raw_content:
Narrative:
It was reported when "house lockdowns" occur, clients are not allowed to have any contact with anyone outside of the facility. Confidential interviews revealed that when the house goes on "lockdown or safety closure", clients are to remain in their bedrooms and are allowed to go to the backyard, eat meals in the dining room, and be supervised one-on-one with staff. Records reviewed if clients are on "level zero" they would be either in their bedroom or outside, have staff with them from 7 am-10 pm, and have no privileges. If a client does not complete the "level zero" requirements within 24 hours, they will be placed out of the program or discharged from the program. Confidential interviews report that restrictions consisted of no television, no electronics, no community excursions, and remaining in bedrooms except for going to the backyard or to the dining room to eat meals. This practice conflicted with the facility's approved discipline policy. Based on witness statements and record review of facility documentation, the allegation that staff is using inappropriate discipline towards minors is substantiated. The preponderance of evidence standard has been met. The facility is cited for violation of the California Code of Regulations, Title Division Six, regulation 87072.1(a) Discipline Policies and Procedures. On February 22, 2022, Community Care Licensing (CCL) received an allegation that the staff are not properly trained. It was reported that staff is not properly trained, and some staff has not completed all of their Pro-Act Training within 90 days. During the investigation, LPA reviewed the Employee Roster, Staff Training History, and training certificates. During the records reviews of thirty-eight training certifications, there are five staff that are listed as not completing their Pro-Act Training within 90 days. LPA reviewed the facility's policy about staff training which states all staff must complete Pro-Act Training within the first 90 days. Based on witness statements and record review of facility documentation, the allegation that staff is not properly trained is substantiated. The preponderance of evidence standard has been met. The facility is cited for violation of the California Code of Regulations, Title Division Six, regulation 87095.65 (b) Emergency Intervention Staff Training. On February 22, 2022, Community Care Licensing (CCL) received an allegation that the staff do not know how to perform emergency evacuations. It was reported that staff does not know how to perform emergency evacuations. Confidential interviews revealed that staff is aware of the exit doors in the facility and to meet SEE LIC 9099C outside at a designated location. However, interviewees were unable to provide the name of the relocation sites, which are equipped to provide safe temporary accommodation for clients, in case of evacuation. Confidential interviews revealed that the form was posted in the facility with the names of the relocation sites, and they would need to look at the form to know where to go in case of evacuation. Based on witness statements, the allegation that staff does not how to perform emergency evacuations is substantiated. The preponderance of evidence standard has been met. The facility is cited for violation of the California Code of Regulations, Title Division Six, Chapter 1, Article 3, regulation 80023 (b) 2 (C), Disaster and Mass Casualty Plan. A copy of this report was provided to and reviewed with Carmen Powers, Program Manager, along with the appeal rights and the LIC 811. A signed copy of the report will be kept in the Facility file. Activity calendars were provided for October 2021, November 2021, December 2021, January 2022, and February 2022. Confidential interviews revealed that clients had participated in some community activities. Other confidential interviews stated that the facility did not have money to take the clients on outings. Records reviewed could not confirm if the activities actually took place. It was reported that clients are only offered one religious option and many speakers and presenters are Christian. Based on confidential interviews, C1 and C2 were interested in other religions and were given the opportunity to practice their believes. Other confidential interviews entailed that clients were not given an option when receiving therapeutic services as they were all Christian based programs. It was reported that staff members threatened clients with law enforcement. Confidential interviews revealed conflicting statements; staff members tell the clients they will call law enforcement to request the Psychiatric Emergency Response Team (PERT). Other interviews revealed that staff threatened to call law enforcement knowing clients were scared of law enforcement. Records review revealed that law enforcement has been called to the facility when clients are demonstrating "unsafe behaviors" or have run away from the facility. There were no witnesses to the alleged incident. It was reported that clients are not allowed to speak Spanish in the facility. Confidential interviews entailed conflicting statements; clients were speaking Spanish so the staff could not understand them, and clients would curse and make negative comments toward other clients. Other confidential interviews revealed clients were told not to speak Spanish in group therapy sessions since there was not a Spanish-speaking facilitator, and clients were told not to speak Spanish at the dinner table as there was not a Spanish-speaking staff member at the facility. It is unknown if the facility did not allow the clients from speaking Spanish due to the well-being of other clients or if Spanish is not allowed to be spoken in the facility. It was reported that clients were "pushed to AWOL" because staff did not want to work with them anymore. Conflicting statements revealed that interviewees could not recall if a client was removed against regulations. Records reviewed revealed that some clients were removed before required placement preservation strategies were implemented, including Child-Family Team meetings however, no confidential interviews supported the records. It was reported that clients snuck out several times and got high and snuck in without being noticed by staff. Conflicting interviews revealed that clients had left the facility to partake in illicit drug use and had returned to the facility without staff knowing they had left the facility; however, it is not clear how long the clients were away from the facility. It was reported that staff do not provide assistance with grooming or allow razors in the facility. Based on conflicting statements, clients are allowed to use the razors and check them out from staff and return them to staff when not in use. Other interviewees revealed that clients need permission from their authorized representatives before using a razor and are offered hair removal cream. It was reported that clients are required to use their own money to purchase grooming supplies and hair supplies. Conflicting statements revealed that the facility provides hygiene and grooming supplies and other statements revealed that clients have to purchase hygiene supplies because the facility will not purchase the supplies. Based on interviews and information obtained, the allegations that staff does not have planned activities for the minors, staff interfere with the minor's religious beliefs, staff threatened the minors while in care, staff are preventing the minors from speaking their native language, staff unlawfully removed a minor while in care, staff do not provide adequate supervision to the minors, and staff do not provide assistance with grooming may or may not have occurred, however, it is not supported or proven by the evidence. Therefore, the allegations are unsubstantiated at this time. A copy of this report was discussed and provided to Carmen Powers, along with a copy of the LIC 811.

Investigation Findings:
13On April 25, 2022, at 10:45am, Licensing Program Analyst (LPA) Charmaine Linley and Licensing Program Analyst, Gloria Meza-Gonzalez, made an unannounced complaint inspection at the facility. LPA Linley met with Carmen Powers, Program Manager, to discuss and deliver the investigative findings for the allegation noted above. LPA Linley conducted an unannounced inspection of the facility on March 1, 2022. No safety concerns were observed. During the investigation, LPA Linley interviewed two clients (C1, C3) and five staff (S1, S2, S3, S6, S7) and three County Social Workers (CSW1, CSW2, CSW3) (see confidential name list, LIC 811, dated 04/25/2022). LPA Linley reviewed the following documentation: Program Statement, House Rules, House Logs, Training Documentation, and ProAct Training Certificates. On February 22, 2022, Community Care Licensing (CCL) received an allegation that the staff are demonstrating inappropriate forms of punishment. It was reported that when clients act out, they are sent to their room in isolation and are not allowed social interaction. SubstantiatedEstimated 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: TIFFANY'S PLACEFACILITY NUMBER: VISIT DATE: 04/25/2022

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

met_with: Carmen Powers, Program Manager


state: CA

facility_name: TIFFANY'S PLACE

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
returned to the facility and the staff did not allow them to enter the facility and called law enforcement. Law enforcement was told the bed was closed and the client could not return to the facility. Based on confidential interviews, C2 was denied entry into the facility. Based on Record reviews, it was revealed that the client was discharged from the program without the facility engaging with the county placing agency for a preservation strategy. Based on confidential interviews and documents reviewed, the preponderance of evidence standard has been met regarding the allegation that the facility did not follow proper discharge procedures of C2, therefore the complaint allegation is substantiated. This posed a potential Health, Safety, or Personal Rights risk to C2 in care, the facility will be cited for violating California Title 22, Division 6, Chapter 5 regulation 87068.4 (d) (1) Removal and/or Transfer Procedures. A copy of this report was provided to and reviewed with Carmen Powers, Program Manager, along with the appeal rights and the LIC 811. the Department determined there was not enough information to determine if the staff failed to provide supervision. Although the allegation that staff did not supervise the clients resulting in a minor operating a staff member's vehicle may or may not have occurred, however, it is not supported or proven by the evidence. Therefore, the allegations are unsubstantiated at this time. A copy of this report was discussed and provided to Carmen Powers, Program Manager, along with a copy of the LIC 811.

Investigation Findings:
13On April 25, 2022, at 11:45am, Licensing Program Analyst (LPA) Charmaine Linley and Licensing Program Analyst, Gloria Meza-Gonzalez, made an unannounced complaint inspection at the facility. LPA Linley met with Carmen Powers, Program Manager, to discuss and deliver the investigative findings for the allegations noted above. LPA Linley conducted an unannounced inspection of the facility on March 1, 2022. No safety concerns were observed. During the investigation, LPA Linley interviewed two clients (C1, C3) and five staff (S1, S2, S3, S5, S6) and three County Social Workers (CSW1, CSW2, CSW3) (see confidential name list, LIC 811, dated 04/25/2022). LPA Linley reviewed the following documentation: Program Statement, House Rules, House Logs, and Significant Incident Reports. On March 3, 2022, Community Care Licensing (CCL) received an allegation that the facility did not follow the proper discharge procedures for a minor. The client was alleged to have stolen a staff member's vehicle, left the facility, returned, and was not allowed to enter the facility. Based on Confidential Interviews, the client SubstantiatedEstimated 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: TIFFANY'S PLACEFACILITY NUMBER: VISIT DATE: 04/25/2022

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

complaint_status: unsubstantiated


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
On 05/17/2021, Community Care Licensing (CCL) received allegations that S1 did not provide adequate supervision to C1, S1 allowed C1 to consume alcohol, and S1 allowed C1 to bring alcohol into the facility. Confidential interviews revealed that S1 and C1 went on a one-to-one outing in the community. Interviews revealed that S1 took C1 to Target to purchase a beauty product and C1 ended up stealing a bottle of alcohol. When S1 and C1 returned to the facility, C1 showed S1 the bottle. Confidential interviews revealed that S1 and C1 went on another one-to-one outing to an unapproved location where C1 used drugs and stole another bottle of alcohol while under the supervision of S1. Confidential interviews revealed that S1 did not attempt to remove the alcohol from C1. Additional interviews revealed that C1 was able to hide and consume alcohol in the facility due to S1 not informing other staff that C1 had the bottle in their possession. Other confidential interviews indicated that C1 provided C2 with alcohol for consumption. Furthermore, S1 resigned when S1 was told by another staff that management thinks that S1 provided C1 with the alcohol. Based on confidential interviews and documentation reviewed the allegations that S1 did not provide adequate supervision to C1, staff allowed C1 to consume alcohol, and S1 allowed C1 to bring alcohol into the facility are substantiated. This poses immediate health, safety, and personal rights risk of harm to clients placed in care. The facility is being issued a citation per Title 22, Division 6, Chapter 1: Responsibility for Providing Care and Supervision 80078(a) and Health and Safety Code 1558(a)(2) Conduct Inimical. See page LIC809d for the cited deficiencies. An exit interview was conducted, and appeal rights were discussed. An exit interview was conducted and a copy of this report, LIC811, and appeal rights were given to the DOO Guillen.

Investigation Findings:
13On April 25, 2022 at 10: AM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez and LPA Charmaine Linley conducted an unannounced complaint inspection at the facility. LPA Meza-Gonzalez met with Director of Operations (PO) BriAnn Guillen to discuss and deliver the investigative findings for the allegations noted above. LPA Meza-Gonzalez conducted an unannounced inspection of the facility on July 29, 2021. No safety concerns were observed. During the investigation, LPA Meza-Gonzalez interviewed two clients (Client #1 [C1] , Client #2 [C2]) , five out of seven staff (Staff #1 [S1], Staff #2 [S2], Staff #3 [S3], Staff #4 [S4], Staff #6 [S6]), Program Administrator (PA) , Facility Social Worker (ASW), Chief Executive Officer (CEO), DOO and County Social Worker (CSW) (see confidential name list, LIC811, April 25, 2022). LPA Meza-Gonzalez reviewed the following documentation: Special Incident Reports (SIRs), staff roster, S1's employment application, C1, and C2's face sheet, and needs and service plans. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Gloria Meza-Gonzalez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 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: TIFFANY'S PLACEFACILITY NUMBER: VISIT DATE: 04/25/2022

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

met_with: BriAnn Guillen

complaint_status: SUBSTANTIATED


raw_content:
Narrative:
On May 6, 2021, Community Care Licensing (CCL) received allegations that staff is forcing clients to engage in religious activities and staff is wearing inappropriate and/or offensive clothing to the facility. Confidential interviews revealed inconsistencies in whether staff forces clients to participate in church and Christian based youth groups. Additional interviews revealed that clients were not forced to participate in religious activities however other additional interviews revealed that if clients did not participate in the religious activities then the clients had to stay in the rooms. Interviews revealed there were other activities for clients to do if they did not participate in the religious activities. Confidential interviews revealed inconsistencies in whether the CEO wore an anti-Muslim shirt in front of the clients; some interviews revealed that the CEO did where an offensive shirt while other interviews stated that the CEO did not wear the inappropriate shirt. Based on confidential interviews and record review, although the allegations that staff is forcing clients to engage in religious activities and the CEO wore inappropriate and/or offensive clothing to the facility may or may not have occurred, the allegation is not supported or proven by the evidence gathered. Therefore, the allegation is determined to be unsubstantiated. An exit interview was conducted, and a copy of this report, the appeals, and LIC 811 were given to CEO Burgard.

Investigation Findings:
13On June 17, 2022, at AM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez and LPA Carol Anderson conducted an unannounced complaint inspection at the facility. LPA Meza-Gonzalez and LPA Anderson met with Chief Executive Officer (CEO) Lynn Burgard to discuss and deliver the investigative findings for the allegations noted above. LPA Meza-Gonzalez conducted an unannounced inspection of the facility on May 12, 2021. No safety concerns were observed. During the investigation, LPA Meza-Gonzalez interviewed two out of three clients (Client #1 [C1] and Client #2 [C2]), five out of five staff (Staff #1 [S1], Staff #2 [S2], Staff #3 [S3], Staff #4 [S4], Staff #5 [S5]), Program Administrator (PA), Facility Social Worker (ASW), CEO and Director of Operations (DOO) (see confidential name list, LIC811, dated June 17, 2022). LPA Meza-Gonzalez was not able to interview Client #3 (C3). LPA Meza-Gonzalez reviewed the following documentation: C1, C2, and C3's face sheets, needs of service plan, and staff roster. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Gloria Meza-Gonzalez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 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: TIFFANY'S PLACEFACILITY NUMBER: VISIT DATE: 06/17/2022

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

met_with: Lynn Burgard


raw_content:
Narrative:
On May 11, 2021, Community Care Licensing (CCL) received an allegation that the facility is charging clients for food outside the menu. Confidential interviews revealed that C3 cooked steaks because C3 did not want to eat what was on the menu. Additional interviews revealed that C3 was charged for cooking steaks that were outside of the menu. Interviews revealed that C3 was charged for the steaks as part of restitution due to C3 had cooked all the steaks that were for a meal on a different day. LPA Meza-Gonzalez reviewed C3's LIC 405 which shows that C3 was charged for steaks. Based on confidential interviews and documentation reviewed the allegation that the facility is charging C3 for food outside the menu is substantiated. This poses potential health, safety, and personal rights risk of harm to clients placed in care. The facility is being issued a citation in accordance with interim Licensing standards (ILS) V3.1 87072. Discipline Policies and procedures. See page LIC809d for the cited deficiencies. An exit interview was conducted, and appeal rights were discussed. An exit interview was conducted and a copy of this report, LIC811, and appeal rights were given to CEO Lynn Burgard. On May 11, 2021, Community Care Licensing (CCL) received allegations that the facility does not have enough food for the clients. Confidential interviews revealed that there are inconsistencies to whether there was enough food for the clients in care. Additional Interviews revealed that allegedly a client had requested mangos however they were denied due to the fruit being expensive and exotic. LPA Meza-Gonzalez observed the facility had a sufficient amount of perishable and non-perishable however insufficient amount of fruits. Based on confidential interviews and record review, although the allegation that the facility does not have enough food for the clients may or may not have occurred, the allegation is not supported or proven by the evidence gathered. Therefore, the allegation is determined to be unsubstantiated. An exit interview was conducted, and a copy of this report, the appeals, and LIC 811 were given to CEO Burgard.

Investigation Findings:
13On June 17, 2022, at 9: AM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez and LPA Carol Anderson conducted an unannounced complaint inspection at the facility. LPA Meza-Gonzalez and LPA Anderson met with Chief Executive Officer (CEO) Lynn Burgard to discuss and deliver the investigative findings for the allegations noted above. LPA Meza-Gonzalez conducted an unannounced inspection of the facility on May 12, 2021. No safety concerns were observed. During the investigation, LPA Meza-Gonzalez interviewed two out of three clients (Client #1 [C1]) and Client #2 [C2]), three staff (Staff #1 [S1], Staff #2 [S2], Staff #3 [S3]), Program Administrator (PA), Facility Social Worker (ASW), CEO and Director of Operations (DOO) (see confidential name list, LIC811, dated June 17, 2022). LPA Meza-Gonzalez was not able to interview Client #3 (C3). LPA Meza-Gonzalez reviewed the following documentation: C1, C2, and C3's face sheets, needs of service plan, staff roster, grocery receipts, house rules, discipline policy, LIC 405- Record of client's Cash resources, and menu. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Gloria Meza-Gonzalez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 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: TIFFANY'S PLACEFACILITY NUMBER: VISIT DATE: 06/17/2022

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:


raw_content:
Narrative:
On December 21, 2021, Community Care Licensing (CCL) received allegations that staff failed to use an emergency intervention plan to protect clients from self-harming and staff failed to use an emergency intervention plan to prevent clients from leaving the facility without permission. Confidential interviews reported that staff is following all proper protocols when dealing with monitoring the clients for self-harm and leaving without permission. Other interviews were not consistent stating that the staff did not follow the emergency intervention plans. Additional interviews revealed that an emergency intervention plans are developed upon admission of the clients with the FSW and sent to the clients' County Social Workers. There were no witnesses to the alleged interventions. Based on confidential interviews and record review, although the allegations that staff failed to use an emergency intervention plan to protect clients from self-harming and staff failed to use an emergency intervention plan to prevent clients from leaving the facility without permission may or may not have occurred, the allegation is not supported or proven by the evidence gathered. Therefore, the allegation is determined to be unsubstantiated. An exit interview was conducted, and a copy of this report, the appeals, and LIC 811 were given to CEO Burgard.

Investigation Findings:
13On June 17, 2022, at 10: AM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez and LPA Carol Anderson conducted an unannounced complaint inspection at the facility. LPA Meza-Gonzalez and LPA Anderson met with Chief Executive Officer (CEO) Lynn Burgard to discuss and deliver the investigative findings for the allegations noted above. LPA Marisol Lopez conducted an unannounced inspection of the facility on December 22, 2021. No safety concerns were observed. During the investigation, LPA Meza-Gonzalez interviewed one (Client #1 [C1]), five out of six staff (Staff #1 [S1], Staff #2 [S2], Staff #3 [S3] Staff #4 [S4], Staff #6 [S6]), Program Administrator (PA), Facility Social Worker (ASW), CEO, Director of Operations (DOO), and three County Social Worker (CSW1, CSW2, and CSW3) (see confidential name list, LIC811, dated June 17, 2022). LPA Meza-Gonzalez was not able to interview client #2 (C2), Client #3 (C3), and Staff #5 (S5). LPA Meza-Gonzalez reviewed the following documentation: client roster, staff roster with contact information, C1, C2, and C3 face sheet, needs and service plan, and Emergency intervention plan. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Gloria Meza-Gonzalez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 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: TIFFANY'S PLACEFACILITY NUMBER: VISIT DATE: 06/17/2022

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


raw_content:
Narrative:
On December 21, Community Care Licensing (CCL) received an allegation that clients' mental health needs are not being met. Confidential interviews revealed that CEO is also the Head of Service for the mental health program. The CEO is one of the clinicians that provided individual therapy. Additional interviews revealed that C1 declined the services of the CEO. Additional information revealed that FSW was providing group therapy. Based on confidential interviews and record review, although the allegation that C1, C2, and C3 mental health needs are not being met may or may not have occurred, the allegation is not supported or proven by the evidence gathered. Therefore, the allegation is determined to be unsubstantiated. An exit interview was conducted, and a copy of this report, the appeals, and LIC 811 were given to CEO Burgard

Investigation Findings:
13On June 17, 2022, at 11: AM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez and LPA Carol Anderson conducted an unannounced complaint inspection at the facility. LPA Meza-Gonzalez and LPA Anderson met with Chief Executive Officer (CEO) Lynn Burgard to discuss and deliver the investigative findings for the allegations noted above. LPA Marisol Lopez conducted an unannounced inspection of the facility on December 22, 2021. No safety concerns were observed. During the investigation, LPA Meza-Gonzalez interviewed one (Client #1 [C1]), five out of six staff (Staff #1 [S1], Staff #2 [S2], Staff #3 [S3] Staff #4 [S4]), Staff #6 [S6]), Program Administrator (PA), Facility Social Worker (ASW), CEO, Director of Operations (DOO), and three County Social Worker (CSW1, CSW2, and CSW3) (see confidential name list, LIC811, dated June 17, 2022). LPA Meza-Gonzalez was not able to interview client #2 (C2), Client #3 (C3), and Staff #5 (S5). LPA Meza-Gonzalez reviewed the following documentation: client roster, staff roster with contact information, C1, C2, and C3 face sheet, needs and service plan, and Emergency intervention plan. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Gloria Meza-Gonzalez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 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: TIFFANY'S PLACEFACILITY NUMBER: VISIT DATE: 06/17/2022

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


raw_content:
Narrative:
posted in multiple areas of the home and inside of the client's intake packet. Administration stated that clients are not allowed to use the phone during school or activity hours. Administration stated no client is retaliated against for contacting CCL. Information obtained from confidential interviews stated that staff members do encourage the clients to contact CCL with their concerns or issues and the number is present. Other confidential interviews stated that staff members do not allow clients to call CCL and they try to deter them by making the clients wait hours to call. Additional witnesses stated no concerns have been advised regarding staff not allowing clients to contact CCL. It was also reported that clients rights are not posted. Administration stated that the clients' rights are posted in the upstairs and downstairs hallways. It was also stated that the clients' rights were posted in the staff office. It was also advised that the clients' received their rights during the intake process. Confidential interviews stated that rights are posted and clients are aware of their rights. Other confidential interviews stated no rights are posted in areas were clients are allowed to go. It was stated that the rights are only posted in the staff office. Additional witnesses stated they believe that the rights are posted in the hallway areas. It was reported that staff does not provide clients with clothes. Administration stated that clients clothing inventory is held to the standard of San Diego County even if they are from a different county. Administration stated that clients are allowed to go shopping via online due to Covid-19 to ensure they have adequate amounts. Administration stated that clients are allowed to wear what they desire as long as it is appropriate and abides by the facility rules. LPA Harris received contradicting information from confidential interviews. Information stated that staff do allow clients to go shopping and other confidential interviews stated that they haven not been shopping in months. Information from additional witnesses stated there were no concerns regarding clients clothing as they always appear well dressed. Based on interviews and information obtained, the allegations that minors not allowed to call CCL, minors rights not in posted in the facility, and staff did not provide minor with clothes may or may not have occurred, however it is not supported or proven by the evidence. Therefore, the allegations are unsubstantiated at this time. Exit interview conducted and a copy of the report will be provided to CEO. Signed copies will be placed in the complaint file.

Investigation Findings:
13Licensing Program Analyst (LPA) Jazmond Harris provided the findings for the investigation pertaining to the listed allegation to CEO, Lynn Burgard. On January, 14 2021, at 10: AM, LPA Nicole Strickland initiated the complaint investigation with CEO. LPA Harris conducted interviews with Administrator, Facility Manager, Staff Members, Social Worker, Michelle White, Probation Officer, and three out of four clients (C1, C3, C4). On January 5, 2021, Community Care Licensing (CCL), received information which stated minors are not allowed to call CCL, minors rights are not posted in the facility, and staff did not provide minor with clothes. It was stated that staff discouraged and retaliated against clients who contacted CCL. It was also reported that the facility does not have the personal rights documents posted in the facility, and Client #2 was forced to wear pajamas every day. Information obtained from administration pertaining to the minors not allowed to call CCL stated that clients are encouraged to contact CCL with issues or concerns. Administration stated that the phone number is UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Jazmond D Harris 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 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: TIFFANY'S PLACEFACILITY NUMBER: VISIT DATE: 06/08/2021

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

met_with: CEO-Lynn Burgard


summary: Facility Evaluation

raw_content:
Narrative:
On 05/11/2021 at 1: PM, Licensing Program Analyst (LPA) Cheraki Davis conducted an SB Psychotropic Medication Inspection and met with Facility Administrator Briann Smith-Guillen. The inspection was conducted via tele-inspection using video conference due to COVID-19. A virtual health and safety inspection were completed and no immediate deficiencies were observed. All files and medication documents were sent to LPA Davis on dates prior to inspection. A medication count was also conducted via video conference on this date. LPA reviewed two facility staff records and one client record for this facility. LPA began one client interview via video conference at 2: PM LPA began two staff interviews via video conference at 1: PM. LPA conducted an exit interview with Briann Smith-Guillen, Facility Administrator. No deficiencies are being cited at this time. LPA scanned and emailed this LIC 809 to Briann Smith-Guillen, Facility Administrator with a request for signature. Original signed copies will be placed in the facility file.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Briann Smith, Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On June 15, 2021 at 11: AM, an informal office conference was held virtually with Tiffany's Place Short Term Residential Treatment Program (STRTP) via MS Teams due to the COVID-19 pandemic. In attendance for Community Care Licensing (CCL) were: Regional Manager (RM) LaCresha Cook, Licensing Program Managers (LPMs) Stephanie Hudak and Ann Valenzuela, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez. San Diego County Representatives were: Institution Evaluation Unit (IEU) Program Manager (PM) Natasha Hood, Protective Service Supervisor (PSS), Eileen Marshall, Senior Protective Service Worker (PSW), Andrea Hernandez, IEU Contracts, Sheila Lyn Worthington and Behavior Health Services (BHS), Trang Hoang. Sacramento County Representatives were Program Planner (PP) Linda Abelelbaki, Program Manager (PM) Leslie Olson. Lastly, for Tiffany's Place, present were Chief Executive Officer (CEO) Lynn Burgard, Program Administrator (PA) BriAnn Guillen. The following issues were discussed: · Complaints · STRTP Provisional License During the meeting, LPM Valenzuela discussed increase of complaints at STRTP since facility opened. In 2020, there were four complaints and in 2021, six complaints as of June 15, 2021. STRTP was licensed on September 26, 2019, however, began accepting foster youths in February of 2020. Most of the complaints have to do with personal rights and staff training. PA Guillen was given the opportunity to speak regarding the increase of complaints relating to personal rights training. PA Guillen stated that the staff receive personal rights training during the first 90 days upon hire as well as during staff meetings; and are in the process of updating what training should be done on an annual basis. PA Guillen stated that she does the training however CEO Burgard and the Facility Social Worker can also do the training. LPM Valenzuela stated that staffing needs to be according to the foster youth's needs and there is available funding to increase staff. PA Guillen stated they have reached out for support from San Diego County for additional funds in order to meet the foster youths' needs for additional staffing. PA Guillen stated their current census is two and there are ample staff for two foster youths. LPM Valenzuela asked facility representatives if they are scheduling Child Family team meetings (CFTs) and PA Guillen said yes; it is schedule by the County Social Worker or Facility Social Worker. PA Guillen said that sometimes she attends as well as CEO Burgard. See LIC 809C page CEO Burgard stated she needs to get information from Department of Health Care Services Associate Governmental Program Analyst (AGPA) Stephen Conn regarding if the accreditation is required to submit their mental health program application and she would be researching accreditation processes, deadlines and their available options. In lieu of the issues presented during this meeting, the STRTP is being required to submit a Corrective Action Plan (CAP) by June 29, 2021, detailing the following: 1) submit an addendum to the Program Statement regarding what personal rights training entails and who will be conducting the training. Also, PA Guillen had mentioned that she is currently revising the annual training, and CCL requested they include that information in the CAP, 2) submit the last two copies of the board meeting minutes; minutes to include what actions the STRTP will be taking as a result of today's office conference. All recommendations/suggestions and requirements given during the meeting by both CCL and STRTP representatives were acknowledged. In closing, all parties were satisfied with all information that was discussed during the meeting. CCL will follow-up with the STRTP in 14 days. A copy of this report reviewed and emailed to CEO Burgard. Original signature will be placed in file. Amended: A copy of this report was given to PA Guillen. Lastly, the status of the STRTP provisional license was discussed. LPM Valenzuela advised Tiffany's Place that their provisional license is set to expired on September 26, 2021. LPM Valenzuela asked if they had hired a Head of Service and CEO Burgard stated yes, they just hired this week and a Head of Service will start on the first or the second week of July 2021. CEO Burgard stated she wasn't aware that the license for Tiffany's Place was going to expire on September 26, 2021. CEO Burgard stated that she was under the impression that as long as she had the Mental Health Approval that the State of California would provide some leeway or an extension for the accreditation process. RM Cook stated that there is no extension beyond 24 months per statute. CEO Burgard had spoken to CARF (accreditation agency) and it was told to her that accreditation should be done within 24 months of receiving a provisional license. RM Cook reiterated that there is no extension to the provisional license past 24 months. LPM Hudak provided information that per the current STRTP guidelines, in order for CCL to justify the extension of the provisional license past the 12-month expiration date, the facility needs to be in the process of obtaining Mental Health Approval and/or Accreditation. CEO Burgard asked if STRTP does not have accreditation by September 26, 2021, then would they need to close the STRTP? RM Cook stated that if the STRTP does not have accreditation then they will need to close as there is no extension available beyond the 24 months. RM Cook asked CEO, what would be their plan? CEO Burgard stated they don't have a plan. CEO Burgard stated in order to get accredited they need to be operating to CARF standards for at least 6 months. She said they just hired a consultant to assist in getting accreditation through CARF. CEO Burgard has a contract with County of San Diego Behavioral Health. CEO Burgard said the accreditation audit will be conducted in December. CEO Burgard stated that the focus was changed when COVID-19 hit, from the accreditation process to the needs of the foster youth. RM Cook clarified for the CEO Burgard that CARF are their own entity and are not a part of CCL. Suggestion was given to check with the other accreditation agencies and see if they can expedite the accreditation process to be completed prior to the expiration date of the provisional license. It was suggested if they cannot complete the accreditation and mental health approval process by the expiration date, the STRTP can submit an application to go through the process to change facility type. Suggestions were given as to alternative facility programs; they can apply for a Group Home for private pay clients or Group Home for Regional Center clients. PA Guillen asked what will happen if they cannot meet the expiration date, can they apply for STRTP again. LPM Hudak said yes, but the STRTP has to wait a year after application denial; the provisional license is considered part of the application process. See LIC809c Page 2

met_with: Lynn Burgard and BriAnn Guillen


summary: Facility Evaluation

raw_content:
Narrative:
On 06/22/2021 at 8: AM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez conducted an unannounced inspection at the above facility. LPA Meza-Gonzalez met with Program Administrator (PA) BriAnn Guillen. The purpose of this inspection is for PA Guillen to sign the informal conference report dated 06/15/2021 due to Chief Executive Officer (CEO) Lynn Burgard was unable to open the email with the reports.


summary: Facility Evaluation

raw_content:
Narrative:
On June 25, 2021, at 12: PM, Licensing Program Analyst (LPA), Jazmond Harris conducted an unannounced visit to the facility and met with Facility Manager, Carmen Powers. The visit was conducted in order to obtain a signature on an amended documented date June 16, 2021. Exit interview conducted and a copy of the report will be provided to the facility.

met_with: Facility Manager-Carmen Powers


summary: Facility Evaluation

raw_content:
Narrative:
On 09/21/2021 at 9: AM, Licensing Program Analysts (LPAs) Gloria Meza-Gonzalez and Licensing Program Manager (LPM) Ann Valenzuela conducted unannounced inspection to the facility. The purpose of the inspection is to conducted a required annual inspection. LPA Meza-Gonzalez and LPM Valenzuela met with Program Administrator (PA) Rushel Brooks. The facility serves 6 ambulatory female minors ages 12 to 17 and non-minor dependents. There is three clients in care. LPM Valenzuela reviewed ten staff files and three client files (see confidential list, dated: 09/21/21). LPA Meza-Gonzalez interviewed three clients and seven staff Due to time constraints, the annual inspection is being extended for physical plant and three staff interviews. Based on observations made during the inspection, no deficiencies observed during today's visit. An exit interview was conducted, and this report was reviewed with Director of Operation BriAnn Guilen and a copy of this report was provided.

visit_type: Annual

met_with: Rushel Brooks


summary: Facility Evaluation

raw_content:
Narrative:
On 09/27/2021 at 10: AM, Licensing Program Analysts (LPAs) Gloria Meza-Gonzalez conducted unannounced inspection to the facility. The purpose of the inspection is to conducted an annual continuation. LPA Meza-Gonzalez met Director of Operations (DO) BriAnn Guillen. The facility serves 6 ambulatory female minors ages 12 to 17 and non-minor dependents. There is three clients in care. The facility was inspected both inside and out with DO Guillen at 10: AM. The facility is a two-story split-level home with three bedrooms, three and half bathrooms, recreation/study room, multipurpose room, laundry room, living room, dining room, two kitchens, and staff office. The first floor is set up as follows: LPA Meza-Gonzalez observed in the first floor: living room with seating space and operable television. There was an ample amount of recreational and leisure supplies such as books and for client use. The kitchen table with seating for eight, kitchen contains utensils, dishware, pots, pans, cooking ware and operable appliances. There are two bedrooms with two twin beds and there is one client per bed. There is adequate drawer and closet space for children's belongings. Each bedroom has two desks and dressers. Each bedroom has a bathroom the clients share. The bathrooms were clean and in good repair. LPA Meza-Gonzalez tested the hot water temperature in clients' bathroom which read 106 degrees F, which is in range of 105-120. There is a staff bathroom in the hallway. The recreation room is used for art and other recreational activity as for independent study. LPA Meza-Gonzalez observed on the second floor: a bedroom with two twin beds and there is one client per bed. There is adequate drawer and closet space for children's belongings. The bedroom has two desks and dressers. The clients share a bathroom. The multipurpose room is used for visitation, trainings, therapy, and meetings. The staff office and a second kitchen for staff use only. LPA Meza-Gonzalez observed a closet with extra linen supplies. Continue on page 2 - LIC809C Inside the facility there is an operable smoke detector located in each bedroom and hallways on both floors. There is also an operable carbon monoxide detected located in the hallway of the first and second floor. The fireplace is properly screened. Cleansers/chemicals are locked and stored in a closet on the first floor next to the staff bathroom. All hazardous items have been properly made inaccessible to areas where clients will have access. The facility has a signal system for reach bedroom on both floors. Sharp knives are inaccessible locked in a closet in the lock staff office. The first aid kit is located in a locked cabinet in the second floor contains all required items. The medications are stored in a locked cabinet in the locked staff office. There is a locked mini refrigerator inside the staff office if medication needs to be kept cool. The medication logs, dispensing records, staff, and client records will be kept in a locked cabinet inside the staff office. LPA Meza-Gonzalez observed a minimum seven-day non-perishable supply of food and two-day perishable. There was a variety of snacks available for clients. There are no guns or weapons as stated by DO Guillen this time. There are four fire extinguisher, two in the first floor (one in the hallway and one in the kitchen) and two on the second floor (one in the hallway and one in the staff kitchen). A copy of the license was readily available to LPA Meza-Gonzalez during time of inspection and its located on a shelf in the dinning room. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There are no bodies of water. Program Administrator Rushel Brooks is present at the facility a minimum of 20 hours a week. Appropriate staff and client ratios were verified during this inspection. The facility employs one Program Director/Chief Executive Officer, one Director of Operations, one Social Worker/Mental Health Rehabilitation Specialist, one Mental Health Head of Service, one Program Administrator, eleven Facility Managers, and one direct care staff are used in accordance with regulatory requirements. Licensee received their Mental Health Certification on July 1, 2021. Licensee received their accreditation from Joint Commission of Accreditation (JCO) on August 5, 2021. Licensing fee payments have been paid. The following required posted items were observed and accessible to children: Ombudsman and Foster Youth Bill of Rights, Grievance Procedures, Personal Rights, Visitation policies, house rules and current menu. Continue on page LIC809C LPA Meza-Gonzalez conducted confidential interview for three staff. Based on observations made during the inspection, no deficiencies observed during today's visit. An exit interview was conducted, and this report was reviewed with DO Guillen and a copy of this report was provided.


summary: Facility Evaluation

raw_content:
Narrative:
On 12/09/2021 at 10: AM, Licensing Program Analysts (LPAs) Gloria Meza--Gonzalez and LPA Danielle Garcia conducted an unannounced inspection. LPA Meza-Gonzalez met with Program Administrator (PA) Rushel Brooks. The purpose of the inspection is to conduct a case management to deliver an amended report. An exit interview was conducted and a copy of this report was given to PA Brooks.


summary: Facility Evaluation

raw_content:
Narrative:
On May 23, 2022 at 9: AM, Licensing Program Analyst (LPA) Gloria Meza-Gonzalez and Investigative Branch Investigator Annette Renquist conducted an inspection at the above facility. LPA Meza-Gonzalez met with Mental Health Rehabilitation Specialist (MHRS) Michelle White and Program Administrator (PA) BriAnn Guillen. LPA Meza-Gonzalez interviewed Client #1 (C1) regarding a previous placement. An exit interview was conducted and a copy of this report was emailed to PA Guillen due to technical difficulties with the printer.

met_with: Michelle White and BriAnn Guillen


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Dina Camara conducted a case management inspection 05/24/22 at 9: 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, 13 out of Direct Care Staff and 2 out of 2 youth files were reviewed. 2 out of Direct Care Staff and 2 out of 2 youth were interviewed. (See the Confidential Names List, LIC 811, dated 05/24/2022). The Plan of Operation including policies and procedures were reviewed. Minutes from the board of directors' meetings 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 case plans, quarterly assessments, and 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. LPA Dina Camara 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 Briann Guillen, Administrator.

met_with: Briann Guillen, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 11/4/2021 at 2: PM, Licensing Program Analysts (LPAs), Gloria Meza-Gonzalez and LPA Danielle Garcia conducted an unannounced inspection at the above facility. The purpose of the inspection is to conducted a case management. LPA Garcia and LPA Meza-Gonzalez met with Program Administrator (PA) Rushel Brooks. LPA Garcia conducted a confidential interview in which it was revealed that there was no facility manager on premise on 10/23/2021 when S1 from 5: PM until 11: PM. S1 is a direct care staff. Based on the information gathered, LPA Meza-Gonzalez explained that due to the deficiency, the facility will be cited in violation for Interim Licensing Standards, Version 3.1: 87065 (f) personnel requirements. This poses a potential health, safety and personal rights risk of harm to children placed in care. See page 2 for the cited deficiencies. An exit interview was conducted, and appeal rights discussed. A copy of this report was given to PA Brooks. .


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On May 31, 2022, at 9: AM, Licensing Program Analyst (LPA) Gloria Meza- Gonzalez conducted an unannounced inspection at the above facility. LPA Meza-Gonzalez met with Residential Program Manager (RPM) Carmen Powers. The purpose of the inspection is to conduct case management regarding a previous inspection. On May 23, 2022, LPA Meza-Gonzalez observed that there was a curtain in the doorway of bedroom #1. Bedroom #1 is occupied by C1 (see confidential name list, LIC811 dated May 31, 2022). Upon entering the bedroom, LPA Meza-Gonzalez observed the bathroom door is missing. On May 31, 2022 at 9: AM, LPA Meza-Gonzalez observed there is no curtain in the door way or door of bedroom #1. RPM Powers stated that the bedroom door was removed for safety reasons. Based on interviews and LPA Meza-Gonzalez observation made on May 23, 2022, C1's bedroom did not have a door which is a violation of the facility's fire clearance which poses a health, safety, and personal rights risk to clients in care. The facility is being cited for Title Regulations, Section 80000(b) General. A copy of this report, LIC 811, and appeal rights were emailed to RPM Powers due to technical difficulties with the printer.

Deficiencies:
80000(b): 1
2
3
4
5
6
7

met_with: Carmen Powers

title:
1
2
3
4
5
6
780000(b) General. The licensee shall ensure compliance with all applicable law and regulations.

This requirement was not met as evidenced by

description:
1
2
3
4
5
6
7


summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Administrator Brittany Burns regarding a complaint investigation at the Short Term Residential Therapeutic Program. The purpose of the inspection was to deliver the findings for the above allegation. During the course of the investigation, LPA Bertoli inspected the facility, interviewed 3 youth, 4 staff, and 2 social workers, and reviewed documentation. LPA confirmed through interviews with staff and clients that staff engaged in a struggle with client C1 (see LIC 811 dated 10/29/21) over possession of a blanket that C1 wanted to take outside to keep warm. It was also confirmed by interviews with staff and clients and Incident Reports that doors were removed from client's bedrooms. Based on the information obtained, there is a preponderance of the evidence to prove that staff violated personal rights of clients. Therefore, the above allegation is substantiated. Title 22 deficiencies were cited regarding the struggle with the blanket and an Advisory Note was issued regarding door removal. Appeal Rights were provided and discussed with the facility. An exit interview was conducted and a copy of the report was left with the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Brian Bertoli 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 21-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, GOLF COURSE DR. STE. A- ROHNERT PARK, CA FACILITY NAME: TLC CHILD AND FAMILY SERVICES-ORCHARD HOUSEFACILITY NUMBER: 496801036

met_with: Brittany Burns


raw_content:
Narrative:
Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility. This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the Staff threaten a client or yelled at a client; therefore, the above allegations are unsubstantiated.

Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Administrator Brittany Burns regarding a complaint investigation at the STRTP. The purpose of the inspection was to deliver the findings for the above allegations. During the course of the investigation, LPA Bertoli inspected the facility, interviewed 5 youth, 5 staff, and 1 social worker, and reviewed documentation. The alleged victim, C5 (see LIC811 dated 3/24/22) was not able to identify staff that were involved. Other than C5, none of the clients or staff said that they had witnessed or knew of the allegations occuring to C5. The Investigating Social Worker also acknowledged the same result. LPA Bertoli was unable to determine if staff threatened client or yelled at client C5. There is a lack of clear evidence to make a determination as to whether a regulatory violation did occur. (continued on LIC9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Brian Bertoli 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 21-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, NEOTOMAS AVENUE, STE. FACILITY NAME: TLC CHILD AND FAMILY SERVICES-ORCHARD HOUSEFACILITY NUMBER: VISIT DATE: 03/24/2022


raw_content:
Narrative:
This department has investigated the allegations, and although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the staff handled minor in a rough manner or sprayed minor with chemicals; therefore, the above allegations are unsubstantiated. Appeal Rights were provided and discussed, and no deficiencies were cited. An exit interview was conducted and a copy of the report was given to the facility.

Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brian Bertoli met with Administrator Brittany Burns regarding a complaint investigation at the STRTP. The purpose of the inspection was to deliver the findings for the above allegations. During the course of the investigation, LPA Bertoli inspected the facility, interviewed youth and staff, and reviewed documentation. None of the youth or staff had knowledge of any youth being handled in a rough manner. Staff and youth acknowledged that one youth was sprayed with water when they were playing in the laundry room. LPA Bertoli was unable to determine if staff handled minor in a rough manner or sprayed minor with chemicals. There is a lack of clear evidence to make a determination as to whether a regulatory violation did occur. (continued on LIC9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: Brian Bertoli 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 21-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, NEOTOMAS AVENUE, STE. FACILITY NAME: TLC CHILD AND FAMILY SERVICES-ORCHARD HOUSEFACILITY NUMBER: VISIT DATE: 01/26/2023


facility_name: TLC CHILD AND FAMILY SERVICES-ORCHARD HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
An announced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Joel Segura on 06/09/2021 at 3:00pm. This inspection was conducted via MS Teams due to COVID19 restrictions on conducting on site inspections at licensed facilities. LPA Segura conducted SB Psychotropic Medication interviews on 06/08/2021 at 1:30pm with three staff , Administrator Brittany Burns, Medical Coordinator Dania Dudley and Facility Manager Janae Baddeley . At 3pm on todays date LPA Segura and Medical Coordinator Dania Dudley, counted medications and verified PMAR and centrally stored medication logs for three children. Dania also assisted with a physical plant inspection of the facility. No deficiencies were observed during this tele-inspection. A follow up inspection will be conducted to interview clients on 06/10/2020. LPA Segura provided this report to the administrator via email for signature and acknowledgment the report was received.

met_with: Dania Dudley


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Brian Bertoli and David Hiett conducted an unannounced inspection for the purposes of completing an Annual/Required Inspection and met with administrator Brittany Burns. Also assisting with records and the inspection were Treatment Director Karen Bergman and Operations Manager James Freeman and others. A pre-screening call was done prior to arrival, and Administrator Burns indicated that no one was Covid positive, symptomatic, or had known exposure. However, upon arrival it was disclosed that two youth had just become symptomatic overnight. Appropriate protocols were followed in the facility for the inspection and all interviews were conducted outdoors. The Physical Plant was toured inside and out by LPA Bertoli. Water temperatures were measured at 110 degrees. Seven-day Non-perishable food supply was inspected and was found to be adequate. Two-day perishable food supply was inspected and were found to be adequate and consistent with the menu. LPA inspected bedrooms and found that there was adequate linens and each bed had mattress pads. The home is clean and in good repair. There are no firearms in the facility. There are no open bodies of water on the property. Medications are locked in the office. Toxics and cleaning solutions are locked in the laundry room. Required documents are posted. Disaster drills are conducted quarterly, there are charged operable fire extinguishers, carbon monoxide and smoke detectors are in the facility. Five clients and four staff were interviewed. Client files were partially reviewed at the administration office and will be completed on another date. Per Title Regulations, no deficiencies were cited during this inspection. Advisory notes were issued for the Disaster Plan, however those issued for HSC 1565(c) and CCR 80023(d)(2) do not apply, as documentation of compliance was received after they were saved on the system. An exit interview was conducted and a copy of the report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Brian Bertoli conducted an unannounced inspection for the purposes of completing an Annual/Required Continuation Inspection and met with Administrator Brittany Burns. Assisting with records was Executive Assistant Jessica Quigley. A pre-screening call was done with Administrator Burns prior to arrival, and there were no changes since last visit, but advised they may have updates during the day. The records were reviewed at the administrative office and no further updates occurred. Staff records were reviewed and found to be acceptable. LPA Bertoli also reviewed Emergency Interventions, and Core Therapeutic Services were reviewed with Clinical Director Reese Clark. Per Title Regulations, no deficiencies were cited during this inspection. An exit interview was conducted and a copy of the report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Brian Bertoli and David Hiett conducted an unannounced inspection for the purposes of completing an Annual/Required Continuation Inspection and met with Administrator Brittany Burns. Assisting with records was Executive Assistant Jessica Quigley. A pre-screening call was done with Administrator Burns prior to arrival, and there were no changes since last visit. The records were reviewed at the administrative office. Client records were reviewed and found to be acceptable. A Technical Advisory was issued for ILS 87070(c)(1). The Annual/Required inspection is complete. Per Title Regulations, no deficiencies were cited during this inspection. An exit interview was conducted and a copy of the report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli made an announced visit to the facility for the purpose of reviewing the remodeling plans for the 'Phoenix House' portion of the facility. LPA Bertoli met with Administrator Brittany Burns, who assisted with the inspection. A COVID pre-screening call was made prior to the visit, and there were no known cases, exposures, or symptomatic youth or staff. LPA Bertoli toured the facility, reviewed plans, and discussed the nature of the changes and the potential impact on the youth. The youth that were previously in 'Phoenix' will be housed in the 'Orchard House' portion of the facility, which has eight bedrooms. The two houses combined constitute the licensed facility, which has a capacity of 16. The facility is converting two bedrooms to office spaces for the Facility Manager and the Medication Coordinator/Nurses office. The home will have eight bedrooms remaining, and they will not have more than six youth at a time in the home. The remodeling is expected to take approximately 3 months. LPA Bertoli has determined that the modifications to the facility are acceptable for the Short-Term Residential Therapy Program. No Title 22 deficiencies were found on this visit. An exit interview was conducted with Administrator Burns and a copy of this report was given to the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Brian Bertoli conducted an unannounced inspection for the purposes of completing an Annual/Random Inspection and met with administrator Brittany Burns. Also assisting with the inspection was Facility Manager Brittany Silva. A pre-screening call was done prior to arrival, and Administrator Burns indicated that no one was Covid positive, symptomatic, or had a known exposure. The Physical Plant was toured inside and out by LPA Bertoli. Water temperatures were measured at 107 degrees. Seven-day Non-perishable food supply was inspected and was found to be adequate. Two-day perishable food supply was inspected and were found to be adequate and consistent with the menu. LPA inspected the six bedrooms and found that there was adequate linens and each bed had mattress pads. The home is clean and in good repair. There are no firearms in the facility. There are no open bodies of water on the property. Medications are locked in the office. Toxics and cleaning solutions are locked in the laundry room. Required documents are posted. Disaster drills are conducted quarterly, There are charged operable fire extinguishers, carbon monoxide and smoke detectors are in the facility. Three clients and two staff were interviewed. Ten staff files were reviewed at the administrative office and client files will be completed on another date. Disaster Preparedness, Emergency Interventions, and Core Therapeutic Services were reviewed. Per Title Regulations, no deficiencies were cited during this inspection. An exit interview was conducted and a copy of the report was left at the facility.

met_with: Brittany Burns and Brittany Silva


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Brian Bertoli conducted an unannounced inspection for the purposes of completing an Annual/Required Continuation Inspection and met with Administrator Brittany Burns. A pre-screening call was done with Administrator Burns prior to arrival, and there were no changes since last visit. The records were reviewed at the administrative office. Four Client records were reviewed and found to be acceptable. The Annual/Random inspection is complete. Per Title Regulations, no deficiencies were cited during this inspection. An exit interview was conducted with Karen Bergman and a copy of the report was left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Brian Bertoli on the above date. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA Bertoli met with Administrator Brittany Burns and Medication coordinator Dania Dudley and inspected the facility inside and out. LPA reviewed no children's records, as there were no children at the facility that were eligible. LPA Bertoli reviewed two staff personnel files on site at the facility. LPA reviewed psychotropic medications and medication records. LPA interviewed two staff on site to discuss the facilities policies and procedures of operation. LPA interviewed no children currently prescribed psychotropic medication. LPA provided a copy of this licensing report to Administrator Brittany Burns. No deficiencies are being cited at this time. LPA conducted exit interview with Administrator Brittany Burns.

met_with: Brittany Burns and Dania Dudley


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Brian Bertoli made an unannounced visit to the facility and met with Facility Manager Kayla Martinez. The purpose of the visit was to confirm closure of the Short-Term Residential Therapeutic Program. The Request for Closure, written confirmation that there are no STRTP youth remaining, and license were received by CCL. LPA Bertoli inspected the facility at 1:45pm and confirmed that no STRTP youth were present. The STRTP facility was adjacent to the TLC Group Home, which will expand their capacity and utilize both buildings. Closure of the STRTP will be effective June 5, 2023. An exit interview was conducted with the Administrator to confirm the closure.

met_with: Kayla Martinez


summary: Facility Evaluation

raw_content:
Narrative:
An announced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Joel Segura on 06/09/2021 at 3:00pm. This inspection was conducted via Google meet due to COVID19 restrictions on conducting on site inspections at licensed facilities. LPA Segura sent the Administrator Brittany Burns a Document Request checklist on 05/25/2021. LPA Segura received client documents via email on 06/04/2021. The facility has 6 clients in placement at this time. On 06/07/ LPA Segura reviewed the child documents submitted by the facility. On 06/08/ LPA Segura conducted SB Psychotropic Medication interviews at 1:30pm with three staff , Administrator Brittany Burns, Medical Coordinator Dania Dudley and Facility Manager Janae Baddeley. LPA Segura and student assistant Stephanie Martinez reviewed the child files. Review of the files revealed that the following items were observed to be out of compliance with Interim Licensing Standards (ILS). Below LPA will reference each child file as C1 through C5, see confidential names list LIC 811 dated 06/14/2021. Note facility submitted documents for C3; however, this resident is not a minor; therefore, not subject to this inspection. C1, C2, C4 and C5: Psychotropic Medication Administration Record (PMAR) lists all psychotropic medications on a single PMAR rather than a separate PMAR per medication as required by ILS (Interim Licensing Standard) 87070(b)(12) C1, C2, C4 and C5: PMAR used by the facility does not include the quantity of medication and number of refills initially prescribed as required by ILS 87070(b)(12)(C). Continued on 809C The staff file reviews were conducted on 06/11/2021 the documents submitted appeared to be in compliance of the Interim Licensing Standards. Three deficiencies were observed in the course of this inspection (refer to LIC 809D) and cited from the California Code of Regulations, Title 22, C2, C4 and C5: Master Treatment Plan being used as the Assessment Needs and Services Plan (ANSP) not signed by the child, authorized representative or both. As required by ILS 87068.2(e) The facility was advised on 07/06/2020 that the use of a separate PMAR for each medication is required. Further the facility was also advised to review the health and safety code 1507.6(b)(2)(B) to ensure the required information was captured on the facility specific PMAR. The facility was also advised on 07/06/2020 that written approval from the child and authorized representative is required prior to implementing a Needs and Services Plan. According to the submittal of documents for this inspection, the facility did not implement the use of a single PMAR per psychotropic medication, incorporate specific details on the PMAR and written authorization of the NSP by the client and authorized representative; therefore a deficiencies will be issued for not complying with the Interim Licensing Standards. On the following day -06/08/2021- at approximately 3pm LPA Segura and Medical Coordinator Dania Dudley, counted medications and reviewed PMAR and centrally stored medication logs. In the course of conducting the medication counts Dania indicated that the facility has started to use the departments PMAR LIC 622B instead of the facility specific PMAR. Interviews of C2 and C5 were conducted on 06/10/2021 at 3:30PM. Client 1 did not participate in an interview as they were in crisis when LPA called for the previously scheduled interview. Client 4 had been discharged from the program the previous Monday therefore was not present to participate in an interview. Continued on 809C


facility_name: TMHA-YOUTH TREATMENT PROGRAM

raw_content:
Investigation Findings:
13On 9/25/2024 at 4:00pm Licensing Program Analyst (LPA) Enrique Hernandez made an unannounced inspection to the above facility for the purpose of concluding the investigation on the above allegation and deliver the finding. LPA spoke with Allison Jensen Facility Administrator and together, discussed the investigative finding. During the investigative process by Licensing program Analyst (LPA), Enrique Hernandez, all relevant parties have been accounted for. It was reported that a Staff did not provide adequate supervision resulting in minor being sexually assaulted by another minor in care. LPA Hernandez could not interview Client 1 (C1) because C1 had left the facility. LPA intended to contact C1 via the phone provided by the social worker, but it was disconnected. Lastly, statements alleging minor being sexually assaulted by another minor in care were not corroborated during the investigation. 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. No deficiencies are being cited at this time. Exit interview was conducted, and due to technical difficulties with the printer, a copy of this report will be emailed. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Kevin C Sauk LICENSING EVALUATOR NAME: Enrique M Hernandez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Allison Jensen/Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 02/06/24 at 09: AM Licensing Program Analyst (LPA) Jhane Haynes made an announced visit to the above facility for the purpose of conducting a pre-licensing inspection. LPA met with Program Manager(PM) Alley Jensen who granted access to the facility. Together LPA and PM toured the home inside and out. This is a six bedroom, four bathroom single-story home with barn access in rural area. There are no swimming pools or bodies of water of the premises. LPA observed the following during facility tour: Entry: contains required postings, rug, and entry to staff office. Staff Office will have Dutch door to administer medications. Garage will be a space for on site visits, containing space for computers, door leading to storage space will have emergency food supplies and door to building exterior. Water heater is located her. Left Hallway contains locked storage closet that will hold chemicals. Leads to three client bedrooms, linen closet and staff hallway. Bedroom #1 contains adequate closet space. Bathroom#1 contains functioning toilet, double sinks and shower with running water. Bedroom #2 contains adequate closet space. Bedroom #3 contains adequate closet space. Staff Hallway leads to two office spaces, laundry area and bathroom. (Continued on LIC809-C) Office #1 will be reserved for individual/family therapy. It is equipped with soundproofing tiles and door leading to exterior. Office #2 contains cabinets for locked medications. Laundry Space will contain washer and dryer. Bathroom #3 contains functioning toilet, sink and shower with running water. Living Room contains adequate seating for clients, rug, fireplace that is inaccessible to clients. Switch is in locked office. Kitchen/Dining contains center island with three chairs, dishwasher, four burner stove and oven in operating condition, refrigerator and microwave. Adjacent to the refrigerator is a walk in pantry. There are sliding glass door that leads to exterior. Right Hallway leads to three client bedrooms, bathroom and sensory room. Bathroom #4 contains functioning toilet, double sinks and shower with running water. Breakout/Sensory Room contains large chair and soundproof tiles. Clients will be able to make phone calls here. Bedroom #4 contains adequate closet space. Bedroom #5 contains adequate closet space. Bedroom #6 contains adequate closet space. Fire and carbon monoxide alarms were tested and in working condition. Stations where fire extinguishers will be placed are located throughout the facility. Exterior opens up to large green area, there are tables and chairs, small fountain, and tortoise cage. Left side of property houses solar panels that a fence will be places and standing wells of the far side of property which ladder will be locked. 1/3 of Barn contains office, bathroom and space reserved for group and CFT meetings. There is an door leading to exterior. Two-thirds of the barn is rented out to staging company who does not have access to facility. Bathroom #5 located in barn contains sink and toilet. Due to early inspection, LPA will return once staff office is complete and furniture has been moved in to complete process. An exit interview was conducted and a copy of this report was left with Program Manager.

visit_type: Prelicensing

met_with: Alley Jensen Program Manager(PM)


summary: Facility Evaluation

raw_content:
Narrative:
On 03/26/24 at 11:22AM Licensing Program Analyst (LPA) Jhane Haynes and Licensing Program Manager (LPM) Kevin Sauk arrived at the above facility for the purpose of conducting a pre-licensing inspection. LPA met with Facility Administrator (FA) Alley Jensen who granted access and together provided a tour. LPA and LPM observed new fencing outlined around the facility to separate buildings and solar panels. The six-foot fencing surrounding the exterior property line is pending completion. Wells observed to be locked and inaccessible. Staff office has Dutch door fully installed. Countertops in garage space have been installed for client usage. Company leasing 2/3 of the barn had moved out and will be replaced by another renter for storage. LPA will return post-complete facility move in. No deficiencies will be cited today. An exit interview was conducted and copy of the report will be emailed to facility administrator.

met_with: Alley Jensen Facility Administrator (FA)


summary: Facility Evaluation

raw_content:
Narrative:
On 07/26/24 at 09:57AM Licensing Program Analyst (LPA) Jhane Haynes made an unannounced visit to the above facility for the purpose of conducting a pre-licensing inspection. LPA met with Program Manager(PM) Alley Jensen who granted access to the facility. Together LPA and PM toured the home inside and out. This is a six-bedroom, four-bathroom single-story home with barn access in rural area. There are no swimming pools or bodies of water of the premises. LPA observed the following during facility tour: Entry: contains required postings including personal rights, house rules and complaint procedures, rug, and entry to staff office. Staff Office contains desk, chairs, secured cabinets for medications, nails polish, old batteries, sharps, and nail products. There is also a secured cabinet for client files and door leading to the garage. Garage contains computers for school, couch, TV, and door leading to storage space. It contains emergency food supplies, refrigerator, additional storage shelves and door to building exterior. Water heater is located here. Left Hallway contains locked storage closet that holds extra first aid, hygiene and cleaning supplies. Leads to three client bedrooms, linen cabinet, and staff hallway. Bedroom #1 rooms C5 and contains a twin bed, dressers, and adequate closet space. Bathroom#1 contains hampers, functioning toilet, double sinks, and shower with running water. Bedroom #2 rooms C4 and contains a twin bed, dressers, ceiling fan and adequate closet space. Bedroom #3 rooms C3 and contains a twin bed, dressers and adequate closet space. Staff Hallway leads to two office spaces, laundry area and staff bathroom. Therapist Office for individual/family therapy. It is equipped with soundproofing tiles, couch, chairs, desk and door leading to exterior. Med Room/Milieu Office contains cabinets for locked medications, desk and chairs. Laundry Space contains washer and dryer, storage cabinets for laundry supplies. Bathroom #2 contains functioning toilet, sink and shower with running water. (Continued on LIC809-C) Living Room contains adequate seating for clients, TV, Bookcases, rug, fireplace that is inaccessible to clients. Switch is in locked office. Kitchen/Dining contains center island with three chairs, dishwasher, four burner stove and oven in operating condition, refrigerator, and microwave. Adjacent to the refrigerator is a walk-in pantry. Menu is posted on the fridge. There are perishables for up to two day and non-perishables for up to a week. Fridge operates at 37 degrees and the freezer at 0. Grocery shopping is done weekly. There are adequate dinnerware for clients and secured cabinets for daily cleaning supplies. There are sliding glass door that leads to exterior. Right Hallway leads to three client bedrooms, bathroom, and sensory room. Bathroom #3 contains functioning toilet, double sinks and shower with running water. Breakout/Sensory Room contains large bean bags, activities and soundproof tiles. Clients are accompanied by staff in this room. Bedroom #4 rooms C1 and contains a twin bed, dressers, and clothing rack. Bedroom #5 rooms C2 and contains a twin bed, dressers, and clothing rack. Bedroom #6 is vacant and contains a twin bed, dressers and clothing rack. Exterior opens up to large green area, there are tables and chairs, small fountain, and tortoise enclosure. Left side of property houses solar panels and standing wells of the far side of property which ladder are locked and inaccessible to clients. 1/3 of Barn contains office, half bathroom and group therapy space. It contains a TV, couch, table, chairs and secured activity cabinets. There is a door leading to exterior. Fire extinguishers are located throughout the facility. The facility utilizes two vans to transport youth in operating condition with current registration and insurance. Due to time constraints, LPA will return to complete inspection. No deficiencies will be cited at this time. An exit interview was conducted, and a copy of this report was emailed to the Program Manager.


summary: Facility Evaluation

raw_content:
Narrative:
On 07/26/24 at 09:57AM Licensing Program Analyst (LPA) Jhane Haynes made an unannounced visit to the above facility for the purpose of conducting a case management inspection following an incident report received by the department on 07/23/24. Possible inappropriate interaction between staff and client. LPA met with Program Manager(PM) Alley Jensen who granted access to the facility. LPA conducted interviews with C1, S1 and PM. LPA obtained contact information of S2 and supervising social worker of C2. Further investigation is needed to determine whether a violation occurred. No deficiencies will be cited at this time. An exit interview was conducted, and this report was emailed to the Program Manager.


summary: Facility Evaluation

raw_content:
Narrative:
On April 8, 2025 at 3: PM Licensing Program Analyst (LPA) Connie Jones-Steward made an announced visit at TMHA Youth Treatment Program to conduct the SB Psychotropic Medication Inspection. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9(a)(2). LPA conducted a Health and safety risk assessment upon arriving at the facility. During the inspection, LPAs Jones-Steward met with the Administrator Allison Jensen and conducted a brief walk through of the physical plant inside and out. LPA observed no physical plant deficiencies LPA was informed that only two clients met the SB484 review criteria. LPA reviewed two (2) client medical binders and Needs and Services Plans. LPA Jones-Steward interviewed 1 client as the other was not available . LPA reviewed the LIC-500 to confirm that all staff have criminal background clearances. LPA also conducted a physical count of the existing medication with the aid of the administrator. LPA Jones-Steward will conduct staff file reviews and interviews on April 9th, 2025. No deficiencies were found on this date.

met_with: Allison Jenson, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with Administrator Allison Jensen on 04/09/2025 to complete the SB 484 inspection. LPA reviewed three staff files and conducted two staff interviews. LPA Jones-Steward issued no deficiencies regarding staff training or knowledge in the area of psychotropic medication handling. However one technical advisory was issued, This concludes the SB Inspection for 2025. Exit interview was conducted and the administrator was given a coy of this report.

met_with: Allison Jensen, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On May 14,2025, at 11:55 am, Licensing Program Analyst (LPA) Nestor Gomez arrived at the above facility, for the purpose of conducting an Annual Required Inspection on the TMHA - Youth Treatment Program (STRTP) facility. LPA Gomez met with Facility Manager (FM), Laila Ness who granted access to the facility. The annual fees are current. Together LPA and Facility Administrator (FA), Allison Jensen toured the home inside and out. The facility is a six-bedroom, four-bathroom single-story home with barn access in rural area. There are no swimming pools or bodies of water of the premises. The current census is four (4). During the time of inspection, LPA Nestor conducted an inspection of the following areas: Entry: contains required postings including personal rights, AED, house rules and complaint procedures, rug, and entry to staff office. Staff Office: contains desk, chairs, secured cabinets for medications, First aid kit, nails polish, old batteries, sharps, and nail products. There is also a secured cabinet for client files and door leading to the garage. Continue on 809-C (Page 1) Garage: contains three (3) computers for school, couch, TV, and door leading to storage space. This area contains emergency food supplies, generator, refrigerator, additional storage shelves and door to building exterior. Water heater is located here. Left Hallway: contains locked storage closet that holds extra first aid, hygiene and cleaning supplies. Leads to three client bedrooms, linen cabinet, and staff hallway. Bedroom #1: Bedroom is occupied by one (1) client, (C4). It contains a twin bed, dressers, and adequate closet space. Bedroom #2: Bedroom is occupied by one (1) client, (C1). It contains a twin bed, dressers, ceiling fan and adequate closet space. Bedroom #3: Bedroom is occupied by one (1) client, (C2). It contains a twin bed, dressers and adequate closet space. Bedroom #4: Bedroom is occupied by one (1) client, (C3). It contains a twin bed, dressers, and clothing rack. Bedroom #5: Bedroom is vacant. It contains a twin bed, dressers, and clothing rack. Bedroom #6: Bedroom is vacant. It contains a twin bed, dressers, and clothing rack. Bathroom #1: contains hampers, functioning toilet, double sinks, and shower with running water. Bathroom #2: contains functioning toilet, sink and shower with running water. Bathroom #3: contains functioning toilet, double sinks and shower with running water. LPA tested the water temperature in this restroom that came out to be 112 degrees Fahrenheit. Staff Hallway: leads to two office spaces, laundry area and staff bathroom. Therapist Office: Used for individual/family therapy. It is equipped with soundproofing tiles, couch, chairs, desk and door leading to exterior. Continue on 809-C (Page 2) Medication Room/Manager's Office: contains cabinets for locked medications, medication fridge, desk and chairs. Laundry Space: contains washer and dryer, storage cabinets for laundry supplies. Living room: contains adequate seating for clients, TV, Bookcases, rug, fireplace that is inaccessible to clients. Switch is in locked office. Kitchen/Dining room: contains center island with three chairs, dishwasher, four burner stove and oven in operating condition, refrigerator, and microwave. Adjacent to the refrigerator is a walk-in pantry. Menu is posted on the fridge. There are perishables for up to two day and non-perishables for up to a week. Fridge operates at 37 degrees and the freezer at 0. Grocery shopping is done weekly. There is adequate dinnerware for clients and secured cabinets for daily cleaning supplies. There are sliding glass door that leads to exterior. Right Hallway: leads to three client bedrooms, bathroom, and sensory room. Breakout/Sensory Room: contains large bean bags, activities and soundproof tiles. Clients are accompanied by staff in this room. Exterior: opens to large green area, there are tables and chairs, small fountain, and tortoise enclosure. Left side of property houses solar panels and standing wells of the far side of property which ladder are locked and inaccessible to clients. 1/3 of Barn: contains office, half bathroom and group therapy space. It contains a TV, couch, table, chairs and secured activity cabinets. There is a door leading to exterior. LPA additional observations: There is a total of seven (7) fire extinguishers located throughout the facility and each facility vehicle is equipped with a fire extinguisher. The water temperature tested from bathroom #3 was 112 degrees Fahrenheit. LPA observed the licensee test the smoke/carbon monoxide alarms. The main water valve is located by the side of the garage. There are no cameras located on the facility property. Continue on 809-C (Page 3) Vehicles: LPA Nestor inspected two (2) facility vehicles in total. 1. Honda Odyssey (Grey) with current registration that expires in 5/2/2026. Insured by Nonprofit Insurance Alliance of California that expires 7/01/2025. VIN (last 4): 8966. 2. Honda Odyssey (Grey) with current registration that expires in 5/8/2025. Insured by Nonprofit Insurance Alliance of California that expires 7/1/2025. VIN (last 4): 9287. At the time of the inspection this vehicle is not in use. Licensee showed proof that the registration was renewed for the vehicle, and they are waiting for the registration to come in the mail. Vehicles are in good condition with no issues. Staff Interview: LPA Nestor conducted two (2) staff interview with S3and S2. Client Interview: LPA Nestor conducted two (2) client interviews with C3 and C1. Due to time constraints, LPA Nestor will return to complete the inspection. There were no deficiencies observed or cited at this time. An exit interview was conducted, and a copy of this report was emailed to the FA. (Page 4)

met_with: Allison Jensen - Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On May 15, 2025, at 9:00 am, Licensing Program Analyst (LPA) Nestor Gomez returned to the above-mentioned facility to continue the annual inspection that was started on May 14, 2025. LPA Gomez met with Facility Administrator (FA), Allison Jensen who granted access to the facility. The following was observed during the Inspection: Staff Interview: LPA Nestor conducted two (2) staff interview with FA and S4. Staff Records Review: LPA reviewed four (4) staff records for the FA, S2, S3 and S4. Clients Records Review: LPA reviewed two (2) client records for C1 and C3 which meet qualification. PER California Code Regulation, there are two deficiencies to be cited at this time and one technical violation. See LIC809D for details. Exit interview was conducted with the Facility Administrator and a copy of this report was emailed to the Facility Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 11/25/25, at 11:55 am Licensing Program Analyst (LPA) Nestor Gomez made an unannounced inspection to the above-mentioned facility, for the purpose of conducting a Case Management inspection to address concerns regarding an incident reports that were received on 6/26/25. LPA met with Youth Rehab Specialist (S1), Jessica Moody, who granted access to the facility. LPA interviewed C4 and C2 in person during today's inspection. Statements were obtained and details about the incident were gathered. Exit interview was conducted and a copy of this report will be emailed the Facility Administrator, Alley Jensen.

met_with: Jessica Moody - Youth Rehab Spcialist


summary: Facility Evaluation

raw_content:
Narrative:
On 10/16/2025 at 9:17 am Licensing Program Analyst (LPA) Nestor Gomez made an unannounced inspection to the above-mentioned facility, for the purpose of following up on a Case Management inspection regarding an incident report that was received on 10/15/2025. LPA met with Millieu Social Worker (S1), Michaela Roy, who granted access to the facility. No further investigation or interviews are required on the above incident. PER California Code Regulation 80075(b)(5)(B), there is one (1) deficiency to be cited at this time. See 809-D. Exit interview was conducted and a copy of this report will be emailed the Facility Administrator, Allison Jensen.

met_with: Michaela Roy - Milieu Social Worker