facility_name: NIKKI'S ANGELS SMALL FAMILY HOME

raw_content:
Narrative:
****Continued from LIC 9099**** . During investigation, a confidential interview denied the FP threatened to spank the children in care. Another confidential interview stated that the LIC would threaten to spank FC3 and FC4 when they did not do their chores. A confidential interview stated the LIC would call FC1 and FC2 "stupid and a whore". However, another confidential interview stated the words "stupid or whore" were never used at the SFH. LPA received a conflicting information. Based on confidential interviews, the allegations the FP threatened to spank FC3 and FC4 and FPinappropriately to FC1 and FC2 may have happened or be valid, but there is not a preponderance of evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted. A copy of this report and appeal rights were explained and given to the Licensee, Nicole Wilson.

Investigation Findings:
13On January 7, 2025 at 1: PM, Licensing Program Analyst(LPA) Karen Beal met with Licensee Nichole Wilson to deliver the investigative finding for the above-stated allegations. On October 31, 2024, at 12: PM, LPA initiated the investigation at Nikki's Angels Small Family Home (SFH) and obtained pertinent documents from the facility files. LPA interviewed the foster parent (FP) and foster child 1 (FC1), foster child 2 (FC2), foster child 3 (FC3), attempted to interview foster child 4 (FC4) but was unable to due to FC4 limited ability to communicate. In addition, LPA interviewed the County Social Workers (CSW). On October 28, 2024, Community Care Licensing (CCL) received a complaint that foster parent threaten minor with physical harm and foster parent spoke inappropriately to minor in care. Specifically, it was alleged the Licensee (LIC) threatened to spank foster children and the LIC used inappropriate language towards FC1 and FC2. R- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION PACIFIC INLAND CR, MAIN ST., SUITE FACILITY NAME: NIKKI'S ANGELS SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 01/07/2025

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

met_with: Nichole Wilson, Licensee


state: CA

summary: Facility Evaluation

raw_content:
Narrative:
On October 31, 2024, at 1: PM Licensing Program Analyst (LPA) Karen Beal began a post licensing inspection for Nikki's Angels Small Family Home . LPA met with applicant Nichole Wilson who led a tour of the home. The facility was toured both inside and out with the applicants. Applicants are applying for a capacity of 4 ambulatory children and the house is a 5 bedroom two-story house: Downstairs: It consists of a kitchen; a closet, a bathroom, a pantry, dining room, living room; family room and the garage. Bedroom #1- it is vacant and it is located downstairs Upstairs: Bedroom #2- licensee's Bedroom Bedroom #3- foster children's room FC1 and FC2- two twin beds Bedroom #4 foster children's room FC3 and FC4- two twin beds Bedroom # Bio daughter room Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. Outside the bedrooms, there is a laundry room. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items will be stored upstairs in the laundry room and have been properly made inaccessible, children will not have access. Medication lockbox were locked and stored in downstair closet. Sharp knives were inaccessible and stored downstairs in a locked box in the pantry. First Aid kit expires on 02/2026 on was accessible with all required items and is located in the washroom. A Fire extinguisher was observed and properly charged. They are located in the kitchen and in the upstairs hallway. There were no guns or weapons as stated by licensee. The hot water temperature was tested and noted to be 118 degrees. Trash cans for storage of solid waste have tight fitting lids. ***Continued to LIC 809-C*** ***Continued from LIC 809*** The Emergency Disaster Plan with exit map, Personal Rights, client list, License, and visitation policies were posted at this time. The home have a telephone service at this time. The backyard where children will have access to play is completely fenced and free of hazards. There is no pool or other body of water. Exit interview conducted and a copy of this report was discussed and provided to Nichole Wilson, licensee.

report_type: Facility Evaluation


summary: Facility Evaluation

raw_content:
Narrative:
On October 6, 2025, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at Nikki's Angels Small Family Home (SFH) pre-licensing inspection for change in capacity. Currently, there are four clients in placement. The home was licensed for a capacity of four ambulatory clients. The licensee is applying to be licensed for a capacity increase from four to six ambulatory clients. The Facility was toured both inside and out with the licensee. The home is a two-story building with five bedrooms and four full bathrooms. During the inspection, LPA observed that the downstairs consisted of the kitchen, a living room, a family room, a dining area and one bedroom. Bedroom #1 was vacant, and it consisted of two twin-sized beds, it would sleep two clients, it was vacant. Medications were stored in a locked box in the storage. Sharp knives were inaccessible and stored in a locked in the pantry. The garage was inspected and used as storage. The water temperature was tested and measured at 112 degrees F. LPA observed a minimum of seven-day non-perishable and a three-day perishable supply of food. There was a variety of snacks available for clients. In addition to the downstairs space, there was also one full bathroom fully functioning and large space under the stairs used as a storage. A trash can was observed to have tight fitting cover. The following required posted items were observed accessible to clients: personal rights, visitation policy, and current menu. The clients' medication log records were kept updated with no discrepancy. Two fire extinguishers were observed and operable. Upstairs was bedroom #2, it was fully furnished with one king-size bed, a full bath; it sleeps licensee. Bedroom #3, it was fully furnished with one twin and one full size beds; it sleeps two clients. Bedroom #4 was fully furnished with two twin-sized beds, a closet and plenty of storage space. It sleeps two clients. Bedroom #5 sleeps a biological daughter seventeen-year-old and was fully furnished, a closet, storage space. The First Aid Kit was in a cabinet and contained all required items. The licensee's bedroom is not accessible to the clients. All bedrooms were arranged for one child per bed. No room was commonly used for other purposes other than a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for each child's belongings. The smoke and carbon monoxide detectors were checked and working. Cleansers/chemicals were locked and stored in the laundry room. The upstairs space includes an additional bathroom used by the clients. All hazardous items have been properly made inaccessible to areas where clients have access. All windows and screens were in good repair. Licensee states that there are no guns/weapons in the home. There was a total of five cameras, one located outdoors, and four indoors, which met the title 22 camera policy. The facility outside grounds were also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. Based on today's inspection and observations, there are no deficiencies being cited at this time. The request to increase capacity to six ambulatory clients will be discussed with the Licensing Program Manager for final approval.

visit_type: Case Management

met_with: Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On January 29, 2026,at 9: AM, Licensing Program Analyst (LPA) Karen Beal arrived at Nikki's Angels Small Family Home to conduct a Random annual inspection. LPA met with Licensee, Nichole Wilson who led a tour of the home. The facility was toured both inside and out with the Licensee. The house is a 5-bedroom two-story house: Downstairs: It consists of a kitchen; a closet, a bathroom, a pantry, dining room, living room, family room, and the garage. Bedroom #1- it is vacant and it is located downstairs Upstairs: Bedroom #2- licensee's Bedroom Bedroom #3- foster children's room FC1 and FC2- One full size bed and a twin bed Bedroom #4 foster children's room FC3 and FC4- two twin beds Bedroom # Bio-daughter room Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No bedroom serves as a passageway to another room. There are adequate drawers and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items will be stored upstairs in the laundry room and have been properly made inaccessible; children will not have access. ***Continued to LIC 809-C*** ***Continued from LIC 809*** Medication lockboxes were locked and stored in downstair closet. Sharp knives were inaccessible and stored downstairs in a locked box in the pantry. First Aid kit expires on 02/2028 and a locked cabinet in the in the laundry room. A Fire extinguisher was observed and properly charged. They are in the kitchen and in the upstairs hallway. There were no guns or weapons as stated by licensee. The hot water temperature was tested and noted to be 119 degrees. Trash cans for storage of solid waste have tight fitting lids. The Emergency Disaster Plan with exit map, Personal Rights, client list, License, and visitation policies were posted at this time. The home has a landline telephone service. The backyard where children will have access to play is completely fenced and free of hazards. There is no pool or other body of water on the premises. Exit interview conducted and a copy of this report was discussed and provided to Nichole Wilson, licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On April 10, 2026, at 10: AM, Licensing Program Analyst (LPA) Karen Beal arrived at Nikki's Angels Small Family Home to conduct a two year annual inspection. LPA met with Licensee, Nichole Wilson who led a tour of the home. The facility was toured both inside and out with the Licensee. The house is a five bedroom two-story house: Downstairs: It consists of a kitchen; a closet, a bathroom, a pantry, dining room, living room, family room, and the garage. Bedroom #1- Foster Child bedroom has a queen size bed and a twin bed and sleeps a Non-minor dependant Upstairs: Bedroom #2- Master Bedroom, has a California King bed and sleeps the Licensee Bedroom #3- foster children's bedroom, has two twin beds and sleeps foster children FC1 and FC Bedroom #4 foster children's bedroom , has two twin beds and sleeps foster children FC2 and FC Bedroom # Adult relative room, has a queen size bed Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No bedroom serves as a passageway to another room. There are adequate drawers and closet space for children's belongings. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items will be stored upstairs in the locked laundry room and have been properly made inaccessible. ***Continued to LIC 809-C*** ***Continued from LIC 809*** Medication lockboxes were locked and stored in downstair closet. Sharp knives were inaccessible and stored downstairs in a locked box in the pantry. First Aid kit expires on 02/2028 and a locked cabinet in the in the laundry room. A Fire extinguisher was observed and properly charged. They are in the kitchen and in the upstairs hallway. There were no guns or weapons as stated by licensee. The hot water temperature was tested and noted to be 117.3 degrees. Trash cans for storage of solid waste have tight fitting lids. The Emergency Disaster Plan with exit map, Personal Rights, client list, License, and visitation policies were posted at this time. The home has a landline telephone service. The backyard where children will have access to play is completely fenced and free of hazards. There is no pool or other body of water on the premises. LPA reviewed staff and foster children's files Exit interview conducted and a copy of this report was discussed and provided to Nichole Wilson, licensee.


facility_name: NIRVANA FAMILY HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Confidential witnesses informed LPA that S1 yelled at C1 when S1 became upset with C1. Furthermore, an additional confidential witness stated that S1 yelled at C1 when C1 yelled at S1. S1 admitted to yelling at C1 when C1 was being verbally aggressive toward S1 and other clients. Regarding the allegation that S1 slammed a video game console on the ground confidential witnesses informed LPA that S1 slammed a video game console on the ground. S1 admitted to slamming a video game console on the ground when C1 did not want to share the video game console with another resident of the SFH. LPA received conflicting information regarding S1 refusing to speak to C1 and slamming a door in C1's face. Based on confidential interviews and record review the preponderance of evidence standard has been met and the allegations that resource parent yelled at minor and resource parent does not treat minor with dignity or respect are substantiated. The facility is being cited for violation of Title Regulations 80072(a)(3) Personal Rights and 80072(a)(1) Personal Rights. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Kezia Houzell. Confidential witnesses informed LPA that clients were fed daily and provided at least three meals a day. County social worker (CSW) informed LPA that CSW was never informed of a shortage of food in the SFH or that clients were limited on their food intake. SFH staff denied the allegation. Another confidential witness informed LPA that on one occasion C1 was not fed dinner. Regarding the allegation that S1 was going through C1's belongings confidential witnesses informed LPA that C1 sometimes sneaks food to C1's bedroom and candy wrappers had been found in C1's bedroom. CSW stated that C1 would sneak food to C1's bedroom so S1 would check to ensure that C1 didn't hide food. CSW stated that she didn't have concerns with SFH staff, not according C1 privacy. Another confidential witness stated that S1 went through C1's belongings often. LPA received conflicting information regarding both allegations. Based on confidential interviews the allegations resource parent resource parent is not providing adequate meals to minor and resource parent is not according privacy, may have occurred, however, they are not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Kezia Houzell.

Investigation Findings:
13On August 13, 2025, at 10: AM Licensing Program Analyst (LPA) Michael Almaraz met with Nirvana Small Family Home (SFH) Licensee, Kezia Houzell, to issue the finding for the above allegations involving clients (C1, C2, C3) listed on the confidential names list (LIC 811) dated August 13, 2025. The complaint was jointly conducted by LPA Almaraz and LPA Rachel Vanegas On April 21, 2025, at 10: AM LPA Vanegas conducted a health and safety inspection of the SFH, and no immediate health and safety hazards were observed. During the investigation LPA Almaraz reviewed three clients (C1, C2, C3) records. Additionally, LPA conducted interviews with two SFH staff, two county social workers, and three of three clients On April 16, 2025, the Department received a complaint alleging resource parent yelled at minor, and resource parent does not treat minor with dignity or respect. It was specifically alleged that staff 1 (S1) threw a video game console onto the ground and yelled at C1. Also, the following day S1 refused to speak to C1 and slammed a door in C1's face. (continued on page 2...) SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Michael Almaraz LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 61-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: NIRVANA FAMILY HOMEFACILITY NUMBER: VISIT DATE: 08/13/2025

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

report_type: Complaint Investigation

met_with: Kezia Houzell

complaint_status: unsubstantiated


raw_content:
Narrative:
County social worker (CSW) stated that they were never informed that minors were locked out of the SFH. County social worker 2 (CSW2) informed LPA that they did not have suspicions of abuse or personal rights violations occurring in the SFH. Other confidential witnesses informed LPA that C1 and C3 were in the backyard and when they went to enter the SFH they could not enter due to the backdoor being stuck which caused them to be locked outside for 10 minutes. Furthermore, it was disclosed to LPA that S1 was present but did not immediately respond to C1 and C3's calls for assistance. LPA received conflicting information regarding the allegation. Based on confidential interviews the allegation staff locked minors outside of the facility, may have occurred, however, it is not supported or proven by evidence. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Kezia Houzell.

Investigation Findings:
13On August 22, 2025, at 9: AM Licensing Program Analyst (LPA) Michael Almaraz met with Nirvana Small Family Home (SFH) Licensee, Kezia Houzell, to issue the finding for the above allegation involving clients (C1, C2, C3) listed on the confidential names list (LIC 811) dated August 22, 2025. The complaint was jointly conducted by LPA Almaraz, LPA Linda Haynes, and LPA Rachel Vanegas. On March 14, 2025, at 2: PM LPA Haynes conducted a health and safety inspection of the SFH, and no deficiencies were observed. During the investigation LPA Almaraz reviewed three clients (C1, C2, C3) records. Additionally, LPA conducted interviews with two SFH staff, two county social workers, and three of three clients. On March 6, 2025, the Department received a complaint alleging staff locked minors outside of the facility. It was specifically alleged that C1 and another minor were locked outside the SFH. Confidential witnesses informed LPA that S1 was present and inside the SFH while C1 and C3 were in the backyard but when C1 and C3 went to enter the SFH the screen door was stuck preventing the minors from entering. (continued on page 2...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jennifer Smith LICENSING EVALUATOR NAME: Michael Almaraz LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 61-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION RIVERSIDE N CRP RO, MAIN ST., SUITE FACILITY NAME: NIRVANA FAMILY HOMEFACILITY NUMBER: VISIT DATE: 08/22/2025

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


summary: Facility Evaluation

raw_content:
Narrative:
On Monday February 26, Licensing Program Analyst (LPA) Linda Haynes met with Applicant Kezia Houzell via Microsoft Teams to complete a component II interview. LPA discussed applicants fingerprints. A signed copy of this form will be placed in applicants file.


summary: Facility Evaluation

raw_content:
Narrative:
On April 12, 2024 at 12: PM, Licensing Program Analyst (LPA) Linda Haynes completed a pre-licensing inspection of Nirvana Small Family Home. LPA met with Applicant Kezia Houzell who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients in placement. The home is a two story building with four bedrooms and three bathrooms which are set up as follows: · Bedroom #1 (Applicants) has one bed will sleep the applicant. · Bedroom #2 (Client's) has two bed, it will sleep two client's. · Bedroom #3 (Client's) has two bed, it will sleep two client's. · Bedroom #4 (Client's) has two bed's, it will sleep two client's. · A great room/living room, kitchen, dining area, three bathrooms, laundry room, a loft/office, three car garage and the backyard. The Client's bedrooms were arranged so that no more than two client's will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. There was a smoke detector/carbon monoxide detector in every bedroom. The seven smoke detectors/carbon monoxide detectors were checked, and they were working properly. The home is equipped with a fire sprinkler system. The home's central air conditioning module was located in the back yard. The home's tank less hot water heater was located the garage. The appliances were in working order. The client's files will be locked inside a filing cabinet in the office. There was adequate food storage space and a supply of two days of perishable foods and a week of non-perishable foods. A trash can for storage of solid waste had a tight-fitting lid and was present. The sharp knives will be in a locked drawer in the kitchen. The medications will be located in a locked cabinet the applicants bathroom. The hot water in bathroom one measured to be 109.7 degrees Fahrenheit, bathroom two was 117.5 degrees Fahrenheit, and in bathroom three 115.4 degrees Fahrenheit. The home's First Aid kit was accessible and is located in the kitchen and contained all required supplies. There are two fire extinguisher present in the home one is located in the kitchen by the kitchen cabinets and the second is located in the upstairs laundry room. They were observed to be properly charged and inspected by the fire department. Licensee stated there were no weapons/firearms in the home. There is no pool or other body of water at the home. The backyard where clients will have access to play is fenced. There are no corrections that need to be made at this time A Component III was completed. An exit interview was conducted. Application will be forwarded to the Licensing Program Manager for Licensing.

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On April 21, 2025 at 10: AM, Licensing Program Analyst (LPA) Rachel Vanegas, arrived unannounced at Nirvana Family Home, Small Family Home (SFH) for the purpose of conducting a post licensing annual inspection. LPA met with the licensee Kezia Houzell who led a tour of the facility both inside and outside. The facility is a two story home with the following layout: First story contains: a living room also used as a recreational space and contains board games, card games, etc. that were observed to be safe, clean, and age appropriate for the children in care, one restroom, bedroom #1, the kitchen, a pantry, a locked drawer that stores sharps/knives, a locked storage cabinet that stores cleaning chemicals and laundry detergent, a locked access door to the attached garage that children in care do not have access to. Bedroom #1 - Has two single beds that sleeps one client and has one vacant bed. There is adequate storage space for personal belongings in drawers and a closet. The second story contains: Bedroom #2, Bedroom #3, Bedroom #4, two additional restrooms, one play area/loft with a desk space that the Licensee utilizes for work. Bedroom #2 - has one bed and sleeps the Licensee. Client medications and staff/client files are double locked and located in the Licensee's bedroom where clients in care do not have access. Bedroom #3 - Has two single beds that sleeps two clients. There is adequate storage space for personal belongings in drawers and a closet. Bedroom #4 - Has two single beds that will sleep two clients and is currently vacant. All bedrooms are arranged so that no more than two clients are in a room and there is one client per bed. **.** LPA observed an adequate supply of perishable and non-perishable foods and posted meal menus in the kitchen. There was a trash can for storage of solid waste with a tight-fitting lid located in the kitchen. The first aid kit is located in a kitchen cabinet and contained all of the required materials. LPA also observed other required postings in the kitchen including the facility license, foster youth personal rights, Complaint Hotline, etc. There are combination smoke detector/carbon monoxide detectors in every bedroom and hallway. The smoke detector/carbon monoxide detectors were tested and are in properly functioning order. There are two fire extinguishers in the home that are observed to be properly charged. One is located in the kitchen on the first floor and one is located in the laundry room on the second floor. The home has a tankless water heater located inside the garage and the temperature is set to 120 degrees Fahrenheit. The hot water temperature was checked in the kitchen and registered at 114.9 degrees Fahrenheit. Telephone services and appliances were in working order at the time of this inspection. The facility outside grounds were also inspected and were observed to be clean and well maintained. Emergency exits were free from obstruction. There is no pool or other body of water. LPA conducted three client file reviews for Client 1 (C1), Client 2 (C2), Client 3 (C3) and observed the needed documents in the files including, consent to medical treatment authorization forms, placement agreements, signed personal rights form, etc. Three out of three files (C1, C2, C3) did not contain documented results of tuberculosis (TB) screening or Needs and Services Plan's signed by authorized representatives. LPA conducted two staff file reviews for Staff 1 (S1) and Staff 2 (S2). LPA observed that two out of two staff files contained needed documents including CPR/First Aid certificates, Drivers License, Job Duties, Health Screening, etc. LPA provided technical assistance and discussed with the Licensee the importance of ensuring easy access for documentation required on Medication Administration Records and Psychotropic Medication Administration Records for proper compliance with Client Records. **** Based on observation and record review, the facility is being cited one Type B violation in accordance with California Code of Regulations (CCR) (Title 22) 80069(c)(1) for not having documentation of a medical/TB examination on file for C1, C2, and C3 within 30 days of admission. The facility is issued one technical violation in accordance with CCR Section 83068.2(b)(12) for C1, C2, and C Needs and Services plan not having authorized representative signatures. An exit interview was conducted and a copy of this report, LIC 811, and appeal rights were reviewed and provided to the Licensee - Kezia Houzell.

visit_type: Annual

met_with: Licensee - Kezia Houzell


summary: Facility Evaluation

raw_content:
Narrative:
On June 13, 2025 at 1:25pm, Licensing Program Analysts (LPAs) Rachel Vanegas and Carissa Aviles arrived unannounced at Nirvana Family Home, Small Family Home (SFH) for the purpose of conducting client interviews for the annual inspection conducted on 04/21/2025. LPAs conducted three client interviews. An exit interview was conducted and a copy of this report, Confidential Names List (LIC 811), and appeal rights were reviewed and provided to the Licensee - Kezia Houzell.

met_with: Kezia Houzell - Licensee


facility_name: NOBLE SMALL FAMILY HOME

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Regarding the allegation that LS refused to pick up FC1, it was specifically reported that FC1 was found at the Metrolink Train Station attempting to go to Los Angeles. Law Enforcement contacted the licensee who was at work and hesitant about leaving work to pick up the foster child, and she stated that she gets off work at 5: PM. During investigation, confidential interview stated FC1 left the home unauthorized. The confidential interview continued stating that FC1 refused to be picked up and decided not to return home due to LS not allowing FC1 to smoke. A confidential witness observed FC1's effort to smoke in the home. The confidential witness believed FC1 did not want to return home due to structural reasons. Based on confidential interviews, the allegation that LS refused to pick up FC1 may have occurred, however, there was not a preponderance of evidence to prove that the violation occurred. Therefore, the allegation is unsubstantiated at this time. An exit interview was conducted and a copy of this report LIC 9099 was discussed and provided to LS.

Investigation Findings:
13On August 15, 2025, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at Noble Small Family Home (SFH) and met with SFH Licensee (LS) Mercedes Noble to deliver the investigative finding for the above stated allegation involving the Small Family Home and foster child listed on the confidential list (LIC811) dated August 15, 2025. On Apil 25, 2025, a complaint report was referred to Community Care Licensing (CCL) alleging Licensee is refusing to pick up minor. On May 5, 2025, LPA Babatunde Aborchie arrived at the SFH to initiate investigation, conducted a safety inspection and interviewed LS. In addition, LPA interviewed a county social worker (CSW). LPA was unable to interview foster child 1 (FC1) due to FC1 being out of state. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Babatunde Aborchie LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, MAIN ST., SUITE FACILITY NAME: NOBLE SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 08/15/2025


summary: Facility Evaluation

raw_content:
Narrative:
On August 10, Licensing Program Analyst (LPA) Babatunde Aborchie, met with applicant Mercedes Noble this date for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the LIC 184, Notice of Incomplete Application, and additional correspondence to assist with the revisions needed for the application. Copy of this report was provided to applicant.

met_with: Mercedes Noble


summary: Facility Evaluation

raw_content:
Narrative:
On November 29, 2023 at 10: AM Licensing Program Analyst (LPA) Babatunde Aborchie began a Pre-Licensing inspection for a Small Family Home license. LPA met with applicant Mercedes Noble who led a tour of the home. The facility was toured both inside and out with the applicant. Applicant is applying for a capacity of 3 ambulatory clients. The home is a single story, it consists of: Bedroom #1, It was furnished with a twin size bunked bed. It sleeps two legal guardianship children of ages 11 and 15 years. Bedroom #2, The room consisted of two twin beds. It will sleep two residents - vacant. Bedroom #3, The room was furnished with a twin bed and a crib. It sleeps applicant. There were also a family room, a living room, dining area and two bathrooms. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in a locked box in the hallway closet. Cleansers/chemicals were locked and stored in the kitchen cabinet under the kitchen sink. Sharp knives were inaccessible and stored in a locked box in the kitchen closet above the refrigerator. There were no guns or weapons as stated by applicant at this time. The hot water temperature was tested and noted to be 118 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items, and it was in the hallway cabinet. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed for small family home will be forwarded to Licensing Program Manager for final approval. A component III orientation was conducted with applicant. An exit interview was conducted. A copy of this report was provided to Applicant/Licensee

met_with: Merceddes Noble


summary: Facility Evaluation

raw_content:
Narrative:
On May 30, 2024, at 11: AM, Licensing Program Analyst (LPA) Joon Choi arrived at Noble Small Family Home to conduct an inspection in regards to a request for a non-ambulatory status. LPA met with applicant Mercedes Noble who led a tour of the home. The facility was toured both inside and out with the applicant. Applicant is converting one room to a non-ambulatory room approved by the Fire Department. The home is a single story facility, and it consists of: Bedroom #1, It was furnished with a twin size bunked bed. It sleeps two legal guardianship children of ages 11 and 16 years. Bedroom #2, The room consisted of two twin beds. It will sleep two residents - vacant. Bedroom #3, The room was furnished with a twin bed and a crib. It sleeps applicant. (crib is vacant) Bedroom #4, (Please note, applicant has received fire clearance to modify / re-classify the pre-existing family room into Bedroom #4). After applicant receives approval for their updated license to place non-ambulatory client(s), this room will house one non-ambulatory client who is awaiting placement. The facility also had a living room, kitchen, dining area, two bathrooms, two car garage and backyard. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in a locked box in the hallway closet. Cleansers/chemicals were locked and stored in the kitchen cabinet under the kitchen sink. Sharp knives were inaccessible and stored in a locked box in the kitchen closet above the refrigerator. There were no guns or weapons as stated by applicant at this time. The hot water temperature was tested and noted to be 118 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items, and it was in the hallway cabinet. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced and free of hazards. There were no deficiencies to be cited at this time. The request to change one room to a non-ambulatory room will be discussed with the Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Applicant/Licensee.

met_with: Mercedes J. Noble, Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On May 29, 2025, Licensing Program Analyst (LPA) Babatunde Aborchie arrived at Noble Small Family Home (SFH) pre-licensing inspection for a relocation. Currently, there are two clients who are under legal guardianship with the licensee, and the home is licensed for a capacity of four clients (one non-ambulatory and three ambulatory clients). The Facility was toured both inside and out with the licensee. The home is a two-story building with five bedrooms and three bathrooms. During the inspection, LPA observed that the downstairs consisted of the kitchen, a den, a living room, a dining area with a large table and one bedroom. Bedroom #1 was vacant, and it consisted of a full-size bed, it will sleep one non-ambulatory client, it has an exit door to the outside. The medications will be stored and locked in a metal storage safe located in the bedroom #1. Sharp knives were inaccessible and stored in a locked cabinet in under the kitchen sink. The First Aid Kit was in the downstairs closet and contained all required items. The garage was inspected and used for cars. The water temperature was tested and measured at 110 degrees F. LPA observed a minimum of seven-day non-perishable and a three-day perishable supply of food. There was a variety of snacks available for clients. In addition to the downstairs space, there was also one full bathroom fully functioning and hallway closets used for storage. A trash can was observed to have tight fitting cover. The following required posted items were observed accessible to clients: personal rights, visitation policy, and current menu. The clients' medication log records were kept updated with no discrepancy. Eight fire extinguishers were observed and operable. The downstairs consisted of a laundry room that always remained locked. The upstairs was a master bedroom #2 for licensee and spouse and it consisted of a king size bed and a bathroom; The licensee's bedroom is not accessible for the clients; bedroom #3 was fully furnished with a queen size bed, a closet and plenty of storage space. It will sleep one client, it was vacant. Bedroom #4 sleeps a seventeen-year-old male client and a twelve-year-old both under legal guardianship and was fully furnished with two twin beds, a closet, storage space. All bedrooms were arranged for one child per bed. No room was commonly used for other purposes other than a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawer and closet space for each child's belongings. The smoke and carbon monoxide detectors were checked and working. Cleansers/chemicals were locked and stored in the laundry room. The upstairs space includes an additional bathroom used for the clients. All hazardous items have been properly made inaccessible to areas where clients have access. All windows and screens were in good repair. There were no guns or weapons in the home as stated by Licensee. There was a total of five cameras, all located outdoor which meet the title 22 camera policy. The facility outside grounds were also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. Clients' files and staff files were reviewed and found to comply. Based on today's inspection and observations, there are no deficiencies being cited at this time. An exit interview was conducted, and a copy of this report was discussed and provided to Licensee.


facility_name: NOJA'S SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On February 4, 2022 at 8: AM Licensing Program Analyst (LPA) Babatunde Aborchie, met with licensee Ms. Noja Anjannette Nash, who led a tour of the home. The purpose of the visit was to conduct an annual inspection of the Noja's Small Family Home. The facility was toured inside and out with the licensee. Currently, there are no clients in the home. The home is set up as follows: · Bedroom #1- Adult son's bedroom with queen bed. Located downstairs - Vacant. · Bedroom #2- Master suite w/full bath. Licensee's bedroom. Located upstairs. · Bedroom #3- Client(s) bedroom has bunk beds and crib. All vacant. Located upstairs. · Bedroom #4- Client(s) bedroom had two cribs and queen bed. All vacant. Located upstairs. · Bedroom #5- Daughter's bedroom with queen bed. Located upstairs - Vacant. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawer and closet space for children's belongings. The fireplace was properly screened. All hazardous items have been properly made inaccessible to areas where children will have access. Cleansers/chemicals were locked and stored in the locked laundry room. Sharp knives are inaccessible and stored in locked closet near laundry room. The first aid kit is located in the locked kitchen closet. There were no guns or weapons as stated by licensee at this time. The hot water temperature was tested and noted to be within regulatory requirements. Proper storage of all food was noted. Trash cans for storage of solid waste had tight fitting lids. The smoke detectors located in the hallways were tested and were in good working order. The carbon monoxide detector located downstairs was also operable. The Emergency Disaster Plan with exit map, Title Personal Rights, and visitation policies were posted at this time. The backyard where children will have access to play is completely fenced and free of hazards. There were no bodies of water on the premises. In accordance with Title 22, Division 6, Chapters 1 & 4 there were no deficiencies being cited at this time. Exit interview conducted and a copy of this report along with a Confidential Names List (LIC 811) was provided to facility licensee.


summary: Facility Evaluation

raw_content:
Narrative:
On April 25, 2023 at 4: PM Licensing Program Analyst (LPA) Karen Beal, met with licensee Noja Nash, who led a tour of the home. The purpose of the visit was to conduct an annual inspection of the Nojas Small Family Home (SFH). The facility was toured inside and out with the licensee. Currently, there are no clients in the home. The home is set up as follows: · Bedroom #1- Adult son's bedroom with queen bed. Located downstairs. · Bedroom #2- Master suite Bedroom # Adult daughter's bedroom located upstairs · Bedroom #4- Client(s) vacant at this time Bedroom #5- Client (s)vacant at this time Loft area is currently being used for office space Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The fireplace is properly screened. All hazardous items have been properly made inaccessible to areas where children will have access. The medications are locked and stored in locked in hall closet Cleansers/chemicals are locked and stored in the locked laundry room. Sharp knives are inaccessible and stored in locked closet near laundry room. The first aid kit is located in the locked kitchen closet. There are no guns or weapons as stated by licensee at this time. Proper storage of all food. . The smoke detectors are good condition. The carbon monoxide detector located downstairs in good condition. The Emergency Disaster Plan with exit map, Title Personal Rights, and visitation policies are not posted at this time. The backyard is completely fenced and free of hazards. There is no bodies of water on the premises. CPR card expires April First Aid card is combined with CPR card due to licensee is in the medical field. In accordance with Title 22, Division 6, Chapters 1 & 4 there are no deficiencies being cited at this time. Upon receiving any clients the licensee will ensure that all licensing regulations are in compliance. Exit interview conducted and a copy of this report along with a Confidential Names List (LIC 811) was provided to facility licensee, Ms. Nash, appeal rights given and explained.

met_with: Noja Nash, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with Mrs. Becky Norris to commence the annual Inspection. However since the children in the home were recently exposed at Sierre Madre Jr. High and the home is under quarantine, the visit was abbreviated. There are currently no children under foster placement. There are two children under adoptive placement. There are no bodies of water and no fire arms in the home. There are no security bars on windows. Smoke alarms and carbon monoxide detectors are working. There is an alarm system serviced by POST. The home is currently under remodeling, due to be completed in early October. Inspection will be continued at that time

met_with: Mrs. Norris


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward arrived at the facility at 11: AM to check on the progress of the home renovations. Ms. Norris was not at home so LPA reached her by telephone. Ms. Norris stated that the completion of her renovations were delayed by 14 days because after her children had been quarantined due to COVID exposure, the workmen would not resume work until the children were cleared. Ms Norris stated that she did approach the City of Pasadena to inquire if she needed any permits and she was told that she did not because the work being done to her home is solely cosmetic not structural. The only things being changed are paint and plaster. Ms. Norris stated that the children are protected from the renovation materials. Their room is not being worked on and they are not allowed into the areas that are receiving work. She also said that when the workmen leave for the day, they take their materials and equipment with them. The inspection will be continued once renovations are complete.

met_with: Becky Norris


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with licensee Becky Norris to complete the annual inspection. There are currently no children under foster placement. There are two children under adoptive placement. There are three bedrooms and two bathrooms. Bedroom #1 is occupied by the licensee and her spouse Bedroom #2 is occupied by Child #1 and #2. It has two twin beds with all the required linens. Bedroom #3 is currently unoccupied. The home is currently under renovation which has been prolonged due to licensee not being able to obtain needed materials because of the national supply chain crisis. Per licensee, all building materials are put away when the workmen leave in the evenings. Therefore they are not accessible to clients. There are no bodies of water and no fire arms in the home. There are no security bars on windows. Smoke alarms and carbon monoxide detectors are working. There is an alarm system serviced by POST. LPA tested the water temperature and had the licensee lower it to between 105 and 120 degrees. LPA observed a full first aid kit. Licensee records were reviewed. Licensee has current caregiver training. Licensee is unable to locate her First Aid/CPR cards but will email them to the Department within 24 hours. There were no deficiencies found as a result of this inspection


summary: Facility Evaluation

raw_content:
Narrative:
On June 14, 2022 at 10:41am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Norris Small Family Home for the purpose of conducting an Annual Random Inspection. LPA met with Becky Norris, Licensee who granted access and together a tour of the facility was conducted. The facility is licensed to provide care and supervision to four (4) children, ages 3-15 years of age, with emotional and developmental disabilities, ambulatory only. The census on the day of this visit is zero (0). The facility is set up as follows: This is a one-story home with a living room/dining area, kitchen, laundry room, three (3) bedrooms, and two (2) bathrooms, and detached garage. Living Room: Equipped with a sofa chair and tables. All furniture is in good repair. Dining Area: Equipped with a table and five (5) chairs. All furniture is in good repair. Kitchen: Equipped with a refrigerator/freezer and a four (4) burner stove and microwave oven. Laundry Room: Equipped with a washing machine and a dryer in good repair. Bedroom #1: Occupied by licensee. Equipped with a queen size bed. There is adequate closet, dresser drawer space, and lighting. Bedroom #2: Occupied by two (2) male adoptive placement's. Equipped with two twin sized beds. There is adequate closet, dresser drawer space, and lighting. Bedroom #3: Vacant. Equipped with two twin sized beds. There is adequate closet, dresser drawer space, and lighting. Continued on LIC 809-C Bathroom #1: Equipped with an operable toilet and tub/shower combination. Clean, sanitary, and in good condition. Bathroom #2: Equipped with an operable toilet and shower. Clean, sanitary and in good condition. Detached Garage: Clean and free of debris. Used for storage. The facility was inspected, and the following was observed: All beds have comfortable mattresses, clean linens, blankets, and pillows that are in good repair. The home is clean, safe, and sanitary. Knives, cleaning solutions, and medication are inaccessible to children. Licensee has an appropriate First Aid kit in the home which also contain scissors, tweezers, and a thermometer. Hot water temperature was tested and is within a safe range. The facility has two (2) fully charged regulation fire extinguishers. Smoke/carbon monoxide detectors tested audible and operable. There are no security bars on the windows. There are no firearms or dangerous weapons in the home. Outdoor activity space is free of obstructions and hazards. There is no swimming pool on the premises. All posting requirements have been met. The home is operating within the capacity and limitations of the license. Caregiver(s)/adults working/residing in the facility have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. Licensee has two (2) youth under guardianship ages 14 yrs. and 15 yrs. old. Licensee states that they are in the adoption process and the adoption will be finalized by October 2022. LPA advised Licensee of licensing fees due by August 27, 2022 of $454.00. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit Interview was conducted, and a copy of this report will be emailed to the Licensee.

met_with: Becky Norris-Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On August 19, 2024 at 11: AM, Licensing Program Analyst (LPA), Cheri Wilkerson and Licensing Program Manager (LPM), JoAunne Griffin made an unannounced visit to Norris Small Family Home for the purpose of conducting an Annual/Random Inspection. LPA and LPM met with Becky Norris, Licensee who granted access and together a tour of the home was conducted. A health and safety assessment was conducted. The facility is set up as follows: This is a one-story home with a living room/dining area, kitchen, laundry room, three (3) bedrooms, and two (2) bathrooms, and a detached garage. Living Room: Equipped with a sofa, two (2) chairs, table, and a covered inoperable fireplace. Dining Area: Equipped with a table and four (4) chairs. Kitchen: Equipped with a refrigerator/freezer, four (4) burner stove, microwave oven, dishwasher, and ample cabinet space. Laundry Room: Equipped with a washing machine, dryer, and ample cabinet space. Bedroom #1: Occupied by Licensee and Adult #1. Bedroom is equipped with a full-size bed. There is adequate closet, dresser drawer space, and lighting. Bedroom #2: Occupied by two (2) male legal guardianship placements. Bedroom is equipped with trundle bed with two (2) twin sized mattresses. There is adequate closet, dresser drawer space, and lighting. Bedroom #3: Vacant. Bedroom is equipped with one (1) full-size bed. There is adequate closet, dresser drawer space, and lighting. Continued on LIC 809-C Bathroom #1: Bathroom located next to the laundry room is equipped with an operable toilet and shower. Bathroom was observed to be clean, sanitary, and in good condition. Bathroom #2: Bathroom located in the hallway was equipped with an operable toilet and tub/shower. Bathroom was observed to be clean, sanitary and in good condition. Detached Garage: Cleaning supplies, knives, and drinking alcohol was observed to be stored in garage an inaccessible to children in care. Garage has had recent water damage. Items are stored in six (6) sheds located in the backyard. Licensee is in the process of having repairs made and selling items currently stored. The facility was inspected, and the following was observed: The facility was observed to be clean, safe, and sanitary. Water temperature was tested and is within a safe range. The facility has one (1) fully charged regulation fire extinguisher. Smoke and carbon monoxide detectors were observed to be operable. There are no firearms or dangerous weapons in the home. Front outdoor activity space is free of obstructions and hazards. Backyard outdoor space is currently being used to store items that were placed in the garage due to recent water damage and repairs. Front outdoor space is used by children in care for activity space. There are no bodies of water on the premises. License issued by Community Care Licensing Division, Personal Rights, and Disaster Plan was posted. The home is operating within the capacity and limitations of the license. Licensee has been advised that capacity will need to be reduced due to available bed space. LIC 200 will be provided. Licensee and Adult #1 have DOJ/FBI criminal record clearances and Child Abuse Index Checks. There were no deficiencies cited at this time. An exit Interview was conducted, and a copy of this report will be emailed to the Licensee at steven-norris@att.net.

met_with: Becky Norris, Licensee


facility_name: NORTHSTAR HOMES

summary: Facility Evaluation

raw_content:
Narrative:
On May 22, 2025, at 1: PM, Component II of the application process for Northstar Small Family Home, took place at the Regional Office in El Segundo in attendance were Licensing Program Analyst (LPA) Lanice White, Licensing program Manager (LPM) Enrique Hernandez and Applicant Cameron Nguyen. The purpose of this Component II meeting was to review the submitted application and Program Statement, addressing and resolving any outstanding items and concerns. During the meeting applicant was informed live-scan is not cleared through guardian determination status in process since November 20, 2024. The applicant was informed license will not be given until live-scan is cleared. The following incomplete application forms were discussed: - LIC 200 application: Section 15A Missing property owner information - LIC Surety Bond: Missing, will need this form handling client money - LIC Health Screening: Need signature on page one - LIC 508D: Missing the criminal record statement - B4: First Aid certificate - B5: Lease rental agreement (Continued see 809-C) Program Statement Discussion and Updates Required: - Needs & Service Plans - Client and staff records - Discharge & Removal Procedures - Reporting requirement - Visitation Policy - House Rules & Discipline - Behavior Management & Crisis Intervention - Medical, Psychiatric & Dental Care - Transportation - Telephone polices - Education & IEP Coordination - Staffing, Training, and Supervision - Emergency Preparedness - Health related services The applicant was advised that all revisions and corrections to the application and Program Statement are due by June 23, 2025. A copy of this report will be provided to the applicant, Cameron Nguyen.

met_with: Cameron Nguyen


summary: Facility Evaluation

raw_content:
Narrative:
On 10/9/2025, at 9:00 am, Licensing Program Analyst (LPA) Nestor Gomez arrived at the above facility, for the purpose of conducting an Annual Required Inspection. LPA Gomez met with the applicant, Cameron Nguyen, who granted access to the facility. During the time of inspection, LPA Nestor conducted an inspection of the following areas: Kitchen: equipped with a refrigerator, microwave, and dishwasher. All appliances are in working order. The trash can in the kitchen was equipped with a lid. The pantry did not have enough food for a capacity of 6 clients. Bedroom #1: located downstairs. This bedroom is currently vacant. The bedroom is equipped with a queen size bed, a closet, 2 nightstands and dresser/entertainment center. Bedroom #2: located upstairs. This bedroom is currently vacant. The bedroom is equipped with full sized bed, 2 nightstands, a closet and a dresser. Bedroom #3: located upstairs. This bedroom is currently vacant. The bedroom is equipped with full sized bed, 2 nightstands, a closet and a dresser. At the time of the inspection applicant stated that this room would fit two full sized if they needed it, but applicant states that he wants all the kids to have their own room. LPA explained that since the license capacity is for 6 clients there would need to be 6 beds available. Continue on 809-C (Page 1) Bedroom #4: located upstairs. This bedroom is currently vacant. The bedroom is equipped with The bedroom is equipped with full sized bed, 2 nightstands, a closet and a dresser. Bedroom #5: located upstairs. This bedroom is currently occupied by the applicant. . Bathrooms: There is a total of three (3) bathrooms in the home. One (1) downstairs and two (2) upstairs. The two (2) bathrooms upstairs will be split between the clients and applicant. The applicant will be using the bathroom attached to the master bedroom and the clients will be using the bathroom in the upstairs hallway by the client's bedrooms. Office space: located upstairs. Applicant stated the room will be locked. Applicant stated that the sharps, cleaning supplies and the medication will be centrally stored in this room. The medication will be placed in a locked cabinet in the office space. Garage: Applicant stated that the garage will be locked, and it will be used mostly for storage. Storeroom: This room is located between the laundry and garage. This room will be inaccessible to clients in care. Applicant is using it as a storage space. Living room: equipped with a couch, shelf space, a television and a coffee table. Dining room: equipped with a large table. At the time of the inspection there weren't any chairs, but the applicant stated they ordered two benches and four chairs. Hallway closet: The hallway closet downstairs will also be used for storage. This room does not have a lock. Continue on 809-C (Page 2) Laundry Room: equipped with a washing machine and dryer that are in working condition. Applicant stated that the laundry supplies will be stored in the upstairs office space since the laundry room does not lock. Backyard: equipped with a grill and fire pit. Applicant stated that they will be getting outdoor seating for the backyard. The space was empty at the time of the inspection. Additional Observations: The water temperature at the kitchen sink and downstairs bathroom was tested and measured at 140 degrees Fahrenheit at the time of the inspection. Applicant stated that they would adjust the water temperature to meet regulations. There are two (2) fire extinguishers located upstairs in the linen closet at the time of the inspection. LPA observed the carbon monoxide/smoke detectors to be in working order when tested by the licensee. LPA observed no required postings. Applicant did not have a first aid kit available. LPA did not observe a menu posted. Applicant did not have a house phone (phone service) installed at the time of the inspection. Applicant did not have a refrigerator for medication. LPA observed the gas fireplace in the living room to be accessible. LPA observed the rug in the living room to need non-slip materials. Vehicles: LPA Nestor inspected one (1) facility vehicles in total. The vehicle is a Lexus NX (White). The vehicle was not present at the time of the inspection. LPA will need to return for an additional pre-licensing inspection. Exit interview was conducted and a copy of this report was emailed to the applicant.

met_with: Applicant - Cameron Nguyen


summary: Facility Evaluation

raw_content:
Narrative:
On 03/24/2025, at 8:45 am, Licensing Program Analyst (LPA) Lanice White arrived at the above facility, for the purpose of conducting an post-licensing Inspection. LPA White met with the applicant, Cameron Nguyen, who granted access to the facility. During the time of inspection, LPA White conducted an inspection of the following areas: Living room: equipped with a couch, shelf space, a television and a coffee table. Dining room: equipped with a large table. At the time of the inspection there weren't any chairs, but the applicant stated they ordered two benches and four chairs. Hallway closet: The hallway closet downstairs will also be used for storage. This room does not have a lock. Kitchen: equipped with a refrigerator, microwave, and dishwasher. All appliances are in working order. The trash can in the kitchen was equipped with a lid. Bedroom #1: located downstairs. This bedroom is currently vacant. The bedroom is equipped with a queen size bed, a closet, 2 nightstands and dresser/entertainment center. Bedroom #2: located upstairs. This bedroom is currently vacant. The bedroom is equipped with full sized bed, 2 nightstands, a closet and a dresser. Bedroom #3: located upstairs. This bedroom is currently C1 room. The bedroom is equipped with full sized bed, 2 nightstands, a closet and a dresser. Continued on 809-C (Page 2) page Laundry Room: equipped with a washing machine and dryer that are in working condition. The laundry supplies is stored above in the locked cabinet . Bedroom #4: located upstairs. This bedroom is currently vacant. The bedroom is equipped with The bedroom is equipped with full sized bed, 2 nightstands, a closet and a dresser. Bedroom #5: located upstairs. This bedroom is currently occupied by the Licensee . Bathrooms: There is a total of three (3) bathrooms in the home. One (1) downstairs and two (2) upstairs. The two (2) bathrooms upstairs will be split between the clients. The licensee will be using the bathroom attached to the master bedroom and the clients will be using the bathroom in the upstairs hallway by the client's bedrooms. Office space: located upstairs. the room is locked cleaning supplies and the medication will be centrally stored in this room. The medication is locked cabinet in the office space. Garage: The garage used mostly for storage. The garage was locked not available to clients Storeroom: This room is located between the laundry and garage. This room will be inaccessible to clients in care. Applicant is using it as a storage space. Backyard: equipped with a grill and fire pit. Vehicles: inspected one (1) facility vehicles in total. The vehicle is a Tesla Model 3 (White). The vehicle was present and in good condition. The vehicle is registered with an expiration date of 11/08/2026. The vehicle is insured through Tesla and it expires on 05/02/26. Continued see 809-C page LPA observed the home to have a fully charged two (2) fire extinguishers, a complete First Aid Kit, and a lock box to store refrigerated medications. The homes hallway cabinets store extra linen and hygiene products. The smoke and carbon monoxide detectors were tested and found to be in working order. Extra disinfectants and cleaning solutions are kept locked. The home has a working telephone readily accessible to children in care. LPA observed the home to be clean, safe, and sanitary. Passageways, stairways, and open porches are unobstructed. The front and backyard were clean and free of debris. There are no bodies of water located on the premises. There are no firearms or dangerous weapons in the home. There is one small dog on site all vaccine are up to date. Client Records: LPA reviewed 1 client records, Staff Records: LPA reviewed 1 staff records Staff Interview: LPA conducted a confidential interview with Licensee. Client Interviews: None, client was at school during visit. An exit Interview was conducted, and a copy of this report was left with the Licensee. There were no deficiencies cited at the time of the visit.

met_with: Cameron Nguyen - Licensee


facility_name: OGONNA SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On August 16, 2023 at 10: AM Licensing Program Analyst (LPA) Babatunde Aborchie began a Pre-Licensing inspection for a Small Family Home license. LPA met with applicant Ogonna Oyemata who led a tour of the home. The facility was toured both inside and out with the applicant. Applicant is applying for a capacity of 2 ambulatory clients. The home consists of: Downstairs: Bedroom #1, It was furnished with a desk and chair. It is used as an office. Bedroom #2, The room consisted of two twin beds. It will sleep two residents - vacant. There were also a family room, a living room, dining area, kitchen and one bathroom. Upstairs: Bedroom #3, The room was furnished with a queen bed. It is used as a guest room - vacant. Bedroom #4, The room was furnished with a bunked bed and a twin bed. It sleeps three biological children ages 9, 8 and 6 years. Bedroom #5, Master bedroom. The room consisted of one queen sized bed. It sleeps the applicant and the spouse. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. Inside the facility the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in the kitchen cabinet. Cleansers/chemicals were locked and stored in the garage cabinet. Sharp knives were inaccessible and stored in the locked kitchen cabinet above the cooking stove. There were no guns or weapons as stated by applicant at this time. The hot water temperature was tested and noted to be 112 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit were accessible with all required items, and it was in the kitchen pantry. A Fire extinguisher was observed and properly charged. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. The backyard where children will have access to play was completely fenced and free of hazards. There are no deficiencies to be cited at this time. The request to be licensed for small family home will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Applicant/Licensee

met_with: Ogonna Onyemata


summary: Facility Evaluation

raw_content:
Narrative:
On 6/20/2025, Licensing Program Analysts (LPAs) Claudia Aguilera and Cynthia Ramos conducted a 2 year required inspection at Ogonna Small Family Home (SFH). The home is licensed to serve two children, currently there is one client in the home. The facility was toured inside and out with the Licensee, Ogonna Onyemata. The home is two story residence with 4 bedrooms and 3 bathrooms. Upon entering LPAs observed a receiving area with two couches, coffee table, an office, a formal dining room with a large table with eight chairs. Bathroom #1 was inspected and fully functioning. Bedroom #1 was fully inspected and consisted of two twin beds, closet, drawers and sleeps 14-year-old client. Through the hallway, the kitchen was observed to be organized and clean, no sharp/knives were accessible to clients. In the kitchen, medications are kept locked in a cabinet, a fire extinguisher was also observed and operable. A family room was observed with a sectional couch, tv and fireplace. A dining room table was also observed with four chairs. The kitchen island also provided additional seating. The laundry room was also located downstairs and fully inspected; cleaners/detergents are kept locked. The second level of the home, the master suite (Bedroom #2) is occupied by the licensee and spouse, master suite also has a bathroom (Bathroom #2). Bedroom #3 consists of two twin beds and sleeps licensee's two sons. Bedroom #4 consists of one twin bed and sleeps licensee's biological daughter. Bathroom #3 was inspected and located in the hallway upstairs. The upstairs area also included a large loft with television, couch, games, and books. The water temperature was tested and measured at 119. F. LPAs observed a minimum of seven-day non-perishable and a three-day perishable supply of food. All windows and screens were in good repair. The smoke and carbon monoxide detectors were tested and operable. There were no guns or weapons in the home as stated by Licensee. The backyard was also inspected, there were no hazards or obstructions observed. There are a total of four cameras, two in the common areas and two outdoor, which meet the title 22 camera policy. During the visit. there were no deficiencies observed, however, LPAs issued three technical advisory (TAs) that was explained and given to licensee. An exit interview was conducted, a copy of this report was provided to Licensee.

met_with: Licensee, Ogonna Onyemata


facility_name: OLAW SMALL FAMILY HOME

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Narrative:
In regard to youth refusing medication and youth's truancy, youth explained that it's the youth's preference to stop taking medication and youth cannot be forced to take them. Youth explained that it's also the youth's choice to stop attending school. Youth acknowledge that youth's treatment team constantly provides guidance and support to ensure youth's safety and well-being. FP denied the allegations and explained that youth spends time outside the home with FP, staff/alternate caregiver and with individuals from youth's treatment team. FP follows the youth's safety plan due to youth's known unsafe behaviors. FP contacted law enforcement and the placement agency once it was discovered that youth left the home. FP reached out to youth's therapist and school personnel when youth started refusing to take medication and attend school. There were multiple meetings held to support the youth and ensure that youth's goals are met as identified in the youth's treatment and safety plans. Additional information obtained during the investigation revealed that FP went above and beyond to ensure that youth is always safe. FP maintains effective communication with school personnel, placement agency staff and other members of the youth's team. Despite this, youth refused to follow through with the youth's placement preservation plan. Based on information obtained, the allegations are determined to be unsubstantiated. Although the allegations may have happened or are valid, there is no preponderance of evidence found to support it. The following reports were provided to the facility representative at the conclusion of today's inspection: LIC9099, LIC9099-C and LIC Confidential Names. Appeal rights forms were also given and explained. There was no deficiency citation issued.

Investigation Findings:
13On July 22, 2025 at 9:35am, Licensing Program Analyst (LPA) Irene Yamamoto conducted a subsequent complaint inspection at the facility and met with the licensee. The purpose of the inspection is to deliver the finding regarding the above allegations received by the Department on April 4, 2025. This LPA investigated the allegations. Confidential interviews were conducted with the identified youth and the foster parent (FP) on 4/7/25 and county placement agency staff on 6/16/25. Pertinent records were reviewed including, but not limited to the Personnel Report, Initial Needs and Case Plan Summary, Needs and Services Plan, Child and Family Team Meeting (CFTM) notes, Medication Records and Incident Reports. Information obtained from confidential interviews did not support the allegations. The allegations were denied by the youth who explained that the youth left without permission because the youth wouldn't be allowed to spend time with individuals the youth wanted to. The youth informed FP and a staff/alternate caregiver that the youth planned on returning home when they reached out to the youth during youth's AWOL. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Irene Yamamoto LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: OLAW SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 07/22/2025

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

met_with: Leah Wilson, Licensee


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis conducted a virtual Component II session with Olaw Small Family Home on October 20, 2023 at 10:30am by way of Microsoft Teams. LPA met with the applicant, Leah Wilson, and discussed the following: 1. Staff Associations 2. Small Family Home Program Statement revisions 3. Emergency Disaster Plan 4. Admission Policies 5. Application 6. Fire Inspection 7. Menu 8. Placement Criteria/Placement Agencies LPA asked questions regarding the applicant's Program Statement to assess their understanding of the regulations in place for a Small Famiy Home. LPA advised the applicant that all revisions/corrections need to be submitted directly to him for review. The Pre-Licensing inspection will take place on Thursday, November 9, 2023. LPA discussed the upcoming Pre-Licensing inspection in general and what it involved. LPA advised the applicant that their program statement will also be reviewed by his manager, LPM Yan Yeung.

met_with: Leah Wilson


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis went to the Olaw Small Family Home on November 16, 2023 at 12:15pm for the purposes of an announced Pre-licensing inspection. The Department has received application materials from the applicant to become licensed as a Small Family Home licensee at the site. LPA met with the applicant, Leah Wilson, and together they toured the facility. The facility is located in a residential neighborhood and consists of three bedrooms and four bathrooms. Bedroom #1 has one full bed, dresser, and closet space. The bedroom is vacant. Bedroom #2 has one crib, dresser, and two closets. The bedroom is occupied by the applicant's infant son. Bedroom #3 has one queen bed, dresser, and closet space. The bedroom is occupied by the applicant. Sharp knives, chemicals, and cleaning supplies are kept locked in areas inaccessible to children. LPA observed a locked medication box. Overall, the facility appeared clean, safe, and sanitary. LPA observed a fully charged fire extinguisher mounted on the wall in the living room area. The smoke alarms were operable throughout the facility. The outdoor areas were observed to be free of debris and hazards. LPA observed the kitchen area to be clean and the refrigerator was well stocked with ample food supply. LPA also observed adequate perishable and nonperishable food items at the facility. The applicant stated that there weren't any firearms or other weapons on the premises. There is adequate space for indoor and outdoor activities. The applicant stated their Emergency Plan, Inspection Report, Disaster Plan and Policy, and facility license will be posted on the wall in the hallway downstairs. The food and nutrition menu will be posted on a dry eraser board in the kitchen. The facility is a three- story townhome. Bedroom #1 is downstairs. Bedroom #2 and Bedroom #3 are on the third level. LPA observed a fully stocked First Aid Kit. LPA also observed a fully stocked pantry and a fully stocked linen closet in the facility. The laundry area is on the third floor. LPA found no Title 22 deficiencies on this date. Exit interview conducted LPA Davis discussed cooler weather conditions and precautions with the applicant and provided the applicant with the Department's website address (www.ccld.ca.gov). LPA also conducted a Component III at the facility with Leah Wilson, applicant. During the Component III meeting, the following forms were given and/or discussed: LIC 311E Records To Be Maintained At The Facility - Small Family Home LIC Appraisal/Needs and Services Plan LIC Physician's Report for Community Care Facilities LIC Identification and Emergency Information LIC Preplacement Appraisal Information LIC Centrally Stored Medication and Destruction Record LIC Unusual Incident/Injury Report The provider was also briefed about the importance of incident reporting and client education.


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) T. Davis went to the Olaw Small Family Home on June 13, 2024 at 10:45am for the purposes of a Post Licensing inspection. LPA met with Leah Wilson, licensee, and discussed the nature of today's inspection. The facility is located inside a residential complex setting along with other townhomes. The facility has three bedrooms, four bathrooms, kitchen, living room, and a garage. LPA and the licensee toured the facility which is a tri-level townhome. During the inspection, LPA observed three bedrooms in the facility. Bedroom #1 has one full bed, dresser, and closet space. The bedroom is occupied by client #1 (refer to LIC812 dated June 13, 2024). Bedroom #2 has one crib, dresser, and closet space. The bedroom is occupied by the licensee's biological son (see LIC812). Bedroom #3 has one queen bed, dresser, and closet space. The bedroom is occupied by the licensee. Sharp knives, medications, and cleaning supplies are kept locked in areas inaccessible to children. LPA observed four bathrooms to be in good repair and working order. There is adequate space in the living room and dining area. LPA observed a fully charged fire extinguisher in the kitchen area. Overall, the facility appeared clean, safe, and sanitary. There is a properly secured in-ground swimming pool on the premises enclosed with a self-latching gate and accessible with a key. The licensee stated that there weren't any firearms or other weapons on the premises. Smoke alarms were operable throughout the facility. There is adequate space for indoor and outdoor activities. The outdoor areas were observed to be free of debris and hazards. LPA reviewed files and found the files to be in order. LPA found no Title 22/ILS violations on this date. Exit interview done LPA discussed the warm weather conditions and precautions with licensee and provided licensee with the department's website address (www.ccld.ca.gov).


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA), Caitlin Chambers, Licensing Program Analyst (LPA), Juliet Robles, and Licensing Program Manager (LPM), Yan Yeung, went to the Olaw Small Family Home on 3/21/25 at 8:45am for the purposes of a annual inspection. LPA met with Leah Wilson, licensee, and conducted a comprehensive inspection at the facility.. The facility is located inside a residential complex setting along with other townhouses. The facility has three bedrooms, four bathrooms, kitchen, living room, and a garage. The licensee resides here with her son, and one client, C1 (See 811). LPAs, LPM, and the licensee toured the facility with the licensee. There are cameras that are unplugged as of 3.21.25. During the inspection, LPA observed three level townhouse in a gated community with three bedrooms in the facility. Bedroom #1 has one full bed, a white dresser with clothes in it and closet space with clothes in it. The bedroom was occupied by client #1 (refer to LIC811 dated 3.21.25). Bedroom #2 has one toddler bed, dresser, and closet space. The bedroom is occupied by the licensee's biological son (see LIC811). Bedroom #3 has one queen bed, dresser, and closet space. The bedroom was occupied by the licensee. There was adequate space in the living room and dining area. LPA observed a fire extinguisher in the kitchen area. The temperature of sinks and showers is above 125 degrees Fahrenheit. There are two dogs in the home that are kept away from client when the client is home. The garage is always locked. In the garage there are chemicals and supplies not locked up. The temperature of the home was 74 degrees Fahrenheit. The licensee stated that there were no firearms or ammunition on the premises. LPAs observed smoke alarms were operable throughout the facility. There is adequate space for indoor and outdoor activities. The outdoor areas were observed to be free of debris and hazards. The kitchen has a menu on the fridge with food that matches the menu. A medication check was done. LPA observed that the staff was cleared in fingerprints in the system. The car registration and insurance is current. LPA reviewed one staff file and one client file. LPA Robles interview the licensee. There is a pool on premise that is gated with a metal fence at least five feet tall about three minutes away from the townhouse. LPA requested an addendum for the cameras in the home. LPA issued the following citations one technical violation, one Type A violation for and four Type B violations. Exit interview was completed. A copy of the LIC 809, LIC D, and an LIC 811 was given to the licensee, appeal rights were reviewed,


summary: Facility Evaluation


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA), Caitlin Chambers conducted an inspection visit to the facility to follow up on a Plan of Corrections (POC) for a citation given 03.21.25 under Title Regulations with a POC of 4.01.25, for the following: Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees Fahrenheit (48.8 degrees C). In the facility on 03.21.25 the downstairs sink, in the clients (C1) room was 113 degrees Fahrenheit, the shower in the clients room was 126.1 degrees Fahrenheit, the sink in the kitchen upstairs was 120.1 degrees Fahrenheit, and sink in the bathroom on the second floor was 123.7 degrees Fahrenheit. On the annual inspection on 03.21.25, the temperature was too high out of range and did not meet the regulation 80088(e)(1). Today on 04.01.25, the temperature in the sink downstairs in the client's room read 118.5 degrees Fahrenheit, and the shower downstairs in the client's (C1) shower read 120.1 degrees Fahrenheit, the sink in the kitchen read 122.9 degrees Fahrenheit, and the sink in the bathroom on the second floor read 121.6 degrees Fahrenheit. Based on LPA's observation using a temperature tool, the licensee did not comply with the section cited above in each of the sinks and showers that are accessible to the client that is above 125 degrees F which poses an immediate health, safety or personal rights risk to persons in care. This report was given to the Licensee as a not cleared Plan of Correction. A civil penalty was given of $100 per day for a total of $1100 as a result to the non- compliance of the first Type A citation given on 3.21.25 with a due date of 3.22.25 (the start date of the penalty)- 4.01. Appeals rights were reviewed. An exit interview was conducted.


summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA), Caitlin Chambers conducted a Plan of Correction inspection on 4.7.25 and met with Administrator, Leah Wilson. A 421FC was given to licensee on 4/1/2025. The assessment dates should be from 3/23/25 to 4/1/25 for a total of $1,000 instead of $1,100. This report supersedes the amount on the form given on 4/1/2025. LPA Chambers toured the facility and checked water temperatures at the facility. LPA observed previous deficiencies and cleared all deficiencies that was cited on 3/21/2025. On today's visit the temperature in the sink downstairs in the client's room read 107.7 degrees Fahrenheit, and the shower downstairs in the client's (C1) shower read 107.7 degrees Fahrenheit, the sink in the kitchen read 107.7 degrees Fahrenheit, and the sink in the bathroom on the second floor read 107.3 degrees Fahrenheit. LPA observed and cleared all deficiencies that was cited on 3/21/2025 which included all four Type B violations and all technical violations were cleared during this POC visit and the letters of the POC were given to the licensee. This 809 report was given to the licensee, a plan of corrections letter, and a new-revised LIC 421FC form with the new amount of $1000 as indicated on this report . Appeals rights were reviewed on page two. An exit interview was conducted.


facility_name: ONE LOVE CARE

summary: Facility Evaluation

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Narrative:
On August 4, 2022, Licensing Program Analyst (LPA) Babatunde Aborchie conducted a post-licensing inspection of One Love Care Small Family Home (SFH). LPA met with the licensee, Dericka Solomon, the facility was toured inside and out at 11: AM. There is currently one client in placement (See Confidential Names List (LIC 811) dated August 4, 2022. The facility was toured both inside and out. The facility is a two-story residence with 5 bedrooms and 3 full bathrooms. There was one-bathroom downstairs and two bathrooms upstairs. Downstairs Bedroom #1: the room was furnished with one twin-size bed - Sleeps C Bedroom #2: the room was furnished with one twin-size bed - Vacant Upstairs Bedroom #3, the room was furnished with one Queen-size bed - Vacant Bedroom #4, the room was furnished with one Queen-size bed - Vacant Bedroom #5, the room was furnished with one King-size bed - Sleeps Licensee There was one living room downstairs and a loft upstairs There was a dining room area with a table that fit 6 clients A physical plant inspection was completed and included the following checks: Facility grounds are clean; free of debris and observable hazards. Hot water temperature was 110.9 degrees. There was adequate indoor and outdoor activity space. Sports equipment/toys/books/games were observed for client's recreation time. All facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. Licensee maintains an adequate supply of perishable and non-perishable foods and followed the posted menu. All required forms are posted including the Grievance Procedures, Visitation Policies, Personal Rights form, and Foster Care Ombudsman poster. Medications are locked and centrally stored in the Kitchen. A complete First Aid Kit was locked and stored in the bedroom #2. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction Exit interview conducted and a copy of this report was discussed and provided to Licensee on this date.

met_with: Licensee


summary: Facility Evaluation

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Narrative:
On December 15, 2022 at 10: AM, Licensing Program Analyst (LPA) Babatunde Aborchie began a facility inspection for a Small Family Home capacity increase. LPA met with applicant Dericka Solomon who led a tour of the home. The facility was toured both inside and out with the applicant. The applicant was applying for a capacity increase of 2 non-ambulatory developmentally disabled. The home is a two-story home and consists of: Downstairs: Bedroom #1, the room consists of one twin size bed- it will sleep one child - currently vacant. Bedroom #2, the room consists of one twin size bed - it will sleep one child- currently vacant. There was a living room, dining area, the kitchen, the garage and an additional storage. Upstairs- Bedroom #3, the room was furnished with a queen size bed- it currently sleeps one foster child. Bedroom #4, the room was furnished with a queen size bed- it currently sleeps one foster child. Bedroom #5, the room was furnished with a Cal-king size bed- it sleeps applicant/Licensee. Bedrooms were arranged so that no more than two children share a room, and there was one child per bed. No room commonly used for other purposes used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawers and closet space for children's belongings. Upstairs outside the bedrooms, there was a loft designated game and play area which contained toys and books. It was observed to be safe, clean, and age appropriate for the age group of children to be cared for. The smoke detectors were checked and were working properly. The fireplace was in the living room area and it was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The medication will be locked in a container located in the pantry. Cleansers/chemicals were locked and stored in the garage. Sharp knives were inaccessible and stored in a locked cabinet in the kitchen area. There were no guns or weapons as stated by Applicant at this time. The hot water temperature was tested and noted to be 109 degrees. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. First Aid kit was accessible and contained all required items. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted. There were no pool or other body of water and the backyard where children will have access to play was completely fenced and free of hazards. Based on this inspection, the home is appropriate for a capacity increase of 2 non-ambulatory clients. All requirements were met at this time. The request of capacity increase will be forwarded to Licensing Program Manager for final approval. Facility will accept two non-ambulatory developmentally disabled children in addition to current two ambulatory developmentally disable children and licensed for a total capacity of 4 foster children age 0-17. Facility prefers to serve children that are medically fragile and with special health care needs age 2 to 10. Exit interview conducted and a copy of this report was discussed and provided to applicant this date.

met_with: Licensee/Deicka Solomon


summary: Facility Evaluation

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Narrative:
On June 2, 2023 at 09: AM, Licensing Program Analyst (LPA) Karen Beal began a facility inspection for a Small Family Home (SFH) annual inspection. LPA met with applicant Dericka Solomon who led a tour of the home. The facility was toured both inside and out with the applicant. The applicant was applying for a capacity increase of 2 non-ambulatory developmentally disabled. The home is a two-story home and consists of: Downstairs: Bedroom #1, the room consists of one twin size bed- twin bed Bedroom #2, the room consists of one twin size bed - twin bed There was a living room, dining area, the kitchen, the garage and an additional storage on the lower lever of the home. Upstairs- Bedroom #3, the room was furnished with a twin bed. Bedroom #4, the room was furnished with a queen size bed. Bedroom #5, the room was furnished with a king size bed- it sleeps the Licensee. Bedrooms were arranged so that no more than one child share a room, and there was one child per bed. No room commonly used for other purposes used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawers and closet space for children's belongings. Upstairs outside the bedrooms, there was a loft use for watching television. It was observed to be safe, clean, and age appropriate for the age group of children to be cared for. The smoke detectors were checked and were working properly. The fireplace was in the living room area and it was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly stored in the locked laundry room on the upper level of the home. Knives are stored under the kitchen sink double locked in a cabinet. The medication will be locked in a container locked in a cabinet in the dining area. The first aid kit is stored in a closet by the staircase. The first aid kit expires in 2027. Licensee first aid/cpr expires 07/26/24. The fire extinguishers are located on the upper and lower level of the home and expires 02/2024. The posting of documents was in the hall leading to garage. Postings contained the license, personal rights, menu, visitation policy and admission policy. The back yard is well groomed. There were toys and patio furniture for lounging. There were no hazards or safety concerns observed.

met_with: Dericka Soloman, Licensee


summary: Facility Evaluation

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Narrative:
On June 13, 2024, at 10: AM Licensing Program Analyst (LPA) Rafael Enriquez began an announced inspection for the Small Family Home license. LPA met with licensee Dericka Solomon, who led a tour of the home. The facility was toured both inside and out with the licensee. Licensee is applying for a change of capacity from 4 clients 2 ambulatory and 2 non-ambulatory capacity children, ages 2-17 years to 6 clients 4 ambulatory and 2 non-ambulatory capacity children, ages 3-17 years . The home consists of: Downstairs: Bedroom #1, It was furnished with a twin sized bed with the front door as the exit door to the front yard. It will sleep one non-ambulatory foster child - Vacant. Bedroom #2, It was furnished with a twin sized bed with the front door as the exit door to the front yard. It will sleep one non-ambulatory foster child - Vacant. There was also a living room, a dining area, a kitchen, a pantry, a bathroom and a coat closet. Upstairs: Bedroom #3, It was furnished with a bunk bed with twin sized mattresses. It will sleep two foster children. -It sleeps one foster child aged 6 years. Bedroom #4, The room was furnished with a bunk bed with one twin sized bed and one full sized bed. It sleeps 1 foster child 14 years. Bedroom # The master bedroom, furnished with a king-sized bed, had a bathroom and a walk-in closet. It sleeps the licensee and spouse. There was also a loft, a bathroom, a laundry room, and a linen closet. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There is adequate drawer and closet space for children's belongings. The smoke detectors were checked and were working properly. There are no deficiencies noted at this time. A copy of this report was explained and provided to Licensee Dericka Solomon.

met_with: Licensee- Dericka Solomon