inv. Christen Krogstad on 04/04/2022. On 06/13/2022, the investigation was re-assigned to Investigator Victoria McIntosh. During Confidential Interviews and staff shift notes reviewed by IB Investigators Krogstad and McIntosh, clients denied staff ever touching them. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that Minor(s) sexually abused while in care, therefore the above allegation is UNSUBSTANTIATED. An exit interview was conducted, and a copy was given to Carrie Stafford, Program Director. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: CANYON OAKS YOUTH CENTERFACILITY NUMBER: 415600309

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

report_type: Complaint Investigation

met_with: Victoria Valencia

complaint_status: unsubstantiated


raw_content:
Narrative:
Although the allegation may have happened or is valid, based on LPA's observations and interviews, there is not a preponderance of the evidence to prove the alleged violation did not did not occur. Therefore, the allegation is unsubstantiated. No deficiency citations were issued at today's visit. An exit interview was conducted, and a copy of this report and the licensee's appeal rights were provided to Administrator Victoria Valencia and Mental Health Program Specialist Christina Bolanos.

Investigation Findings:
13On 2/26/25, Licensing Program Analyst (LPA) Mariah Hawkins conducted a complaint investigation visit at the facility in order to deliver the findings of the investigation of the above complaint allegation. LPA met with Administrator Victoria Valencia and Mental Health Program Specialist Christina Bolanos and informed of the purpose of the visit. Based on the complaint report, the allegation of inappropriate touching pertains to an incident of alleged sexual assault. Based on confidential interviews, observation, and record review: While riding a four-wheeler at an equestrian center as part of equine therapy, a client pushed another client after the latter got too close to the former. Facility staff always accompany clients to equine therapy but do not provide close supervision, which is to allow clients to fully engage with the equine instructors. Reports that disclosures of the incident were made to facility staff could not be supported by interviews and record review, and it could not be evidenced that facility staff witnessed or were made aware of the incident. Further, the confirmed details of the incident do not support the allegation. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: CANYON OAKS YOUTH CENTERFACILITY NUMBER: VISIT DATE: 02/26/2025

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


summary: Facility Evaluation

raw_content:
Narrative:
At AM Licensing Program Analyst (LPA) Isabel Mendoza made an unannounced annual inspection to facility. LPA met with Christina Bolanos, Residential Counselor 3, and Administrator, Karrie Stafford. Later in the inspection, Victoria Valencia joined in. The facility is licensed to serve a capacity of 12 clients, prefer ages 12-17 years old and also NMD. Currently the current census is 7 ambulatory clients, and no NMDs in care. The purpose of this inspection was to comply with a regulatory requirement for a yearly required inspection. At 9: AM LPA toured the facility inside and out and found the facility to be safe, clean and in good repair. All passageways are unobstructed. All smoke detectors are in working order. There are no firearms on the property. The fire extinguisher has been checked and is up to date. There are no bodies of water on the property. The facility is maintained at a comfortable temperature at 69 degrees. LPA recorded water temperature at 108.3 degrees which is within regulation. LPA inspected the medication storage and administration records and observed that the logs were complete and matched the stored medications. LPA Mendoza reviewed 10 staff files and observed them to contain all necessary documentation. All staff have background clearances and are listed on facility roster. During review on staff training LPA was informed that the facility completes several training on Relias (online portal), however the facility is not filing all employees training certificates. LPA reminded the facility that all training certificates should be maintained. LPA reviewed all residents' files and observed (2) client files where the LIC 601 (Identification and Emergency Information) form had several sections not completed. LPA brought this up to the Head of Service, Victoria Valencia, and the facility completed and requested those missing items. During inspection, LPA obtained a copy of Administrators certificate and emergency intervention plan. (Please refer to LIC 809-C) LPA requested the facility to submit the following items no later than Friday 6/23/21, an updated LIC 500 (staff schedule) and LIC 610 (Emergency Disaster Plan). No deficiencies cited during todays inspection. The facility received four technical advisory notes. Exit interview was conducted and a copy of the report was left with the facility.

visit_type: Annual

met_with: Christina Garcia, Residential Counselor III & Administrator, Karrie Stafford


summary: Facility Evaluation

raw_content:
Narrative:
A virtual Office Meeting was conducted on Friday, August 06, 2021 at PM via Microsoft Team due to COVID-19 safety orders. Community Care Licensing (CCL) met with Administrator Karrie Stafford, Clinical Services Manager, and Noelle Bruton. From CCL, Regional Manager, Nelson Martinez, Licensing Program Manager, Zaid Hakim, Licensing Program Manager, Juanita Arroyo, and Licensing Program Analyst (LPA) Isabel Mendoza. The purpose of this meeting is to review and clarify trends that have been identified over the past two years from incident reports and discuss our review of the current program statement. Trends: CCL reviewed January 2020, January 2021, and February 2021 incident reports. A total of 26 incident reports. 16 incident reports were AWOL/attempted AWOL. Trends: Intervention using trauma informed practices De-escalation techniques Lacking details to support actions on incident reports Clinical interventions are not present Early therapeutic engagement Review of Needs and Service Plans 7. Additional training on engagement of youth 8. Modification to Need and Service Plan Program Statement Revisions: Section 4- Core Services and Supports- Regulation 87078.1, pages 4-8 of program statement. Section 5- Trauma Informed Intervention and Treatment Practices, Regulation 87078.2, pages 1-5. Section 14- Personal Rights, Regulation 87072, page 1. Section 15- House Rules, Regulation 87022.1 and 87072, pages 1-3. Section 17 -Positive Discipline Policies, Regulation 87022.1 and 87072, pages 1-9. Section 22- Emergency Intervention Plan and Runaway Plan, Regulation 87095.24 and 87095.22, page 11. The facility agrees to submit CCL the amended Program Statement by 09/10/21. As a result of this Office Meeting, there were no title 22 deficiencies cited. Exit interview was conducted and a copy of this report was emailed to Administrator, Karrie Stafford for signature. The Administrator agreed to sign and email back to LPA Mendoza.

met_with: Administrator- Karrie Stafford Clinical Services Manager-Noelle Bruton


summary: Facility Evaluation

raw_content:
Narrative:
SB Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Oquendo and Bertoli on 9/29/21 at 10:00AM. LPA spoke with Administrator - Victoria Valencia, who provided files and documents for review. This inspection was conducted at this facility. LPA reviewed client files and viewed the medications, which were locked in a cabinet, located inside the locked staff office. Facility has a capacity of twelve, with nine children in placement. Seven of the children placed at this facility are prescribed psychotropic medications The children were all present at the facility during this inspection. All the children attend school on campus at this facility. This facility previously received an SB 484 inspection on 11/4/20. LPA conducted exit interview with administrator and left a copy of this report.


summary: Facility Evaluation

raw_content:
Narrative:
SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Oquendo and Bertoli on 9/30/21 at 10:00AM. LPA met with Administrator - Victoria Valencia. This inspection was conducted at this facility. LPA reviewed client and staff files and viewed the medications, which were locked in a cabinet, located inside the locked staff office. LPA interviewed clients and staff at the facility. Facility has a capacity of twelve, with nine children in placement. Seven of the children placed at this facility are prescribed psychotropic medications The children were all present at the facility during this inspection. All the children attend school on campus at this facility. This facility previously received an SB 484 inspection on 11/4/20. LPA conducted exit interview with administrator and left a copy of this report.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Michelle Kyane and Licensing Program Manager Angela King conducted a case management inspection on October 21, 2021 at 11: AM, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. 6 of 26 direct care staff and 9 of 11 youth files as identified on the LIC 811 confidential names dated October 21, 2021, were reviewed. 4 of 26 direct care staff and 6 of 11 youth were also interviewed. The Plan of Operation including policies and procedure were reviewed. A copy of this report was discussed and provided to Jordan Gonzales, Supervising Mental Health Clinician.


summary: Facility Evaluation

raw_content:
Narrative:
On December 15, 2021 at 9: AM Licensing Program Analysts (LPA) Isabel Mendoza made an unannounced annual/required visit. LPA met with Victoria Valencia, and Jordan Gonzales. The facility currently has 10 clients in care. At 9: AM LPA toured the facility inside and out and found the facility to be safe, clean and in good repair. All passageways are unobstructed. All smoke detectors are in working order. There are no firearms on the property. The fire extinguisher has been checked and is up to date. There are no bodies of water on the property. The facility is maintained at a comfortable temperature at 69 degrees. LPA recorded water temperature at 109 degrees. LPA inspected the medication storage and administration records and observed that the logs were complete and matched the stored medications. LPA left a copy of LIC A and B to ensure the facility includes all required items on their MARs. At 10: AM LPA Mendoza reviewed all 10 client files, and each file was complete. LPA reviewed 10 staff files and all files were complete and has all required items and training. LPA Mendoza requested the facility to start filing all training materials that is through Relias/online portal. LPA Mendoza was unable to interview staff and clients during todays inspection. No deficiencies cited during todays inspection. The facility received one technical advisory notes. Exit interview was conducted and a copy of the report was left with the facility.

met_with: Victoria Valencia and Jordan Gonzales


summary: Facility Evaluation

raw_content:
Narrative:
On March 10, 2022 at 8: AM Licensing Program Analyst (LPA) Isabel Mendoza conducted an unannounced case management inspection. LPA Mendoza met with Administrator, Karrie Stafford. The purpose of the inspection was to gather additional information regarding 2/26/22 incident report that was submitted to Community Care Licensing (CCL) on 3/3/22. On 2/26/22 five clients (Client 1- Client 5, please refer to LIC 811, dated 3/10/22 for confidential names) awoled from the facility. On 2/28/22 (C2) jumped out of a moving vehicle, and was taken to the hospital. During inspection, LPA interviewed staff members, clients, and received copies of all five clients Needs and Service Plans. There was a total of four staff members on shift, and all five clients left within minutes of each other. One exited the front gate (C5), and the rest jumped a fence and exited from the facilities side door. Staff immediately intervened and two staff (S1) and (S2) tried to follow the clients by foot and by car, but were unsuccessful. All four clients ran in different directions. The facility was within client/staff ratio and followed all AWOL policies and immediately contacted law enforcement. All five clients decided to awol, but only two (C2) and (C4) stayed together. Both clients ended up in an unsafe situation, which resulted in (C2) jumping out of a moving car and (C4) running out of the car, and two unidentified adults getting arrested. Both clients returned on 2/28/22 and the facility observed (C2)'s injuries and immediately was taken to the emergency. All five clients have returned to the facility or are back with their authorized representative. LPA is requesting the facility to submit a follow-up incident report regarding (C2) and (C4). The facility agrees to submit the follow-up to LPA Mendoza by Tuesday 3/15/22. An exit interview was conducted and no deficiencies cited during today's inspection. A copy of the report was left with the Administrator.

met_with: Administrator, Karrie Stafford


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Selena Hood and LPA Lisa Schlembach on 9/7/2022 at 10:15AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA Hood and LPA Schlembach met with Mikey Vicedo, Medical Office Specialist and Christina Bolanos, Medical Steward, and inspected the facility inside and out. The facility currently has seven clients, six of the clients are on psychotropic medications. Facility staff reported that the six clients on psychotropic medications are not foster care youth. LPAs reviewed six of the client files to ensure that the admissions agreements and the parental consent agreements were consistent with this. LPAs did not review client files further or interview clients because the clients present were not foster care youth. LPA reviewed ten of staff personnel files on site at the facility. LPA reviewed the centrally stored medication log including the Medication Administration Record and Psychotropic Medication Administration Record for six clients. LPA interviewed four staff members on site to discuss the facilities policies and procedures of operation. LPA provided a copy of this licensing report to Victoria Valenzia, Head of Service, via email. No deficiencies are being cited at this time. LPA conducted exit interview with Victoria Valenzia, Head of Service, at 2:30PM whose signature confirms the receipt of this document.

met_with: Christina Bolanos


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Britanee Windom and Dung Mac conducted a case management inspection on 5/25/2023 at 11: AM based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. During this inspection, 5 out of Direct Care Staff and 5 out of 11 youth files were reviewed. 3 out of Direct Care Staff and 3 out of 11 youth were interviewed. (See the Confidential Names List, LIC 811, 5/25/2023). The Plan of Operation including policies and procedures were reviewed. Quality Improvement Committee related to the facility's incidents involving contact with law enforcement were reviewed. Based on the analysis of the confidential interviews and youth file review including the needs and service assessments, youth's safety plans, crisis intervention plans, the licensee uses trauma-informed and evidence-based de-escalation and intervention techniques when staff is responding to the behavior of a youth residing in the facility. Interviews with youth and staff indicate the licensee prohibits calls or threats to call law enforcement as a form of discipline. LPAs observed documentation of completed training on policies and procedures on when and how to involve law enforcement in response to an incident. Training records show staff have been trained on Emergency Intervention as required. The licensee is contacting law enforcement in accordance to their Emergency Intervention Plan when there is an immediate risk of serious harm to a child or others. There are no deficiencies cited at this time. A copy of this report was discussed and provided to Laketha Rodriguez, Supervising Mental Health Clinician.

met_with: Laketha Rodriguez


summary: Facility Evaluation

raw_content:
Narrative:
On 8/15/2023, at 11:30AM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced Psychotropic Medication Inspection to the listed facility. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA Hood met with Ana Garcia, Medical Steward. The facility currently has eight clients. Of the eight clients, one client meets the criteria of a foster youth currently prescribed psychotropic medications. LPAs reviewed one client file and five staff files. LPA did not conduct any interviews because the one foster youth in care is on an extended unauthorized absence. LPA reviewed the centrally stored medication log including the Medication Administration Record and Psychotropic Medication Administration Record for all clients, and the previous files for one client. LPA observed Ana Garcia, Medical Steward, conduct the medication count. LPA interviewed two staff members on site to discuss the facility's policies and procedures of operation. No deficiencies are being cited at this time. LPA conducted exit interview with Ana Garcia, Medical Steward, at 2:00PM whose signature confirms the receipt of this document.

met_with: Ana Pereira Garcia


summary: Facility Evaluation

raw_content:
Narrative:
On 12/20/23 at 10AM Licensing Program Analyst (LPA) Celeste Aparicio made an unannounced annual inspection to facility. LPA met with Administrator, Victoria Valencia. Later in the inspection, Administrator Laketha Parker-Rodriguez joined in. The facility is licensed to serve a capacity of 12 clients, prefer ages 12-17 years old and also NMDs. The current census is 9 ambulatory clients, and NMD in who will be leaving that facility in January. The purpose of this inspection was to comply with a regulatory requirement for a yearly required inspection. LPA toured the facility inside and out and found the facility to be safe, clean, and in good repair. All outdoor play fixtures were secured to the ground unless portable by design. All passageways are unobstructed. All smoke detectors are in working order. There are no firearms on the property. There are no bodies of water on the property. The facility is maintained at a comfortable temperature with multiple thermostats installed around the building. LPA recorded water temperature at 107.2 degrees, which is within regulation. LPA inspected the medication storage and administration records and observed that the logs were complete and matched the stored medications. LPA Aparicio reviewed 4 staff files and observed (4) expired Pro- Act training certificates LPA brought this up to Administrator, Laketha Parker-Rodriguez, and the facility completed and provided those missing items. All staff have background clearances and are listed on facility roster. LPA reviewed 4 residents' files and observed them to contain all necessary documentation. During inspection, LPA obtained a copy of Administrators certificate and emergency intervention plan. LPA interviewed three staff and 1 client. Other clients were unavailable on an outing or declined to interview. No deficiencies nor advisories were cited during todays inspection. An exit interview was conducted with Laketha Parker-Rodriguez and a copy of the report was left with the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 12/16/25, Licensing Program Analyst (LPA) Mariah Hawkins conducted a random annual/2yr inspection. LPA met with Mental Health Program Specialist Christina Bolanos and informed of the purpose of the visit. LPA initiated the inspection and conducted confidential staff and client interviews. LPA observed the facility to be clean and well-maintained, to offer indoor and outdoor activity spaces, and to have supply of crafts, games, books, and outdoor equipment. The menu is posted, the kitchen is clean, and there is a large supply of properly stored food. The bathrooms are sanitary. There is a mix of single and double-occupancy bedrooms as well as two classrooms, therapy rooms, meeting room, a chart room where first aid supplies and medications are stored, and staff offices. Personal rights and grievance procedures are posted in the facility. Using the CARE Inspection Tool, no deficiencies were observed or identified in interviews. LPA obtained a current LIC 500, LIC 610C, and a client roster. A continuation visit will be conducted on a later date to complete this inspection. An exit interview was conducted, and a copy of this report was provided to Mental Health Program Specialist.

met_with: Christina Bolanos, Mental Health Program Specialist


summary: Facility Evaluation

raw_content:
Narrative:
On 8/12/22 at 1: PM, Licensing Program Analysts (LPA) Alyssa Ng and George Karkazis conducted an unannounced case management inspection with Canyon Oaks and spoke with Victoria Valencia, Administrator. The purpose of the inspection was to follow up on a staff member calling clients inappropriate names and making them feel uncomfortable. During confidential interviews, clients and staff stated that a staff member would call them "Baby girl", "King" or "Queen". LPA Ng mentioned to Victoria Valencia, Administrator that nicknames can bring up trauma and that staff members should be cautious when speaking to clients. Facility cited for violation of California Code of Regulations, Title 22, Division Six, Section 80072(1) Personal Rights. An exit interview was conducted, appeal rights provided, and given to Victoria Valencia, Administrator.


raw_content:
Narrative:
Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations, "Staff are not providing adequate supervision at night," "Staff retaliate against youth that report concerns," "Staff apply disciplinary actions inconsistently based on the race of the youth," "Staff are operating outside the approved program statement," and "Staff did not accord child dignity in their relationship with staff or other person" are unsubstantiated. At the time of this inspection, no Title 22 deficiencies were observed regarding these allegations. An exit interview was conducted, and a copy of this report was provided to Victoria Valencia, Administrator whose signature below confirms receipt.

Investigation Findings:
13On March 25, 2026, at 10: AM, Licensing Program Analysts (LPAs) Amee Li and Simran Nayyar made an unannounced visit to the above-listed facility with the purpose of delivering complaint findings for the above allegations. LPAs met with Victoria Valencia, Administrator and explained the purpose of the visit. LPAs conducted a facility walkthrough. At the time of the inspection, there were four clients in care and four clients present. During the complaint investigation, LPA Li conducted confidential staff and client interviews and reviewed facility compliance history, plan of operation, positive discipline policy, staff shift reports, client grievance forms, grievance resolutions, and incident reports. Based on confidential interviews and record review, the details of the allegations are unsupported. (Continued on LIC 9099C.) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kristin Pierotti LICENSING EVALUATOR NAME: Amee Li LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO RO, TRAEGER AVE., SUITE FACILITY NAME: CANYON OAKS YOUTH CENTERFACILITY NUMBER: VISIT DATE: 03/25/2026

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

met_with: Victoria Valencia, Administrator


facility_name: CASA DE AMPARO

raw_content:
Narrative:
Based on interviews and record reviews the allegation that facility staff did not prevent C1 from multiple awol's, may have occurred, however is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. Appeal rights explained, and a copy of this report was emailed to Erin Gospodarec for signature. Original signature on file.

Investigation Findings:
13On May 13, 2021 at 2:00 pm, Licensing Program Analyst (LPA) Darlene Almaraz-Oseguera conducted a tele-inspection due to COVID 19. LPA contacted Erin Gospodarec to discuss the investigative findings for the allegation listed above. LPA Nicole Strickland conducted a tele-inspection on January 22, 2021 at 10:12 am. Three of three children, four staff, county social worker and program director were interviewed. It was reported to Community Care Licensing (CCL) that facility staff did not prevent client #1 (C1) from multiple awol's (absent without leave). Confidential staff interviews reported that C1 has awoled from the facility numerous times and staff has verbally redirected C1. Confidential staff interviews reported that staff will follow C1 and verbally counsel C1 but C1 will often ignore staff's directives. Additional interviews reported that when C1 returns to the facility after being awol, C1 will receive consequences and supervision will be increased. LPA was not provided any other specific details or decisive information regarding the alleged allegation that would confirm whether or not the allegation occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Darlene Almaraz 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: CASA DE AMPAROFACILITY NUMBER: VISIT DATE: 05/13/2021

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

met_with: Erin Gospodarec


raw_content:
Narrative:
Based on interviews and record reviews the allegation that due to lack of supervision C1 choked C2, may have occurred, however is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. Appeal rights explained, and a copy of this report was emailed to Erin Gospodarec for signature. Original signature on file.

Investigation Findings:
13On June 7, 2021 at 2:00 pm, Licensing Program Analyst (LPA) Darlene Almaraz-Oseguera conducted a tele-inspection due to COVID 19. LPA contacted Erin Gospodarec to discuss the investigative findings for the allegation listed above. LPA Nicole Strickland conducted a tele-inspection on January 26, 2021 at 03:08 pm. Three of three children (C1, C2, C3) four staff, county social worker and program director were interviewed. It was reported to Community Care Licensing (CCL) that due to lack of supervision C1 choked C2. Confidential staff interviews reported that C1 and C2 were in the bathroom with the door open trying on hair wigs. Confidential staff interviews reported that once staff became aware of the incident, C1 went absent without leave (awol) from the facility. Additional staff interviews reported that when C1 returned to the facility C1's supervision was increased. Confidential interviews reported that C1 was kidding/playing around and did not choke C2 but it appeared as if C1 did choke C2. LPA was not provided any other specific details or decisive information regarding the alleged allegation that would confirm whether or not the allegation occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Darlene Almaraz 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: CASA DE AMPAROFACILITY NUMBER: VISIT DATE: 06/07/2021

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


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Confidential interviews reported that when C1 was placed at the facility C1 did not have a cell phone but had access to a phone in the cottages. S1 and LPA made several attempts to interview C1 but C1 refused to be interviewed. The interviews that were provided to the LPA were not consistent and did not provide any further specific details regarding all of the alleged allegations listed above. Based on interviews and record reviews the allegations that S1 engaged in an inappropriate relationship with C1, staff made inappropriate comments and did not treat C1 with respect and staff denied C1 access to the phone, may have occurred, however is not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Erin Gospodarec.

Investigation Findings:
13On October 22, 2021 at 10:00 am, Licensing Program Analyst (LPA) Darlene Almaraz-Oseguera conducted an inspection at the facility and met with Erin Gospodarec. Special Investigator (SI) Annette Renquist of the Community Care Licensing Investigative Bureau completed the investigation. LPA Ann Valenzuela toured the facility on March 18, 2021 at 1:00 pm and reviewed all of the client files and facility files. Three of four clients, county social workers, three facility staff (S1, S2, S3) and facility administrator were interviewed. It was reported to Community Care Licensing (CCL) that S1 engaged in an inappropriate relationship with C1, staff made inappropriate comments and did not treat C1 with respect and staff denied C1 access to the phone. Confidential staff interviews reported that once C1 was discharged from the facility C1 contacted S1 with the encouragement of C1's social worker but S1 was not communicating effectively with S1's supervisor. Additional confidential interviews reported that no inappropriate boundaries were crossed between C1 and S1. Additional confidential interviews reported that staff did use correct pronouns when addressing C1. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Darlene Almaraz 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: CASA DE AMPAROFACILITY NUMBER: VISIT DATE: 10/22/2021


raw_content:
Narrative:
Confidential interviews revealed that the facility had a ratio of one staff to eight clients for the period of one and a half hours, however, was the first time they have witnessed this ratio. Other Confidential interviews revealed that the facility is staffed per the facility program statement. Confidential interviews could not confirm or dispute that the facility is out of ratio. Based on interviews conducted and evidence gathered during the investigation, the allegation that the facility is out of ratio may have occurred, however is not supported, or proven by evidence. Therefore, the allegations are unsubstantiated at this time. A copy of this report, LIC 811, and appeal rights were reviewed and explained to Director Erin Gospodarec.

Investigation Findings:
13On 12/09/21 at 11: AM, Licensing Program Analyst (LPA) Danielle Garcia, met with Director, Erin Gospodarec to deliver the findings regarding the allegation as stated above. During the investigation, Licensing Program Analyst (LPA) Danielle Garcia was able to interview two residents (C1 and C2), five staff (S1, S2, S3, S4, S5), and record review of facility documents (Staff Contact lists, Facility Program Statement, Personnel List (LIC 500) both clients face sheets and needs and services plans). On 09/23/21, Community Care Licensing received the allegation that the facility is out of ratio. Confidential interviews revealed that staff and clients stated the facility is understaffed during transports of clients or dealing with crises. Confidential interviews revealed conflicting statements of the facility working out of ratio. ***continued on page 2*** UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Danielle Garcia 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, METROPOLITAN DR. # FACILITY NAME: CASA DE AMPAROFACILITY NUMBER: VISIT DATE: 12/09/2021

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


raw_content:
Narrative:
Confidential interviews also revealed that Psychiatric Emergency Response Team (PERT) was contacted to evaluate the client during the crisis, as well as the on call therapist. Confidential interviews revealed that when PERT arrived the one client became escalated. Other confidential interviews have conflicting statements whether the client was taken to the hospital for further evaluation the day of the incident. Confidential interviews revealed that staff notifies the school of the client, the day after a crisis, but did not for this incident. Review of the program statement did not reveal notifying the clients school as a required protocol. Confidential interviews could not confirm or dispute that staff did not prevent a minor from self harming while in care and that staff did not properly report an incident involving a minor. Based on interviews conducted and evidence gathered during the investigation, the allegations that staff did not prevent a minor from self harming while in care and staff did not properly report an incident involving a minor may have occurred, however is not supported, or proven by evidence. Therefore, the allegations are unsubstantiated at this time. A copy of this report, LIC 811, and appeal rights were reviewed and explained to Director Erin Gospodarec.

Investigation Findings:
On 12/09/2021 at 10: PM, Licensing Program Analyst (LPA) Danielle Garcia, met with Director, Erin Gospodarec to deliver the findings regarding the allegations as stated above. During the investigation, Licensing Program Analyst (LPA) Danielle Garcia was able to interview four residents (C1, C2, C3, C4), four staff (S1, S2, S3, S4), and record review of facility documents (Special Incident Reports, Staff Contact lists, all clients face sheets and needs and services plans). On 09/14/2021, Community Care Licensing received allegations that staff did not prevent a minor from self harming while in care and staff did not properly report an incident involving a minor. Confidential interviews revealed no clients were injured due to self harm; however, one client may have received bruises and cuts from restraints, but interviews gave conflicting statements. ***continued on page 2*** UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Danielle Garcia 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, METROPOLITAN DR. # FACILITY NAME: CASA DE AMPAROFACILITY NUMBER: VISIT DATE: 12/09/2021

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


raw_content:
Narrative:
by counseling them on the dangers and consequences of their actions, as well as by providing them alternatives. According to confidential interviews, staff cannot physically prevent clients from leaving, but will physically follow them as much as possible once outside of the facility, as well as file a missing person's report with local police. Confidential interviews also denied that there is a lack of supervision which results in clients assaulting other clients. According to confidential information, staff try and de-escalate clients whenever there is tension, and although staff cannot always immediately physically intervene due to sometimes requiring a need for additional backup, staff will always intervene during physical confrontations between clients. While other confidential information received by Licensing Office stated that allegations had occurred, and that staff do not always do enough to intervene whenever clients attempt to AWOL, despite knowing that clients will very likely engage in underage sex and or drug use. Other confidential information received by Licensing Office also stated that staff do not always intervene whenever clients are engaged in physical altercations, nor provide adequate supervision to prevent it. Based on confidential interviews and information obtained, the allegations that staff are advised to allow minors to engage in inappropriate activities, as well as a lack of supervision resulting in minors assaulting other minors in care, may have occurred, however they are not supported or proven by evidence. Therefore, the above allegations are unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided

Investigation Findings:
13LPA Mena met with Residential Administrative Support Manager, Stephanie Donnellan to discuss the investigative findings for the above stated allegations. An investigation was conducted by LPAs Carol Anderson and Daniel Mena regarding allegations. LPAs Anderson and Mena conducted an inspection to the Short Term Residential Therapeutic Program (STRTP) on May 26, 2021 at 12:00pm and on November 22, 2021 at 12:32pm. No immediate hazards observed. LPAs interviewed four staff (S1, S2, S3 & S4), four foster children (C1, C2, C3 & C4), as well as reviewed client and facility records. Community Care Licensing received information on May 20, 2021 alleging that staff are advised to allow minors to engage in inappropriate activities, as well as a lack of supervision resulting in minors assaulting other minors in care. Information obtained did not corroborate the allegations with a preponderance of evidence. Confidential interviews denied allegations that staff do not do enough to prevent clients from AWOLing (absence without official leave) and engaging in inappropriate activities. According to confidential interviews, staff always try and prevent and dissuade clients from AWOLing UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Daniel Mena 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: CASA DE AMPAROFACILITY NUMBER: VISIT DATE: 01/07/2022

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

met_with: Stephanie Donnellan


raw_content:
Narrative:
and dissuade clients from AWOLing by counseling them on the dangers and consequences of their actions, as well as by providing them alternatives. According to confidential interviews, staff cannot physically prevent clients from leaving, but will physically follow them as much as possible once outside of the facility, as well as file a missing person's report with local police. Confidential interviews also stated that whenever children return from an AWOL, they are assessed and offered medical care if they feel it is necessary or if the child requests it. According to confidential interviews, children are not immediately taken to the hospital to seek medical attention simply for coming back intoxicated. While other confidential information received by Licensing Office stated that allegations had occurred, and that staff do not always do enough to intervene whenever clients attempt to AWOL, despite knowing that clients will engage in dangerous behaviors. Confidential information received by Licensing Office also stated that Child # 1 should have been taken to seek medical care by staff after returning to facility intoxicated, due to their young age. Based on confidential interviews and information obtained, the allegations that staff did not prevent children from AWOLing (absence without official leave), as well as did not seek medical attention for children, more specifically that staff did not take C1 to the hospital after having consumed alcohol while on AWOL, may have occurred, however is not supported or proven by evidence. Therefore, the above allegations are unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided

Investigation Findings:
13LPA Mena met with Residential Administrative Support Manager, Stephanie Donnellan to discuss the investigative findings for the above stated allegations. An investigation was conducted by LPAs Carol Anderson and Daniel Mena regarding allegations. LPAs Anderson and Mena conducted an inspection to the Short Term Residential Therapeutic Program (STRTP) on June 07, 2021 at 12:12pm and on November 22, 2021 at 12:32pm. No immediate hazards observed. LPAs interviewed four staff (S1, S2, S3 & S4), five foster children (C1, C2, C3, C4 & C5), as well as reviewed client and facility records. Community Care Licensing received information on May 27, 2021 alleging that staff did not prevent children from AWOLing (absence without official leave), as well as did not seek medical attention for children, more specifically that staff did not take C1 to the hospital after having consumed alcohol while on AWOL. Information obtained did not corroborate the allegations with a preponderance of evidence. Confidential interviews denied allegations that staff do not take enough action to prevent clients from AWOLing. According to confidential interviews, staff always try and prevent UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Daniel Mena 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: CASA DE AMPAROFACILITY NUMBER: VISIT DATE: 02/03/2022

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


raw_content:
Narrative:
immediately intervene in order to dissuade clients from engaging in behavior and to convince them relinquish the contraband voluntarily. Confidential interviews also stated that staff cannot always immediately intervene in order to physically remove the alcohol from the client, in fear of getting into a power struggle or escalating the situation while the client is in the possession of a glass bottle(s). Confidential interviews stated that clients are always under the supervision of the staff and that staff will confiscate the alcohol as soon as possible, this depending on each situation, number clients involved, and staffing. While other confidential information received by Licensing Office stated that allegations had occurred, and that staff allowed Child #1 (C1) to consume alcohol, despite knowing that C1 was in the possession of it after returning from an AWOL. LPA received inconsistent information regarding the allegation. Based on confidential interviews and information obtained, the allegations that allowed minors to consume alcohol, may have occurred, however is not supported or proven by evidence. Therefore, the above allegation is unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided

Investigation Findings:
13LPA Mena met with Residential Administrative Support Manager, Stephanie Donnellan to discuss the investigative findings for the above stated allegation. An investigation was conducted by LPAs Carol Anderson and Daniel Mena regarding allegation. LPAs Anderson and Mena conducted an inspection to the Short Term Residential Therapeutic Program (STRTP) on June 14, 2021 at 10:37am and on November 22, 2021. No immediate hazards observed. LPAs interviewed four staff (S1, S2, S3 & S4), five foster children (C1, C2, C3, C4 & C5), as well as reviewed client and facility records. Community Care Licensing received information on June 07, 2021 alleging that staff allowed minors to consume alcohol. Information obtained did not corroborate the allegations with a preponderance of evidence. Confidential interviews denied allegations that staff allow clients to consume alcohol. According to confidential interviews, staff do as much as possible in order to prevent clients from bringing in alcohol to the facility after an AWOL (absence without official leave). According to confidential interviews, whenever a client is consuming alcohol at the facility and staff become aware, staff will UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Daniel Mena 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: CASA DE AMPAROFACILITY NUMBER: VISIT DATE: 02/03/2022

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

met_with: Stephannie Donnellan


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
Based on confidential interviews and LPA observation the preponderance of evidence standard has been met regarding the allegation that the exterior gates at the facility are locked and clients are not allowed to exit the ground. This poses a potential Health, Safety, or Personal Rights risk to the children in care; therefore, the above allegation is substantiated. The facility will be cited for violating California STRTP ILS (version 4) section 84072(c)(14) Personal Rights. An exit interview was conducted, and a copy of this report and appeal rights were left with the agency representative.

Investigation Findings:
13On March 18, 2022, at 10: AM, Licensing Program Analyst (LPA) Carol Anderson made an unannounced inspection of the facility to deliver findings for the above allegation. LPA met with Residential Administrative Support Manage Stephanie Donnellan. During the complaint investigation, LPA interviewed two of two staff. LPA observed the facility gates on the premises as locked. The Department received a complaint on November 2, 2021, alleging that exterior gates on facility premises are locked not allowing minors access. Confidential interviews revealed that the exterior gates on the facility have been locked since initial licensed on 4/27/2012. On November 9, 2021, during a complaint investigation, LPA observed the facility's exterior gates as locked, preventing clients from exiting the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Carol Anderson 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, METROPOLITAN DR. # FACILITY NAME: CASA DE AMPAROFACILITY NUMBER: VISIT DATE: 03/18/2022

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

complaint_status: SUBSTANTIATED


raw_content:
Narrative:
Based on interviews and record reviews the allegations that staff did not prevent C1 from self-harming on several occasions, staff are not providing adequate supervision to the clients and staff is out of ratio, may have occurred, however is not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, appeal rights explained and a copy of this report was provided to Erin Gospodarec.

Investigation Findings:
13On May 6, 2022 at 9:30 am, Licensing Program Analyst (LPA) Darlene Almaraz-Oseguera conducted an unannounced inspection to the facility to deliver the findings of the above allegations. LPA met with Erin Gospodarec. LPA Carol Anderson conducted an inspection at the facility on May 26, 2021 at 1:03 pm and no immediate deficiencies were observed. Four of four children (C1, C2, C3, C4), four staff and facility administrator were interviewed. It was reported to Community Care Licensing (CCL) that staff did not prevent C1 from self-harming on several occasions, staff are not providing adequate supervision to the clients and staff is out of ratio. Confidential staff interviews reported that C1 does have a history of self-harming and staff does provide adequate supervision. Confidential staff interviews reported that staff C1 has self-harmed while at school and not at the facility. Confidential staff interviews reported that the facility is not out of ratio and there are plenty of floating staff around the facility. The interviews that were provided to the LPA were not consistent and did not provide any specific details regarding lack of supervision and facility being out of ratio. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Darlene Almaraz 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: CASA DE AMPAROFACILITY NUMBER: VISIT DATE: 04/27/2022

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


raw_content:
Narrative:
Confidential interviews revealed that C1 and C2 had obtained alcohol and had stashed alcohol outside the perimeter fence line of the facility hiding it in the bushes prior to staff finding the alcohol. Confidential interviews revealed that C1 and C2 admitted to drinking at least half of the bottle, and C1 and C2 became drunk and engaged in inappropriate sexual behavior with each other. Confidential interviews revealed staff verbally engaged with C1 and C2 attempting to redirect them, the facility switched out the staff for over four hours until C1 and C2 fell asleep. There were no witnesses to dispute or support the allegations. Based on confidential interviews and information gathered during the investigation. Although the allegations may have occurred, however not supported or proven by evidence. Therefore, the above allegations are unsubstantiated. Exit interview was conducted a copy of this report and appeal rights were left with Erin Gospodarec Associated Executive Program Operations.

Investigation Findings:
13On June 29, 2022, at 10:06AM, Licensing Program Analyst (LPA), Carol Anderson met with Erin Gospodarec Associated Executive Program Operations to deliver findings of the above allegations. The investigation was conducted by Senior Special Investigator Annette Renquist of the Community Care Licensing (CCL) Investigations Branch. Special Investigator Annette Renquist interviewed seven staff (S1 - S7), two clients (C1, C2) and one San Diego County Social Worker (CSW).The investigation included a review of San Diego Sheriff's Department investigative reports, C1 and C2's Appraisal/Needs and Services Plans, as well as reviewed the Special Incident Report. On April 28, 2022, the Community Care Licensing Children's Residential Program San Diego received a complaint alleging that due to a lack of supervision minors engaged in sexual interactions while in care, due to a lack of supervision minors drank alcohol while in care, and staff did not adequately supervise minors in care. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Carol Anderson 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, METROPOLITAN DR. # FACILITY NAME: CASA DE AMPAROFACILITY NUMBER: VISIT DATE: 06/29/2022

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


raw_content:
Narrative:
laundry in their bedroom for five minutes. Confidential interviews reported that staff returned to C2's bedroom after five minutes and prompted C1 to exit C2's bedroom and C1 exited the bedroom. Confidential interviews revealed that C1 and C2 did not get along and often argued with each other. Confidential interviews revealed that C1 made comments about wanting C2 to get kicked out of the cottage and placed on probation. Conflicting confidential interviews revealed that C1 touched C2's upper body area while in C2's bedroom and C2 told C1 to stop. Conflicting interviews revealed that C1 kissed and touched C2 in C2's bedroom and the clients were in the bedroom for ten to fifteen minutes alone before C1 exited C2's bedroom. Although the allegation that C1 and C2 engaged in inappropriate interactions while in care may or may not have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. A copy of this report was provided to and reviewed with Stephanie Donnallen, Residential Administrative Support Manager, along with the appeal right and the LIC 811. A signed copy of the report will be kept in the Facility file.

Investigation Findings:
13On July 1, 2022 at 3:46 pm, Licensing Program Analyst (LPA) Charmaine Linley made an unannounced complaint inspection at the facility. LPA Linley met with Stephanie Donnallen, Residential Administrative Support Manager, to discuss and deliver the investigative findings for the allegation noted above. LPA Linley conducted an unannounced inspection of the facility on 06/10/22. LPA Carol Anderson conducted an unannounced inspection of the facility on 07/19/21. No deficiencies were cited. During the investigation, LPA Linley interviewed one client (C1), one client (C2) was not available to be interviewed, six staff (S1-S6) one staff (S7) was not available to be interviewed, one Juvenile Probation Officer (JPO1), and one County Social Worker (CSW1) were not available to be interviewed (see confidential name list, LIC 811, dated 07/01/2022). On July 15, 2021, the Department received an allegation the youth engaged in inappropriate interactions while in care. The report alleged that C1 later reported they had been touched by C2 on their upper body and lower private parts. Confidential interviews reported that staff gave C1 permission to help C2 fold UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: CASA DE AMPAROFACILITY NUMBER: VISIT DATE: 07/01/2022

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


raw_content:
Narrative:
Contract. On July 21, 2021, Community Care Licensing received an allegation that residents sneak sharp objects into the facility and residents sneak alcohol into the facility. It was reported that C1 left the facility with a group of clients and was found by Law Enforcement breaking windows in the community and C1 cut their arm from wrist to elbow with a razor. Confidential interviews reported the staff checked clients' belongings upon return to the facility; however, clients hid sharp objects and alcohol from staff. Confidential interviews revealed that C1 and C2 would hide sharp objects and alcohol around the perimeter to retrieve at a later time. Conflicting interviews revealed that backpacks have not been searched thoroughly and alcohol and razors and other sharp objects that C1 and C2 had stolen from the store had been brought in through backpacks. Based on interviews that C1 and C2 sneak sharp objects into the facility and residents sneak alcohol into the facility, which may or may not have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Stephanie Donnallen, Residential Administrative Support Manager. A copy of this report will be placed in the facility file.

Investigation Findings:
UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: CASA DE AMPAROFACILITY NUMBER: VISIT DATE: 07/01/2022

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


raw_content:
Narrative:
supervision to minors while in care and staff do not have appropriate living arrangements for the minors. It was reported that C1 used a rock and broke several of the electronic fob sensors, which restricted access to the administrative building, as well as the gates to the facility. It was reported that staff did not know when the broken locks would be replaced, which posed internal and external security issues, along with a fire risk if staff or youth could not use some of the doors or exits. It was reported that C1 and C2 ran away from the facility frequently and C1 is rooming in the same bedroom as C2. It was reported that staff said they could not stop them from rooming together. Confidential interviews revealed conflicting statements regarding the fobs to the exits; confidential interviews revealed that C1 and C2 broke the fob sensors that controlled the entrance gates at four different locations on the campus, and the gate by the parking lot and second set of stairs had a fob sensor that was not broken, in which the gate door allowed access for staff and clients to enter and exit the facility. Other Confidential interviews revealed that all five fob sensors were broken which limited all access. Regarding the allegation that staff did not have appropriate living arrangements for the minors, confidential interviews revealed that C1 and C2 were in a dating relationship and C2 moved into C1's bedroom without permission for several months. Confidential interviews revealed that when C2 moved into C1's bedroom, staff tried to have two staff supervising the clients when they were in the bedroom. In addition, interviews revealed that staff offered incentives, such as going on outings, getting fast food, or getting back on their level in the program if C1 returned to their cottage. However, confidential interviews revealed staff asked clients to sleep out in the living room where staff could supervise them from the staff office. Based on interviews the staff did not provide adequate supervision to C1 and C2 while in care and staff did not have appropriate living arrangements for C1 and C2, which may or may not have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Stephanie Donnallen, Residential Administrative Support Manager. A copy of this report will be placed in the facility file.

Investigation Findings:
UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: CASA DE AMPAROFACILITY NUMBER: VISIT DATE: 07/01/2022

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


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timely manner in an altercation between minors. It was reported that there was a total of three separate confrontations before the fight and staff could have separated the residents sooner. Confidential interviews revealed conflicting statements regarding the physical altercation, some interviews indicate C1 and C3 tried to fight C2 and that other clients started to get involved in the physical altercation and staff told them to stop and escorted the other clients away from the physical altercation. Other interviews indicated that C2 walked up to C1 and hit C1, and staff guided the clients away and told the clients to stop while redirecting the other clients. Additional confidential interviews revealed that C3 kicked C1 and C2 was not involved, and staff tried to deflect another client's hands away during the altercation. Some interviews indicated that C1 was placed in a restraint while other interviews had no recollection of C1 being placed in a restraint. Records reviewed also had conflicting accounts of the events. Based on confidential interviews and records reviewed the staff did not intervene in a timely manner in an altercation between C1, C2, and C3, which may or may not have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, a copy of this report, and the LIC 811 was provided to Stephanie Donnallen, Residential Administrative Support Manager. A copy of this report will be placed in the facility file.

Investigation Findings:
13On July 7, 2022, at 10:15 am, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced to the facility and met with Stephanie Donnallen, Residential Administrative Support Manager, of Casa de Amparo to discuss the investigative findings for the allegation listed above. LPA Carol Anderson conducted an inspection of the facility on 08/27/2021 at 10:04 am. No deficiencies were observed. LPA Linley conducted an inspection of the facility on 06/10/2022 at 1:30 pm. No deficiencies were observed. During the investigation, LPA Linley interviewed three out of six clients (C3, C4, C5), (C1, C2, C6) were unable to be interviewed, and three out of seven staff (S1, S3, S5) (S2, S4, S6, S7) were unable to be interviewed, and one out of three County Authorized Representatives was interviewed (CPO1) and (CSW1-2) were unable to be interviewed (See LIC 811 for confidential names). LPA Linley also reviewed the following documents: Staff Roster, Staff phone contact list, Cottage Rosters, San Marcos Sheriff's Department Incident Reports, and Special Incident Report, dated 08/17/2021. On August 19, 2021, Community Care Licensing received an allegation that staff did not intervene in a UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: CASA DE AMPAROFACILITY NUMBER: VISIT DATE: 07/07/2022

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


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by a staff who grabbed the inside of their thigh causing bruises and was restrained again by another staff who grabbed both of their arms causing bruising. Confidential interviews revealed conflicting statements. Confidential interviews revealed that staff restrained C1's arm and a leg to prevent the youth from harming themself, and that staff did not restrain C1 but used their body and blocked the stairway to prevent youth from harming themself. In regard to the bruises on C1, confidential interviews revealed that C1 had bruising on their inner thighs. Conflicting interviews revealed that C1 had bruises under their armpit and shoulder area. Other conflicting interviews revealed that C1 had bruises already on their arms while they were restrained. Based on interviews, the facility staff inappropriately restrained minor resulting in C1 sustaining bruises, which may or may not have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, a copy of this report, and the LIC 811 was provided to Stephanie Donnallen, Residential Administrative Support Manager. A copy of this report will be placed in the facility file.

Investigation Findings:
13On July 7, 2022, at 10:46 am, Licensing Program Analyst (LPA) Charmaine Linley arrived unannounced to the facility and met with Stephanie Donnallen, Residential Administrative Support Manager, of Casa de Amparo to discuss the investigative findings for the allegation listed above. LPA Carol Anderson conducted an inspection of the facility on 08/27/2021 at 11:07 am. No deficiencies were observed. LPA Linley conducted an inspection of the facility on 06/10/2022 at 1:30 pm. No deficiencies were observed. During the investigation, LPA Linley interviewed one out of one client (C1), eight out of ten staff (S1-S4, S7-S10), two staff were unable to be interviewed (S5, S6), and one out of one County Social Worker (CSW1) (See LIC 811 for confidential names). LPA Linley also reviewed the following documents: Staff Roster, Staff phone contact list, Cottage Rosters, Sheriff's Department Incident Reports, and Special Incident Reports. On August 23, 2021, Community Care Licensing received an allegation that facility staff inappropriately restrained minor resulting in the minor sustaining bruises. It was reported that the minor was restrained UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: CASA DE AMPAROFACILITY NUMBER: VISIT DATE: 07/07/2022

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


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Investigation Findings:
13On July 11, 2022, Licensing Program Analyst (LPA) Eduardo Barragan conducted a complaint inspection at Casa De Ampato and met with Stephanie Donnellan, Residential Admin Support Manager. The purpose of the inspection was to deliver the findings for the above complaint allegations. The Department has investigated the complaint alleging "Staff do not treat minor with dignity" and "Staff did not give minor Community Care Licensing phone number." LPA Barragan spoke with staff, clients and reviewed other predominant documents. Based on documents reviewed, an inspection, and conversations with staff and clients, all the information that was gathered was conflicting. "Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED." An exit interview was conducted with Stephanie Donnellan, Residential Admin Support Manager. A copy of this report and appeal rights were provided to Stephanie Donnellan, Residential Admin Support Manager. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Eduardo Barragan 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 3


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Confidential interviews revealed conflicting statements; C1 became upset at S2 and jumped the fence to go to the Cottage, staff was redirecting them and using crisis communication, and that staff was inside the cottage and it is unknown if any staff were outside monitoring C1. Confidential interviews report that once the door was repaired and fixed after C1 broke the door the first time, C1 broke the door again the same night. Confidential interviews reveal staff was redirecting C1 not to break the door while clients were telling C1 to break the door. Based on the interviews, the facility staff did not properly supervise C1, which may or may not have occurred, however, it is not supported or proven by the evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was discussed with Mike Barnett, CEO. Due to printer malfunction, a copy of this report will be emailed to the Facility Administrator. A copy of this report will be placed in the facility file.

Investigation Findings:
13On August 12, 2022, at 10:55 am, Licensing Program Analyst Charmaine Linley arrived unannounced to the facility and met with Mike Barnett, CEO, of Casa de Amparo to discuss the investigative finding for the allegation listed above. LPA Carol Anderson conducted an inspection of the facility on 10/13/2021 at 2:01 pm and no deficiencies were observed. During the investigation, LPA Linley interviewed one out of four clients (C1), (C2-C4) were unable to be interviewed, and four out of four staff (S1-S4). LPA Linley also reviewed the following documents: Special Incident Report for C1, dated 09/08/2021, Cottage Roster, and C Needs and Services Plan, dated 09/14/2021. On October 6, 2021, Community Care Licensing (CCL) received an allegation that facility staff is not properly supervising minors. More specifically, C1 was upset with a staff member and broke a glass door twice during the same night, due to lack of supervision. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Charmaine Linley 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: CASA DE AMPAROFACILITY NUMBER: VISIT DATE: 08/12/2022

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

met_with: Mike Barnett, CEO


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(C2). According to confidential information, S1 also called for additional backup from other staff as soon as they noticed and overheard C1 and C4's intentions to assault C2. According to confidential interviews, C2 was evaluated by staff and offered ice and medical attention after the incident, but C2 refused and stated that they were fine. According to confidential information, it was not until the following day that C2 expressed the desire to press charges against the other minors and to be seen by nursing staff due to back pain. It was then that staff contacted the police and C2 was taken to the hospital for further medical evaluation. While other confidential information received by Licensing Office stated that these allegations had occurred. Based on confidential information obtained during the course of this investigation, the allegations of a lack of supervision resulting in minors causing harm to another minor while in care, and that staff did report incident and seek medical attention for minor in a timely manner, may have occurred, however is not supported or proven by evidence. Therefore, the above allegations are unsubstantiated at this time. Exit interview was conducted and a copy of this report was provided.

Investigation Findings:
13Licensing Program Analyst (LPA), Daniel Mena met with Administrative Support Manager, Stephanie Donnellan to issue the investigative findings for the above stated allegations. Licensing Program Analysts (LPAs), Danielle Garcia and Daniel Mena conducted inspections to the Short Term Residential Therapeutic Program (STRTP) on September 30, 2021, September 28, 2021, October 18, 21 and on August 18, 2022. LPAs Garcia and Mena interviewed four staff (S1, S2, S3 & S4), Facility Nurse (FN), four of four foster children (C1, C2, C3 & C4), as well as reviewed client and facility records. Community Care Licensing received information on September 17, 2021 alleging a lack of supervision resulting in minors causing harm to another minor while in care, and that staff did report incident and seek medical attention for minor in a timely manner. Information obtained in confidential interviews did not corroborate the allegations with a preponderance of evidence. Confidential interviews denied allegations of a lack of supervision. According to confidential interviews, staff # 1 (S1) immediately intervened and tried to prevent Children # 1 (C1) and # 4 (C4) from physically assaulting Child # UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Daniel Mena 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: CASA DE AMPAROFACILITY NUMBER: VISIT DATE: 08/26/2022


summary: Complaint Investigation - Substantiated - 3 allegations

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Narrative:
The time frames and detailedness of the interviews were all consistent and corresponded together. Additionally, C1 did not reside in the cottage that C1 was tattooing C2 and C3, yet staff was aware that C1 came to the cottage to tattoo C2 and C3. Confidential interviews confirmed this information as well. Based on LPA's observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, (Title 22, Division 6, Chapter 1 regulation 80078(a) Responsibility for Providing Care and Supervision), are being cited on the attached LIC 9099D.") A copy of the report was discussed and provided along with appeal rights to Casa de Amparo administrator Stephanie Donnellan, Residential Admin Support Manager.

Investigation Findings:
13On September 22, 2022, at 2: PM, Licensing Program Analyst (LPA) Eduardo Barragan conducted a complaint inspection at Casa De Amparo and met with Stephanie Donnellan, Residential Admin Support Manager. The purpose of the inspection was to deliver the findings for the above complaint allegation. LPA Carol Anderson conducted an inspection of the facility on October 13, 2021, at 2: PM. No deficiencies were observed.. During the investigation, LPA Barragan toured the facility, reviewed documents (Needs and Services, Facility Sketch, Incident Reports, and reviewed staff roaster), interviewed four of four staff (S1-S4) and eight of eight clients (C1-C8). Based on confidential interviews it was confirmed that staff did not intervene when C1 was giving C2 and C3 a tattoo. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Eduardo Barragan 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY NAME: CASA DE AMPAROFACILITY NUMBER: 374603234

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


summary: Complaint Investigation - Unsubstantiated - 3 allegations

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Narrative:
Confidential interviews indicated that C1 had asked on multiple occasions to change cottages and had previously been moved on two other occasions. Other statements stated that C1 kept wanting to be moved to other cottages. All statements led to a conflicting finding. "Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated." An exit interview was conducted and a copy of this report, along with the appeal rights were explained and provided to Stephanie Donnellan, Residential Admin Support Manager

Investigation Findings:
13On September 22, 2022, at 2: PM, Licensing Program Analyst (LPA) Eduardo Barragan conducted a complaint inspection at Casa De Amparo and met with Stephanie Donnellan, Residential Admin Support Manager. The purpose of the inspection was to deliver the findings for the above complaint allegations. LPA Carol Anderson conducted an inspection of the facility on October 28, 2021, and no deficiencies were noted. LPA Barragan interviewed eight of eight clients (C1 - C8), four of four staff (S1 - S4), reviewed staff notes, Needs and Service reports, and Incident Report. The Department has investigated the complaint alleging staff did not safeguard youth's personal items and staff did not provide comfortable accommodations to youth in care. More specifically, C2 has been stealing C1's personal belongings and C1 does not feel comfortable sharing a room with C2. Confidential interviews revealed conflicting statements such as C2 was stealing C1's food and other interviews revealed that C2 did not steal anything from C1. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Eduardo Barragan 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY NAME: CASA DE AMPAROFACILITY NUMBER: VISIT DATE: 09/22/2022

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


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Narrative:
Additionally, interviews revealed conflicting information as to staff not attempting to prevent C1 from being hit by C2, yet other statements stated that staff was attempting to prevent C1 from being assaulted by C2. All statements led to a conflicting finding. "Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated." An exit interview was conducted and a copy of this report and appeal rights were provided to Stephanie Donnellan, Residential Admin Support Manager

Investigation Findings:
13On September 22, 2022, at 2: PM, Licensing Program Analyst (LPA) Eduardo Barragan conducted a complaint inspection at Casa De Amparo and met with Stephanie Donnellan, Residential Admin Support Manager. The purpose of the inspection was to deliver the findings for the above complaint allegations. LPA Carol Anderson conducted an inspection of the facility on October 28, 2021, and no deficiencies were noted. LPA Barragan interviewed eight of eight clients (C1 - C8), four of four staff (S1 - S4), reviewed staff notes, Needs and Service reports, staff schedules and Incident Report. The Department has investigated the complaints alleging staff is not attempting to prevent minor from smoking marijuana at facility and staff did not prevent minor from being assaulted by another minor in care. Confidential interviews stated that staff does not try to stop the clients from smoking marijuana, while other interviews revealed that staff do attempt to prevent clients from smoking marijuana. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Eduardo Barragan 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 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FACILITY NAME: CASA DE AMPAROFACILITY NUMBER: VISIT DATE: 09/22/2022

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