facility_name: PACIFIC LODGE CAMPUS

raw_content:
Narrative:
LPA obtained evidence that the facility met the regulation of staff to client ratio, records of photos and receipts replenishing basic hygiene products; the facility has implemented various structured programs while in placement and ensured that the children receive individual therapeutic services and resources to help the youth succeed when they transition out. LPA identified discrepancy in information reported by the child regarding lack of support, LPA obtained statements and records that the child was actively engaged in her program and successfully transitioned to independent living program. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has determined that the allegation of Neglect/Lack of Supervision and Personal Right are unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies noted or cited per California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Chapter 7. Version 3. An it interview was conducted in person and the report was provided to the Program Supervisor on 04/27/2021.

Investigation Findings:
13On April 27, 2022 at 9:30AM Licensing Program Analyst (LPA), Rosslyn Gray made an unannounced visit to the PACIFIC LODGE CAMPUS STRTP to conclude the investigation and to deliver the finding. During the investigation, LPA-Gray interviewed and accounted for all available relevant parties; and gathered pertinent information regarding the child's involved in the incident. LPA was unable to contact locate or interview RP who chose to remain anonymous. Information and records obtained revealed that there were no statements or documented evidence to support that the allegations that the facility "Facility is understaffed; Facility does not provide residents with basic hygiene products; Facility lacks structured programs for the youths", occurred. The internal Investigation revealed that, although the child was adamant that allegations in the complaint occurred; there is no evidence to support the allegations Neglect and Lack of Supervision and Personal Rights were violated. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray 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 34-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, N. Continental Blvd. #290B FACILITY NAME: PACIFIC LODGE CAMPUSFACILITY NUMBER: VISIT DATE: 04/27/2022

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

met_with: PROGRAM SUPERVISOR


state: CA

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
LPA obtained evidence that proper supervision was implemented to care the needs of children in placement. Photos of ample food supply was available and receipts to confirm purchased various food items. LPA obtained evidence Special Incident Reports to confirm that the child was indeed accompanied to an emergency medical facility to be treated for the injury sustained to her tooth. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. The Department has determined that the allegation of Neglect/Lack of Supervision and Personal Right are deemed to be unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies noted or cited per California Code Regulation, TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Chapter 7. Version 3.

Investigation Findings:
13On April 27, 2022 at 11:00AM Licensing Program Analyst (LPA), Rosslyn Gray made an unannounced visit to the PACIFIC LODGE CAMPUS STRTP to conclude the investigation and to deliver the finding. During the investigation, LPA-Gray interviewed and accounted for all available relevant parties; and gathered pertinent information regarding the child's involved in the incident. Information and records obtained revealed that there were no statements or documented evidence to support that the allegations that the facility "Food service is inadequate; staff did not supervise the resident, resulting in resident sustaining a broken tooth; Staff are not providing assistance with medications; staff do not supervise the residents adequately and Medical care is not provided when needed", occurred. The internal Investigation revealed that no evidence to support the allegations Neglect and Lack of Supervision and Personal Rights were violated. LPA obtained statements and records that the child had major difficulty adjusting to placement; did not engage in her program and was detained. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray 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 34-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, N. Continental Blvd. #290B FACILITY NAME: PACIFIC LODGE CAMPUSFACILITY NUMBER: VISIT DATE: 04/27/2022

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

report_type: Complaint Investigation

complaint_status: unsubstantiated


raw_content:
Narrative:
The Department has determined that the allegation of Neglect/Lack of Supervision are deemed to be unsubstantiated but if any additional information is received this complaint can be amended and the finding can be changed. There are no deficiencies noted or cited per California Code Regulation TITLE 22, DIVISION 6, CHAPTERS 1, General Licensing Regulations, and Short Term Residential Therapeutic Program (STRTP) Interim Licensing Standards (ILS), Chapter 7. Version 3. An it interview was conducted in person and the report was provided to the Program Supervisor on 05/20/2022

Investigation Findings:
13On May 20, 2022, at 2:00PM Licensing Program Analyst (LPA) Rosslyn Gray concluded the investigation. During the investigation, there were not documented evidence to support that the allegations that "Lack of supervision resulted in group home minor physically assaulting another group home minor". LPA confirmed that a Special Incident Report (SIR) was written in a timely manner. It was determined that staff involved took the necessary steps to intervene. Staff also prevented a personal rights violation by honoring C1's request and remaining unbiased in the decision to press charges against C2. The LIC 500 confirmed that staff met ratio and was present to provide supervision. All available parties involved including law enforcement were congruent with the outcome of the investigation. The STRTP was temporaly closed on May 20, 2021. Based on the interviews conducted, the above allegation is found to be Unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Rosslyn Y. Gray 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 34-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, N. Continental Blvd. #290B FACILITY NAME: PACIFIC LODGE CAMPUSFACILITY NUMBER: VISIT DATE: 05/20/2022

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

met_with: Program Director


raw_content:
Narrative:
Based on confidential statements, the allegation cannot be substantiated due to a lack of corroborating evidence. Confidential statements, record review and file history produced inconsistencies; therefore, the allegation of sexual abuse towards C1 is determined Unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There are no deficiencies cited per California Code of Regulations, Title 22 at this time. Exit interview completed. A copy of this report and LIC811 was provided to Facility Administrator.

Investigation Findings:
13On April 20, 2023, at 3: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection to deliver findings concerning the above-mentioned allegation. LPA met with Ken Garcia, Administrator to discuss the outcome. The investigation was referred and conducted by LPA Martin and Community Care Licensing Investigations Bureau. On March 2, 2023, the El Segundo Children's Residential Program Regional Office received a complaint referral alleging sexual abuse towards Client #1 (C1) who was reportedly sexually assaulted, while in care [see Confidential Names form, LIC 811, dated 4/20/2023]. On March 7, 2023, LPA Martin met with Facility Administrator and obtained pertinent information. The investigation further consists of review of client file, review of associated report from the Department of Children and Family Services and confidential interviews with related parties including, but not limited to, C1 and assigned Social Worker. (Continued on page LIC9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin 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 34-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, N. Continental Blvd. #290B FACILITY NAME: PACIFIC LODGE CAMPUSFACILITY NUMBER: VISIT DATE: 04/20/2023

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

met_with: Ken Garcia, Administrator


raw_content:
Narrative:
The investigation included review of facility file, client file history, related incident report, staff file records, related reports from the Los Angeles Department of Children and Family Services and the Los Angeles Police Department as well as confidential interviews and contacts with Y1, S1, and three staff members. The investigation revealed on 08/22/2023, Y1 accused S1 of inappropriately touching their buttocks area. Confidential statements and records reviewed indicate a lack of evidence to substantiate the alleged. Statements obtained from parties interviewed by the Los Angeles Police Department, the Department of Children and Family Services and CCLD Investigator were inconsistent as to the date, time, and location of said incident. Review of staff file history and confidential interviews found no witnesses to corroborate S1 inappropriately touching Y! or displaying any sexual misconduct. Based on the statements gathered, and records reviewed the Department has determined there is not enough evidence to support the allegation of Sexual Abuse; therefore, the finding is unsubstantiated. A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. There are no deficiencies per California Code of Regulations or Interim Licensing Standards (ILS) cited at this time. Exit interview completed. A copy of this report and LIC811 was provided to Facility Representative.

Investigation Findings:
13On January 31, 2024, at 1: PM, Licensing Program Analyst (LPA), Regina Martin conducted a follow-up complaint inspection to deliver findings concerning the above-mentioned allegation. LPA Martin met with Facility Manager, to discuss the investigative outcome. On August 23, 2023, Community Care Licensing Division (CCLD) received a complaint alleging that Staff member #1 (S1) sexually touched Youth #1 (Y1) while in care (see LIC811, dated 1/31/2024). The investigation was conducted by CCLD Investigations Branch, Investigator Philippe Ryan Miles. On August 28, 2023, LPA Martin met with facility representative, informed of investigation, and obtained records. On August 24, 2023, the facility filed an incident report reporting an allegation of sexual abuse by a staff member (S1) towards a youth (Y1). Staff #1 was released from their position until further investigation. (Continued on page LIC9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Regina Martin 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 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: PACIFIC LODGE CAMPUSFACILITY NUMBER: VISIT DATE: 01/31/2024

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

met_with: Venesha Acosta, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On June 22, 2021 at 11: AM (LPA) Licensing Program Analyst Rosslyn Gray made an unannounced visit to PACIFIC LODGE CAMPUS- STRTP for the purpose to conduct Annual Required facility inspection. LPA met with the Staff#1 (S1) Administrator of the (STRTP) SHORT TERM RESIDENTIAL THERAPEUTIC PROGRAM who granted access to the facility. The entire physical plant was inspected. The facility is currently licensed to provide care and supervision for 35 clients ages 13-17 years Ambulatory Only. Currently there are no children residing in the STRTP cottage and no staff working in the cottage the recent Temporary closure of the STRTP May 20, 2021 "due to staffing issues and renovation". All children have been transferred to the Eagle Rock STRTP and Penny Lane". S1 states that there is no weapons or guns on the premises. There is a swimming pool and on the premises; located mid campus by the AC gym. The Neimeyer Cottage: Has nine (9) bedrooms and occupies two clients and two (2) twin size beds in each room. Bedrooms #1- Bedroom # Bedroom # Bedroom # Bedroom # Bedroom # Bedroom 7 #8, and Bedroom # Currently there are No children occupying the rooms. There are two (2) twin size beds in each room.; adequate shelf space, closet space and lighting, comfortable mattress. The beds have been stripped down to the mattress due to being unoccupied. The clean linen, blankets and pillows are stored in the linen closet located in the Hallway BATHROOMS: The staff bathroom is adjacent to the community bathroom, located outside of the bedroom's mid hallway. The community bathroom is equipped with a four (4) showers, four (4) toilets and a four (4) sinks. There are two windows with blinds and screens that were observed to be in good condition. The Hot water is also is temporarily shut off due the renovation. LPA confirmed that the water works in the kitchen, bathrooms, sinks and ensured that all toilets flushed. The laundry room is located near bedroom #3, equip with a washer and dryer unit. S1 confirmed when clients are present the laundry detergent is distributed to children individually according to the load of their laundry. Due to the Temporary Closure, currently all posting requirements (i. e The Clients Personal Rights; Emergency Plan, weekly menu, etc.) are not posted; however, S1 displayed were they are stored and ready to be posted when the cottage is cleared to reopen. There is a private room located adjacent from the kitchen dining area that is utilized for the children to make phones calls. The Phone Call Log and the children's records are kept in the staff office. Although the cottage is Temporarily Closed LPA observed LPA observed ample stored hygiene supplies and feminine products. Sofas, a large chair and a book shelf was observed in the Living room/TV room. The cottage kitchen is not utilized to cook food and all meals are delivered to each cottage from the facility Dining Hall; snacks are also distributed from the Dining Hall to the staff office 3 times a day to the residents. Sharp knives and hazardous solutions are not accessible to residents. The smoke detectors operated on a connected system and Carbon Monoxide detectors are operational but are temporarily shut off. LPA observed five (5) fully charged Fire Extinguishers stored and ready to be placed in the cottage. The First aid kits are available, located in staff and nursing office. LPA observed them to be in compliance with all items and ready to be utilized. All trash cans are covered with lids are stored away ready to be utilized. S1 confirmed that when the youth are present an assigned staff "Youth Care Counselor "transports clients to local recreational facilities. Activities were previously restricted due to the rules of the CDC COVID- Guidelines. The facility will resume outside extracurricular activities and social events when the temporary closure is lifted. Per California Code Regulation, Title 22, Division 6, Chapters 1, General Licensing Regulations, and (STRTP) Interim Licensing Standards (ILS), Chapter 7. Version 3, there were no deficiencies cited at the time of this inspection. LPA-Gray concluded the Inspection and a copy of this report will left with the Administrator on 06/22/202.

report_type: Facility Evaluation

visit_type: Annual

met_with: Staff #1


summary: Facility Evaluation

raw_content:
Narrative:
On September 2, 2021 at 10:00AM LPA-Licensing Program Analyst Rosslyn Gray conducted a Case management licensee Initiated at PACIFIC LODGE CAMPUS- STRTP. The purpose of the inspection is due to the Licensee request for Capacity Decrease from 35 to 16. Prior to the Inspection LPA ensured that all required forms were obtained, which also included the fee and the Fire Clearance. LPA met with the Staff#1 (S1) Director of the (STRTP) SHORT TERM RESIDENTIAL THERAPEUTIC PROGRAM who provided tour of the Neimeyer Cottage. The facility is currently licensed to provide care and supervision for 16 clients ages 13-17 years Ambulatory Only. There are currently No children residing in the STRTP due to Temporary Closer May 28, 2021. The Neimeyer Cottage is currently under construction. LPA confirmed with the Maintenance Manager that the expectation of the completion is approximately 2 months (i.e painting and installing new blinds in the kitchen. There are a total of nine (9) bedrooms, eight (8) bedrooms are equipped with two (2) twin size beds in each room. The ninth (9) bedroom will be utilized in the event of a emergency and or crisis situation; it is equipped with one (1) twin size bed, a walk in closet and a desk. The Director will ensure to inform LPA when the 9th room is being utilized and an (SIR) Special Incident Report will be documented and submitted. Bedroom #1: Currently unoccupied. Is prepared to be occupied by two (2) clients. There are two (2) twin size beds, comfortable mattresses, lean linen, blankets and pillows. There are two (2) separate walk in closets and a two (2) desk mounted in the wall. There is adequate lighting (ceiling), and the windows are slide locked with vertical blinds; observed to be in good condition. Bedroom #2: Currently unoccupied. Is prepared to be occupied by two (2) clients. There are two (2) twin size beds, comfortable mattresses, lean linen, blankets and pillows. There are two (2) separate walk in closets and a two (2) desk mounted in the wall. There is adequate lighting (ceiling), and the windows are slide locked with vertical blinds; observed to be in good condition. Bedroom #3: Currently unoccupied. Is prepared to be occupied by two (2) clients. There are two (2) twin size beds, comfortable mattresses, lean linen, blankets and pillows. There are two (2) separate walk in closets and a two (2) desk mounted in the wall. There is adequate lighting (ceiling), and the windows are slide locked with vertical blinds; observed to be in good condition. Bedroom #4: Currently unoccupied. This bedroom will be utilized in the event of a Emergency and or Crisis situation. It last bedroom located on the right side at the end of the hallway. It is equipped with one (1) twin size bed, a walk in closet and a two (2) desk mounted in the wall. There is adequate lighting (ceiling), and the windows are slide locked with vertical blinds; observed to be in good condition. Bedroom #5: Currently unoccupied. Is prepared to be occupied by two (2) clients. There are two (2) twin size beds, comfortable mattresses, lean linen, blankets and pillows. There are two (2) separate walk in closets and a two (2) desk mounted in the wall. There is adequate lighting (ceiling), and the windows are slide locked with vertical blinds; observed to be in good condition. Bedroom #6: Currently unoccupied. Is prepared to be occupied by two (2) clients. There are two (2) twin size beds, comfortable mattresses, lean linen, blankets and pillows. There are two (2) separate walk in closets and a two (2) desk mounted in the wall. There is adequate lighting (ceiling), and the windows are slide locked with vertical blinds; observed to be in good condition. Bedroom #7: Currently unoccupied. Is prepared to be occupied by two (2) clients. There are two (2) twin size beds, comfortable mattresses, lean linen, blankets and pillows. There are two (2) separate walk in closets and a two (2) desk mounted in the wall. There is adequate lighting (ceiling), and the windows are slide locked with vertical blinds; observed to be in good condition. Bedroom #8: Currently unoccupied. Is prepared to be occupied by two (2) clients. There are two (2) twin size beds, comfortable mattresses, lean linen, blankets and pillows. There are two (2) separate walk in closets and a two (2) desk mounted in the wall. There is adequate lighting (ceiling), and the windows are slide locked with vertical blinds; observed to be in good condition. Bedroom #9: Currently unoccupied. Is prepared to be occupied by two (2) clients. There are two (2) twin size beds, comfortable mattresses, lean linen, blankets and pillows. There are two (2) separate walk in closets and a two (2) desk mounted in the wall. There is adequate lighting (ceiling), and the windows are slide locked with vertical blinds; observed to be in good condition. BATHROOMS: The community bathroom is located down the outside of the bedroom in the hallway. The bathroom is equip with a four (4)showers, four (4) toilets and a four (4) sinks. There are two (2) windows with blinds that were observed to be in good condition. LPA tested the water temperature in the bathroom sinks and showers. The water drained and all toilets flushed. The laundry room is located near bedroom #3, equip with a washer and dryer unit. The laundry detergent is locked in a locked supply room and will distributed to the clients individually according to the load of their laundry. All posting requirements and Emergency Plan were met. Children will are accorded personal rights. The facility current License, Mental Health Certification; Ombudsperson for Youth in STRPs; Grievances and Personal Rights; are posted on the wall in the cottage dining area. Children are not restricted to make base on the profile list for approved phone calls. There is a private room available for the clients to make phones calls and the Phone Call Log is kept in the staff office. The Needs and Services plans will be kept in the therapist office. LPA observed ample stored hygiene supplies and feminine products stored in a locked closet. The common area is equip with adequate furniture; two (2) sofas, book shelf due to renovation additional furniture (i.e table, television). The cottage kitchen is not being utilized to cook food. There is a Non operable gas stove (shut off) with the burners and all nobs removed. The refrigerator was remove during the renovation and will be re-installed to store non-perishable foods. There is a dining table with six (6) chairs. Snacks are also distributed from the Dining Hall to cottage staff. Clients will have access to snack including fresh fruit inside the cottage. The main course of meal are served in the Dining Hall 3 times a day. Clients are escorted to and from the Dining Hall, and monitored by Youth Care Counselors. The Weekly Menu/ Daily Meals are posted in the main Dining Hall and on the kitchen wall inside the cottage. The LPA walked over to the main Dining Hall to observed the weekly menu posted; ample dining tables, refrigerators, freezers; and gas operated kitchens stoves. The sharp knives and hazardous solutions are inaccessible to clients and stored in the main Dining Hall. The smoke detectors operated on a connected system and Carbon Monoxide detectors are operational in both cottages. LPA observed four (4) fully charged fire extinguishers located in the kitchen and hallways. The First Aid Kits was in compliance with all required items; is located in the staff office. LPA observed trash cans are covered with a lids in the kitchen, bathrooms and bedroom. There is a gym; activity room, art, basketball court, baseball diamond, a music studio, recreational activities. LPA observed bodies of water(8 feet pool) that meets regulations; all staff have keys, and trained in water safety certificates and monitor the clients swimming. The Youth Care Counselor transport clients to outside recreational activities. The facility provides a activity calendar for clients to view. Activities included going to the movie theaters, Go-carting, Miniature Golf, museums etc. Some outside extracurricular activities and social events that take persons into public or crowded places have been restricted. Alternate activities have been implemented based the compliance of the client. There were no deficiencies cited at the time of this inspection. LPA-Gray concluded the inspection and a copy of this report was left at the facility with the Director of STRTP on 09/02/2021.

visit_type: Case Management

met_with: STRTP DIRECTOR


summary: Facility Evaluation

raw_content:
Narrative:
On May 5, 2022, at 11: AM Licensing Program Analyst (LPA), Rosslyn Gray and Licensing Program Manager (LPM), JoAunne Griffin conducted a Case Management Licensee Initiated inspection. The purpose of the inspection is to identify Clark Cottage and Sauble Cottage, as the Short Term Residential Therapeutic Program (STRTP). LPA met with Maria Bhattachan, Chief Administrative Officer (S1) and Ken Garcia, Administrator who granted access to the facility. The entire physical plant was inspected. The facility is currently licensed to provide care and supervision for 16 clients ages 13-17 years old. Currently no children are residing in the STRTP due to temporary closer effective May 28, 2021. Each cottage will have a capacity of 8 clients. There is a pool on the premises that meets regulations. LPA observed pool surrounded by 5-foot self-latching gate that meets regulations; all staff have keys, are trained in water safety, have certificates, and monitor the clients while swimming. There is a dining hall, school and a chapel located on the campus that is not being utilized. Clark Cottage and Sauble Cottage: There are no clients currently residing in cottage. The bedrooms are prepared to be occupied by one (1) client. There is one (1) twin size bed, comfortable mattresses, clean linen, blankets, and pillows. There are two (2) separate walk-in closets and one (1) desk mounted to the wall. There is adequate lighting, and the windows are observed to be in good condition. There is a storage room equipped with extra clothing, linen, and hygiene items. LPA observed ample stored hygiene supplies and feminine products stored in a locked closet. Bathrooms were observed to be clean and in working order. Continued on LIC 809-C In both cottages LPA observed, Ombudsperson for the Youth, Grievances, and a suggestion box. All required postings were posted on the wall in the dining area. Children are not restricted to make phone calls based on the approved phone calls list. There is a private room available for the clients to make phones calls and the Phone Call Log is kept in the staff office. The Needs and Services plans will be kept in the therapist office. The common area is equipped with adequate furniture; three (3) sofas, a bookshelf; furniture (i.e table, television). The kitchen is utilized to with an operable 4-burner electrical stove. The refrigerator is used to store extra snacks and non-perishable foods. There is a dining table with eight (8) chairs. The food menu is posted on the refrigerator. Clients will have access to snack including fresh fruit inside the cottage. The smoke detectors are operated on a connected system and carbon monoxide detectors are operational in both cottages. LPA observed three (3)) fully charged fire extinguishers located in the kitchen and hallways. Fire extinguishers expire May 2022. The First Aid kits are in accordance with all required items and are located in the staff offices. LPA observed that trash cans are covered with a lid in the kitchen, bathrooms, and bedroom. There is a gym, activity room, art room, basketball court, baseball diamond, music studio and recreational activities available. LPA Gray concluded the inspection, and a copy of this report was left at the facility with the S1.

met_with: Chief Compliance and Quality Improvement Officer.


facility_name: PALO VERDE HOUSE

summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Additionally, during inspection on 5/4/22, LPA observed dark spots in the corners and along the seal of the shower-tub in the hallway bathroom and small, dark spots in the shower in the en suite bathroom. During today's inspection, LPA took a glove and was able to smear the spots, indicating they are not stains and are active mold/mildew. LPA inspected the facility's store of cleaning supplies and observed three cans of bathroom cleaner targeting soap scum but no cleaners for mold/mildew or mold/mildew stains. There is no evidence that spots have been treated to ensure no active mold is present. The preponderance of evidence standard has been met, and therefore the above allegations are found to be Substantiated. LPA is issuing two citations of California Code of Regulations (CCR), TItle 22, Section Buildings and Grounds. See attached LIC 9099-D. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Administrator Mattie Marsh, whose signature confirms receipt.

Investigation Findings:
13On 5/24/22 at 1:08PM, Licensing Program Analyst (LPA) Mariah Hawkins conducted a complaint inspection at the facility. LPA met with Administrator Mattie Marsh and informed of the purpose of the visit. Safety precautions were taken, including mask-wearing and pre-visit screening call. During complaint investigation, LPA inspected the facility and interviewed 4 residents and 2 staff. Based on observation and interview, 2 of 4 residents reported seeing bugs in the facility. Photos of 3 different bugs on different occasions inside the facility were sent to LPA, including at least two where bugs were found in a resident's bed. During one observation, LPA was called by a resident, and LPA could hear staff remove the bug as requested by the youth. Additionally, LPA was initially informed by the facility that the facility had a current contract with an exterminator service. However, upon request for the most recent invoice, LPA was provided with a new contract dated 5/6/22, after LPA's intial inspection on 5/4/22. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: PALO VERDE HOUSEFACILITY NUMBER: VISIT DATE: 05/24/2022

met_with: Administrator Mattie Marsh

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
The preponderance of evidence standard has been met, and therefore the above allegations are found to be Substantiated. LPA is issuing three citations, per California Code of Regulations, Title 22, Section Food Services and STRTP Interim Licensing Standards (ILS), Sections Plan of Operation and Personal Rights. An exit interview was conducted, appeal rights provided, and a copy of this report was provided to Administrator Mattie Marsh, whose signature on this form confirms receipt.

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


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Investigation Findings:
13On 12/14/22 at 10: AM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at listed facility and spoke with Mattie Marsh/Patrick Davis, Administrators and Bryce Marsh, House Manager. The purpose of the inspection was to open the complaint and deliver the findings for the above complaint allegations. During investigation, interviews were conducted and documents were reviewed, and it was determined that the facility staff did not surrender valuables entrusted to them to a youth in care upon the youth's disharge and facility staff did not safeguard valuables to them. Based on LPA's interview with staff and record review(s), the preponderance of evidence standard has been met, therefore the above allegations, facility staff did not surrender valuables entrusted to them to a youth in care upon the youth's disharge and facility staff did not safeguard valuables to them is found to be SUBSTANTIATED. Facility is being cited for violation of California Code of Regulations (CCR), Title 22, Division 6 & Chapter 1: 80026(b) Safeguards for Cash Resources, Personal Property and Valuables. At this time, one deficiency was given. An exit interview was conducted, appeal rights provided and discussed, and a copy of this report was given to Mattie Marsh/Patrick Davis, Administrators and Byrce Marsh, House Manager. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: PALO VERDE HOUSEFACILITY NUMBER: 075650097

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

met_with: Mattie Marsh and Patrick Davis


raw_content:
Investigation Findings:
13On 1/9/23 and 1: PM, Licensing Program Analyst (LPA) Alyssa Ng conducted a complaint inspection at Palo Verde and spoke with Mattie Marsh and Patrick Davis, Administrators. The purpose of the inspection was to deliver the findings for the above complaint allegations. This complaint was taken as an assignment by Community Care Licensing's (CCL's) Investigations Branch (IB) and assigned to Inv. Blake Williams on 09/22/2022. Complaint was upgraded to a full investigation on 11/30/2022. During investigation, confidential interviews, police reports, and physical evidence were obtained, it was determined that staff did not handle resident in a rough manner and staff did not choke a resident. Although, the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that staff handles resident in a rough manner and staff choked a resident. Therefore, the above allegations are unsubstantiated. At this time, no deficiencies were cited. Exit interview was conducted and a copy of the report was left with Mattie Marsh and Patrick Davis, Administrator UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Alyssa Ng LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Mattie Marsh/Patrick Davis


raw_content:
Narrative:
During the course of the investigation, LPA Hood conducted seven confidential interviews. LPA reviewed the facility's program statement, incident reports, C1's Needs and Services Plan, and email correspondence. According to four confidential interviews and record review, on 4/28/2023 the facility had informed Community Care Licensing (CCL) and Butte County of a plan to temporarily close on 5/1/2023 via email. This email also documented that C1 would need to be removed from the facility on or before 5/1/2023. This temporary closure and eviction were rescinded on 4/31/2023. Based on three confidential interviews and record review, facility staff did not provide updated service plan to the authorized representative until 5/19/2023. Based on the confidential interviews and record review, the allegations that staff did not provide client's records to authorized representative and staff did not follow proper eviction procedures are substantiated. LPA delivered a Type A citation for STRTP Interim Licensing Standards 87068.4(c)(1). Facility did not provide service plan or proper communication during the eviction process which poses an immediate risk to health, safety and/or personal rights of the client in care. LPA conducted an exit interview with David Beanes, Facility Manager at 1:58PM and provided appeal rights.

Investigation Findings:
13On 6/12/2023 at 12:14PM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to deliver the findings for the listed allegations. LPA met with David Beanes, Facility Manager, who informed them that they were leaving to pick up a client and nobody else was present in the home. LPA Hood attempted to call Administrator, Mattie Marsh, and Director, Patrick Davis. LPA returned to the facility at 1:45PM. LPA met with David Beanes, Facility Manager. During the course of the investigation, LPA Hood conducted seven confidential interviews. LPA reviewed the facility's program statement, incident reports, C1's Needs and Services Plan, and email correspondence. Continued on LIC9099C... SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Selena Hood LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: PALO VERDE HOUSEFACILITY NUMBER: VISIT DATE: 06/12/2023

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

met_with: David Beanes


raw_content:
Narrative:
Based on confidential interviews, the facility had informed Community Care Licensing (CCL) of the inability to safely place C1. Based on the confidential interviews and record reviews, the allegation that facility did not follow eviction protocols may or may not be true. The allegation has not met the preponderance of doubt, and the allegation is therefore unsubstantiated. No deficiencies were cited at this time. LPA conducted an exit interview with Mattie Marsh, Program Manager at 1:35PM whose signature confirms the receipt of this document.

Investigation Findings:
13On 6/22/2023 at 12:11PM, Licensing Program Analyst (LPA) Selena Hood conducted an unannounced visit to the licensed facility. The purpose of this visit was to conduct interviews and deliver the finding for the above allegation. LPA met with Mattie Marsh, Program Manager. During the course of the investigation, LPA conducted five confidential interviews. LPA reviewed the 14-day notice, pertinent incident reports, daily notes, C1's Needs and Services Plan, photographs of staff injuries, and email correspondence. Based on confidential interviews and incident report, C1 was placed on a 5150 hold by Pittsburg Police Department on 6/1/2023. Based on confidential interviews, on 6/2/2023 the facility gave notice to Butte County that they would not be able to accept C1 back from their hospitalization because of multiple staff UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Selena Hood LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: PALO VERDE HOUSEFACILITY NUMBER: VISIT DATE: 06/22/2023

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

met_with: Mattie Marsh


raw_content:
Narrative:
continued from LIC Regarding the allegation that staff made inappropriate statement: During the course of the investigation, LPA Karkazis conducted confidential interviews with staff, clients, and conducted document research. During confidential interviews, inconsistent information was provided. Most interviewees stated that there were no inappropriate statements made, one interviewee stated there was an inappropriate statement, but could not provide details. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that staff made inappropriate statement. Therefore, the above allegation is UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was given to Brice Marsh, House Supervisor.

Investigation Findings:
13On 9-22-23 12:47PM, Licensing Program Analyst (LPA) conducted an unannounced inspection at Palo Verde and met with Brice Marsh, House Supervisor, who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. Regarding the allegation that the facility is not providing outings: During the course of the investigation, LPA Karkazis conducted confidential interviews with staff, clients, and conducted document research. During confidential interviews, most interviewees stated that outings are always provided. The frequency and type maybe changed due to certain behaviors and safety concerns. Other interviewees state activities were only provided one time per month. LPA conducted document research and found that clients had seventeen outings for June 2023. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the facility is not providing outings. Therefore, the above allegation is UNSUBSTANTIATED. continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SAN BRUNO ASC, TRAEGER AVE., SUITE FACILITY NAME: PALO VERDE HOUSEFACILITY NUMBER: VISIT DATE: 09/22/2023

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

met_with: Brice Marsh House Supervisor


raw_content:
Investigation Findings:
13At 02:00PM on 10/23/2023, Licensing Program Analyst (LPA) Karmen Balhotra made an unannounced complaint inspection to the facility listed above for this amendment. The reason for the inspection is to deliver findings for the allegation listed above. LPA met with Brice Marsh, Supervisor who helped facilitate the inspection. Over the course of the investigation, LPA conducted confidential interviews and a file review. Evidence obtained revealed that for the allegation of, Minor inappropriately touched another minor while in care, is found to be substantiated. During confidential interviews, three of four staff members interviewed stated that a former client did inappropriately touch another client in care. Confidential interviews revealed that staff were unaware of sexualized behaviors that the client may have had and that the incident took place after clients were leaving the facility together on unauthorized absences. The facility separated clients upon learning of the incident. Therefore, per evidence obtained, the preponderance of evidence has been met. Based on today's inspection the facility is being cited under section 80072(a)(1) Personal Rights. An exit interview was conducted and a copy of this report was left with Supervisor. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Karmen Balhotra LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Brice Marsh


facility_name: PARADISE ADOLESCENT HOME INC.

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Based on evidence obtained and confidential interviews conducted during the investigation process the allegations above cannot be substantiated due to conflicting statements. 4 out of 5 confidential interviews stated that the client is not spoken to in an inappropriate manner. 3 out of 5 confidential interviews stated that the client is always fed, and that snacks are readily available. Since the client doesn't trust certain staff members to make their food, they will cook for themselves most days with staff supervision. 3 out of 5 confidential interviews also state that no staff member has recorded the client or has driven the client in an unsafe manner. Lastly, LPA Shulz was unable to confirm or deny these claims after attempting to obtain further details from a fellow client that was in the home around the time of the incidents. Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted, copy of this report and the Appeal Rights were discussed and provided to the licensee.

Investigation Findings:
13On September 20, 2024 at 10:35am Licensing Program Analysts (LPAs) Tatyana Shulz and Zaria Turner made an unannounced visit to deliver findings to the above Short Term Residential Therapeutic Program (STRTP) and met with Administrator, Carol Ayers. Prior to the meeting LPA Cabigon, conducted the 10-day inspection of the facility on 4/29/2024. No deficiencies were cited during that inspection. LPA Cabigon requested, the clients most recent, Needs and Services Plan, and staff trainings. LPA Shulz requested resource contacts for staff and other parties involved and the facility roster. LPA Cabigon conducted 1 interview and LPA Shulz attempted 3 interviews and conducted 5 interviews between 4/29/2024-9/09/2024. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Tatyana Shulz 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PARADISE ADOLESCENT HOME INC.FACILITY NUMBER: VISIT DATE: 09/20/2024

met_with: Carol Ayers-Administrator


raw_content:
Narrative:
Based on evidence obtained and confidential interviews conducted during the investigation process the allegation above cannot be substantiated due to lack of evidence. 4 out of 5 confidential interviews stated that they are unaware of how hot the home gets and that once it reaches a certain temperature the AC unit is set to turn on. Before LPA could conduct the 10-day inspection, the facility had already placed a covering over the thermostat preventing clients from altering the temperature of the home without staff consent. During initial inspection on 10/3/ LPA observed the temperature of the home to be between a minimum of 68 degrees F and a maximum of 85 degrees F. Although the allegation may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted, copy of this report and the Appeal Rights were discussed and provided to the licensee.

Investigation Findings:
13On November 15, 2024 at 10:06am Licensing Program Analysts (LPAs) Tatyana Shulz made an unannounced visit to deliver findings to the above Short Term Residential Therapeutic Program (STRTP) and met with Administrator, Carol Ayers. Prior to the meeting LPA Shulz, conducted the 10-day inspection of the facility on 10/3/2024. No deficiencies were cited during that inspection. LPA Shulz requested the Needs & Services Plans for all clients in the home within the past two months and contact information for the children's authorized representatives, as available. LPA Shulz attempted 1 interview and conducted 6 interviews between 10/3/2024-11/14/2024. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Tatyana Shulz 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PARADISE ADOLESCENT HOME INC.FACILITY NUMBER: VISIT DATE: 11/15/2024

met_with: Adminstrator- Carol Ayers


raw_content:
Narrative:
Based on evidence obtained and confidential interviews conducted during the investigation process the above allegation(s) cannot be substantiated because there were inconsistent statements throughout the investigation process. During the investigation LPA Areizaga was informed the residents toilet was fixed. Interviews conducted confirmed that staff addressed the pest issues at the facility by conducting regular pest control services. During LPA's inspection on 12/10/24, LPA did not notice any mold in the facility only the smell of mold. 4 out of 6 interviews conducted confirmed that staff have address the mold smell at the facility. Additionally, minor in question refuses to attend school regularly and staff encourage them to attend school but can't force them. LPA was informed that residents help create the monthly activity plan. It was confirmed during multiple interviews that residents can participate in activities but can have their privileges revoked if they do not attend school or misbehave. Finally, records review confirmed by LPA that client in question refused their medications on a regular basis and staff denied this allegation. LPA was informed that if a resident requests any clothing, staff will purchase the clothing with-in a reasonable time but client in question refused to agree with the reasonable time frame staff provided to go shopping for clothing. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted, a copy of this report and the Appeal Rights were discussed and provided to the licensee.

Investigation Findings:
13On March 4, 2025, at 10: AM Licensing Program Analysts (LPAs) Orlando Areizaga and Sara Luman-Gonzalez conducted an unannounced inspection to Short Term Residential Therapeutic Program (STRTP) to deliver the findings of a complaint investigation. LPA met with Administrator,Carol Ayers and was granted entry. Prior to the meeting LPA Areizaga initiated the complaint investigation on December 10th, 2024. No deficiencies were cited during that inspection. LPA Areizaga requested the following documents: needs and services plan, incident reports, medication log, client personal property and valuables log, resident points distribution sheet, and unusual incident report. LPA's Areizaga and Shulz conducted 7 interviews between December 2024 and February UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Orlando Areizaga 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PARADISE ADOLESCENT HOME INC.FACILITY NUMBER: VISIT DATE: 03/04/2025

met_with: Administrator, Carol Ayers


raw_content:
Narrative:
During the investigation LPA Areizaga received consistent statements regarding staff engaging in a physical altercation with minor in care. 8 out of 8 confidential interviews confirmed staff did physically fight minor in care inside the facility. It was also confirmed that staff have slept at the facility while not on shift. LPA was notified that staff have permission from management to stay at the facility while not working due to them living far from the facility, which is not approved under their Plan of Operation. Based on LPAs observation and interviews which were conducted and records review, the preponderance of evidence standard has been met, therefore the above allegations are founded to be substantiated. California Code of Regulation Interim Licensing Standard (LIS) are being cited on the attached on LIC 9099D. An exit interview was conducted, and Appeal Rights were discussed with Administrator, Carol Ayers. A copy of this report and Appeal Rights were left at the facility. During the investigation LPA obtained inconsistent statements during the investigations process about staff not treating minor with respect. 5 of 8 interviews confirmed that minor(s) in care are always treated with respect. In addition, Client 1 confirmed there is a lack of respect towards minor(s) in care, but LPA Areizaga was unable to confirm with Client 2 the above allegation due to them not being available. Lastly, Social Workers did not have any concerns with minor(s) being treated without respect while in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur therefore the allegation is unsubstantiated.

Investigation Findings:
13On April 29, Licensing Program Analyst (LPA) Orlando Areizaga conducted an unannounced inspection to Short Term Residential Therapeutic Program (STRTP) to deliver the findings of a complaint investigation. LPA met with Administrator, Carol Ayers and was granted entry. Prior to the meeting LPA Areizaga initiated the complaint investigation on March 4th, 2025. No deficiencies were cited during that inspection. LPA Areizaga requested and obtained the following documents: needs and services plan, recent CFT meeting notes, 3 staff file, staff schedule, and staff training. LPA Areizaga conducted 8 interviews between March 2025 to April 2025. LPA was unable to interview Client 2 after several attempts to confirm the above allegations. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Orlando Areizaga 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PARADISE ADOLESCENT HOME INC.FACILITY NUMBER: VISIT DATE: 04/29/2025

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:


summary: Facility Evaluation

raw_content:
Narrative:
On 09/03/2021, starting at approximately 10: AM, Licensing Program Analyst (LPA) Chad Cabigon conducted a Prelicensing Inspection of this facility. LPA was met by Executive Director Maritza Jefferson who gave a tour of the interior and exterior areas of the facility's physical plant. There are no bodies of water on the premises; the front and back yards were free of clutter; and the passageways and egresses were unobstructed. No potentially hazardous items or areas were observed--there is a shed in the backyard that is lockable (it currently does not contain any potentially dangerous equipment). The facility has three bedrooms: the master bedroom has an en-suite full bathroom whose two vanity faucets provided hot water with temperature readings of 110 and 116 degrees Fahrenheit; the temperature reading for the hot water that the shower provided was 109.6; the toilet in that master bathroom was in working condition. There is also a common bathroom off the bedroom hallway: the toilet flushes, the vanity faucet's hot water temperature reading was 121.4, the shower's water temperature was 105.8. The kitchen faucet's hot water temperature reading was 110.2. The house has two refrigerators: one in the kitchen and one in the garage, both are in good working condition. There is also a sizeable walk-in pantry. The house is equipped with two fire extinguishers, one was located in the threshold between the receiving area/dining room, and the other was mounted on the back wall of the kitchen. The house has an office area immediately to the right of entering the house; Ms. Jefferson stated that this room, as well as the built-in cabinet in the office, will be securable as this is where confidential client and staff files will be housed. No structural defects to the house was observed by this LPA: the windows and window screens were in good repair and there were no unfinished areas. Per Ms. Jefferson, the beds, along with all other necessary furnishings for the bedrooms, will be procured shortly; cabinets, storage spaces, and all other areas that need to be inaccessible to future residents will also be secured (locking mechanisms to be installed, for example) by the next Prelicensing inspection. Ms. Jefferson was reminded that she could call this LPA directly for guidance should she have any Regulations-related questions to ensure compliance. A subsequent Prelicensing inspection will be conducted at a future date. A copy of this report is being provided to Ms. Jefferson.

visit_type: Prelicensing

met_with: Maritza Jefferson


summary: Facility Evaluation

raw_content:
Narrative:
On 09/28/2021, starting at approximately 11: AM, Licensing Program Analyst (LPA) Chad Cabigon continued this facility's Prelicensing inspection by conducting another in-person tour of the interior and exterior areas of the house's physical plant. The front and back yards were observed to be free of clutter; utility shutoff valves were located; there were no potentially hazardous outdoor equipment or areas that would be accessible to future clients; and the egresses/pathways were unobstructed. The facility's office area, located adjacent to the house's receiving or family room, was now set up so that the door was securable; in the office were drawers and/or cabinets that were lockable, within which confidential records of clientd and staff are to be housed. The access door to the laundry area, then to the garage (from the inside of the house), was now lockable to keep potentially hazardous chemicals off-limits to future clients. All client bedrooms were now furnished with individual beds and appropriate linen/beddings; adequate storage spaces were also observed within the bedrooms. This concludes the Prelicensing Inspection for this facility. No citations are being issued as a result of this inspection. The facility's provisional license will be issued shortly. Exit interview conducted; a copy of this report is being provided to Ms. Jefferson.

met_with: Maritza Jefferson, Carol Ayers


summary: Facility Evaluation

raw_content:
Narrative:
On 12/28/2021 at approximately 10: AM, Licensing Program Analyst (LPA) Tina Rivera and Licensing Program Manager (LPM) Rosa Rodriguez arrived at the facility to complete a post-licensing inspection. This was an attempted post-licensing inspection. LPA observed the front yard and entry to be clean and clear of clutter. LPA knocked on the door and called Maritza Jefferson, as no one answered the door and appeared to be at the facility. LPA sent Maritza Jefferson an email and text message. LPA and LPM waited in their vehicle for an hour. At 11: AM, Martiza Jefferson returned LPA's phone call and informed LPA that they were on vacation out of the country. They will not return until January 3, 2022. Additionally, there are no placements in the facility at this time. LPA asked if any other staff was available to assist with the inspection, Maritza Jefferson reported that no one is available, as they are on vacation as well. LPA will schedule an inspection for the first week of January to complete the post-licensing inspection. Exit interview was conducted with Maritza Jefferson via telephone at 11: AM. A copy of this report will be sent electronically to MJefferson@paradisehomes.org. Signature on file.


summary: Facility Evaluation

raw_content:
Narrative:
On 10/24/22 at 09:35 a.m. Licensing Program Analyst (LPA) Jacqueline Carmona and Licensing Program Manager (LPM) Rosa Rodriguez made a unannounced visit at the above facility with the purpose of conducting a required Annual Inspection using the Compliance and Regulatory Enforcement (CARE) tools. During the inspection LPA and LPM met with Maritza Jefferson, Executive Director and Carol Ayers, Administrator. There are no staff and clients placed at the facility, therefore clients were not interviewed. LPA Carmona conducted a walk- through of the interior and exterior of the facility. The facility consisted of 4 bedrooms, 1 bedroom is designated as a staff office and there are 2 full bathrooms. LPA Carmona observed the following required posters posted in the facility: employee posters, emergency forms, disaster plan, emergency exits, license, HIPPA, personal rights poster, and mental health poster. Prior to the inspection, LPA Carmona reviewed the facilities: annual fees, administrator certificate, accreditation, personnel roster, facility sketch, LIC 500, LIC 610C, LIC 308, waivers, and exceptions. The facility is current on their fees. LPA Carmona and LPM Rodriguez inspected the following: Physical Plant: Disinfectants/Cleaning solutions are inaccessible Currently there is no perishable food due to having no placement's. The facility has at least a weeks' nonperishable foods. The facility has a "mock" menu posted on the refrigerator. Continue to page There is a working telephone in the kitchen. There are dual Carbon Monoxide/Smoke detectors in the hallway, kitchen, and all 4 bedrooms. The First Aid Kit is fully stocked There is a common room and living room available. There is a dining area with enough seating and dining table in good repair The office has door that locks. There is a locked cabinet reserved for medications. The hot water is 115-degree F. There are 2 fully charged fire extinguishers. There are working toilets, bath and showers, all in good repair. The bedrooms have required bedding and furnishing are in good repair. The facility is free of vermin There is a shed in the backyard, it is empty and unlocked. Operation: All requirements met. No citation cited for this section of the domain. Disaster Preparedness: All requirements met. No citation cited for this section of the domain. Staffing/Client Records: The facility is vacant therefore there are no clients or staff. The facility had a "mock" file for staff and clients. LPA and LPM reviewed the "mock" files and they had appropriate examples of required documents. LPA and LPM reviewed the "mock medication binder which also had the required documents. Core/Therapeutic Services: There are no placement's at the facility. Services are not being provided at this time; however, the facility has a program, and it will be implemented. An exit interview was conducted with Maritza Jefferson, Executive Director and a copy of this report will be emailed to mjefferson@paradisehome.org.

met_with: Maritza Jefferson, Executive Director


facility_name: PARADISE ADOLESCENT HOMES

raw_content:
Narrative:
Based on IB's observations, interviews which were conducted, and records reviewed, the preponderance of evidence standard has not been met, therefore the above allegation is found to be unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur. No Interim Licensing Standards or Title Regulations were cited during today's inspection. Exit interview conducted and a copy of this report is provided to the facility.

Investigation Findings:
UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Chad Cabigon 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 23-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, NATOMAS PARK DR., STE FACILITY NAME: PARADISE ADOLESCENT HOMESFACILITY NUMBER: VISIT DATE: 07/08/2021

met_with: Carol Ayers


raw_content:
Narrative:
Based on interviews conducted by LPA Carmona during the investigation process 5 out of 10 interviews conducted, all corroborated that they never had knowledge or observed youth being molested by staff while in care. LPA Carmona received screen shots of messages disclosing youth in care witnessed staff being inappropriate to youth in care, but LPA Carmona attempted and was unable to interview those clients. In addition, LPA Carmona was also not able to retrieve text messages disclosed to have been sent from staff to youth in care. This agency has investigated the complaint alleging staff molested youth while in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is Unsubstantiated. An exit interview was conducted. A copy of this report and the Appeal Rights were provided via e-mail to the Administrator.

Investigation Findings:
13On 10/13/ Licensing Program Analyst (LPA) Jacqueline Carmona conducted an unannounced visit to the above Shot Term Residential Therapeutic Program (STRTP) to deliver findings for the allegation noted above. LPA Carmona met with Carol Ayers, Administrator. During the investigation, LPA Carmona reviewed the agency's file at the licensing office, including the complaint history and criminal background check for staff. LPA Carmona also reviewed the client's needs and service plans, face sheet, SIR's for the years of 2017 and 2018, one incident report dated 6/30/22, hospital discharge documents, text messages and a behavioral contract. LPA requested and was provided a two-week letter from staff dated 2018. LPA Carmona conducted 10 confidential interviews between 07/07/22- 10/03/22 and 1 attempted interview. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Jacqueline Carmona 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 23-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, NATOMAS PARK DR., STE FACILITY NAME: PARADISE ADOLESCENT HOMESFACILITY NUMBER: VISIT DATE: 10/13/2022

met_with: Carol Ayers, Administrator


raw_content:
Narrative:
Based on interviews conducted during the investigation process the allegations facility staff yell at minor in care, minor is not being accorded dignity between staff at the facility and facility is not providing adequate food to client cannot be substantiated because statements given in the 14 interviews conducted from 9/20/22- 11-/30/22 did not corroborate. 4 confidential interviews conducted on 11/02/22 11/30/22,11/29/22 and 09/20/22 alleged facility did not provide adequate food to client. 10 confidential interviews disclosed the facility did provide adequate food to clients. 9 confidential interviews corroborated that staff do yell at minors and in care. The yelling or raising of the voice from the staff occurs when minors are not following facility rules or when there is non complaint behavior from the client. Confidential interviews dated 11/18/22, 11/29/22 and 11/30/22 corroborated that minors are not being accorded dignity between staff at the facility staff in the facility. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted. A copy of this report and the Appeal Rights were provided to the Administrator.

Investigation Findings:
13On 12/06/22 at 9:47 a.m. Licensing Program Analysts (LPAs) Jacqueline Carmona and Shalisa Stiger conducted an unannounced visit to the above Short Term Residential Therapeutic Program (STRTP) to deliver findings for the allegations noted above. LPA Carmona met with Carol Ayers, Administrator. During the investigation, LPA Carmona reviewed the agency's file at the licensing office, including the complaint history and criminal background check for staff. LPA Carmona also reviewed the client's needs and service plans, face sheet, August case notes, the facilities October 2022 food menu, LIC 624-LE dated 08/21/22, and personal right training logs dated 10/24/22 and 10/18/21.LPA Carmona conducted 14 confidential interviews and 1 attempted interview between 09/20/22- 11/30/22. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Jacqueline Carmona 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 23-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, NATOMAS PARK DR., STE FACILITY NAME: PARADISE ADOLESCENT HOMESFACILITY NUMBER: VISIT DATE: 12/06/2022

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


raw_content:
Narrative:
Based on interviews conducted during the investigation process the allegation facility staff did not provide transportation is substantiated because the facility did not provide transportation to work for a client in care on 11/29/22, 1/7/23, and 1/13/23. The facility's Program Statement states in section 3 the facility will provide clients transportation to employment. During three confidential interviews on 11/29/22 it was disclosed transportation needs of the client couldn't be met due to the facility only having one vehicle and distance of the client's workplace. The facilities Program Statement in section 7 also states there will be two agency authorized vehicles at the facility to ensure that adequate transportation needs are met. When LPA Carmona opened the complaint at the facility on 12/02/22 there was only one vehicle at the facility to ensure adequate transportation needs were met. In addition, two confidential interviews conducted on 12/02/22 corroborated that the facility had not had two vehicles for over a year. During 2 confidential interviews on 11/29/22 and 1 confidential interview on 12/02/22 it was disclosed the facility was not aware their Program Statement contained the terms in section 3 and 7. Although the facility was not aware of the terms in their Program Statement once LPA Carmona addressed them, they made sure to try and transport the client in care to and from work. 7 confidential interviews conducted from 11/29/22- 1/06/23 corroborated that the facility was accommodating transportation to and from work for the client in care to their best ability. Although the client was not provided transportation on 1/07/23 and 1/13/23 it was disclosed in a telephone conversation on 1/13/23 that the facility staff would not be driving in unsafe weather conditions to transport client to work. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, (ILS 87022.1), are being cited on the attached LIC 9099D.") An exit interview was conducted. A copy of this report and the Appeal Rights were provided to the House Manager. Based on interviews conducted during the investigation process on the allegation's facility is not providing medication to client cannot be substantiated because statements given in 3 of the 14 confidential interviews conducted on 12/02/22, 12/12/22, 1/06/23 corroborated the facility attempted to obtain medication refills for the client. In addition, case notes dated 11/20/22, daily logbook dated 11/23/22 and an email dated 11/29/22 prove that the facility staff was attempting to refill client's medication but were not able to reach the primary care physician. The facility was able to get ahold of the public health nurse and obtained the prescription refill. MAR's logs dated November 2022 indicate the client was not administered three medications. Upon the client's intake on 11/10/22 the facility became aware that the client did not have enough medication for the remainder of the month. 2 confidential interviews conducted on 12/06/22 corroborated that clients are receiving their medications daily. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted. A copy of this report and the Appeal Rights were provided to the House Manager.

Investigation Findings:
13On 02/14/ Licensing Program Analysts (LPA) Jacqueline Carmona conducted an unannounced visit to the above Short Term Residential Therapeutic Program (STRTP) to deliver findings for the allegations noted above. LPA Carmona met with Chelsea Dailey, House Manager. During the investigation, LPA Carmona reviewed the agency's file at the licensing office, including the complaint history and criminal background check for staff. LPA Carmona also reviewed the client's needs and service plans, SIR's dated 12/20/22, 12/03/22,12/20/22,12/6/22,11/29/22, and 1/06/23, a copy of client handbook, email dated 11/29/22 and 11/30/22, CFT meeting notes dated 11/16/23, daily log book dated 11/23/22, case notes dated 11/20/23, The Facility Program Statement sections 3 and section 7 and MARs logs for November 2022 and December 2022. LPA Carmona conducted 14 confidential interviews between 11/29/22- 1/09/23 and 1 attempted interview on 1/09/23. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Jacqueline Carmona 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 23-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, NATOMAS PARK DR., STE FACILITY NAME: PARADISE ADOLESCENT HOMESFACILITY NUMBER: VISIT DATE: 02/14/2023

met_with: Chelsea Dailey, House Manager


raw_content:
Narrative:
Based on interviews conducted during the investigation process the allegations above cannot be substantiated because statements given in 9 out of 9 confidential interviews conducted corroborated that client did not have access to a dangerous object. All statements given corroborated that the staff always keeps sharps locked up in a cabinet. In addition, 8 out of 9 confidential interviews corroborated that there was an altercation that occurred between a minor (Y1) and staff. Although the altercation between staff and minor (Y1) occurred it was not initiated by the staff. The staff member intervened by stepping in front of another minor (Y2) to protect the minor (Y2) from being hit by minor (Y1). Lastly there were conflicting statements about staff hitting the minor (Y1) accidentally while trying to block minor (Y1) punches or if it was intentional. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted. A copy of this report and the Appeal Rights were provided to the Facility Manager.

Investigation Findings:
13On 9/07/23 at approximately 1:15 p.m. Licensing Program Analysts (LPAs) Jacqueline Carmona conducted an unannounced visit to the above Short Term Residential Therapeutic Program (STRTP) to deliver findings for the allegations noted above. LPA Carmona met with Chelsea Dailey, Facility Manager. During the investigation, LPA Carmona reviewed the agency's file at the licensing office, including the complaint history and criminal background check for staff. LPA Carmona also reviewed the client's needs and service plans, Personal Rights Training Certificate, Pro-ACT Certificate, Case Notes, Communication Log dated 8/02/23 and LIC 624-LE dated 08/02/23. LPA Carmona conducted 9 confidential interviews and 1 attempted interview between 08/07/23- 9/06/23. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Jacqueline Carmona 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PARADISE ADOLESCENT HOMESFACILITY NUMBER: VISIT DATE: 09/07/2023

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

met_with: Chelsea Dailey, Facility Manager


raw_content:
Narrative:
Based on the evidence obtained/reviewed, in calendar notes, daily log sheets and in witness interviews, the above allegations cannot be substantiated because there were inconsistent statements obtained throughout the investigation process. LPA obtained consistent information in witness interviews when discussing clients' personal rights. Staff members denied the allegations and confirmed that C1 had a lot of behavior issues and constantly eloped from the facility which cause missing scheduled appointments. It was also confirmed that nobody witnessed or heard clients being threatened while in care. Also, LPA learned that proper shoes were not purchased initially but they were purchased when C1 requested them. Lastly, LPA learned that medical information was provided to the responsible party initially, but it was oversight between all the paperwork. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted and copy of this report and the Appeal Rights were provided during today's visit.

Investigation Findings:
UnsubstantiatedEstimated Days of Completion: Estimated Days of Completion: Estimated Days of Completion:

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

met_with: Chelsea Daily, Supervisor


raw_content:
Narrative:
Client subsequently contacted 911 and requested to be taken to the hospital for evaluation even though staff at the facility were making attempts to advise the client that pain in the surgical area was normal. While at the hospital, client was administered pain medication. Lastly, 4 inconsistent staff members interviews indicated that it was unclear how the staff did not meet minor's medical needs, and why the hospital staff never contacted the facility to inquire about the medication list. As it relates to the allegation of staff not meeting minor's dietary needs, LPA conducted a review of the discharge paperwork/postoperative instructions and learned that the client was supposed to be on a soft diet which includes no sharp foods/chips. Client was given options by staff which included soft diet foods in the form of soups, popsicles, and ice cream which were declined. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegations are Unsubstantiated. An exit interview was conducted, and appeal rights were given. A copy of this report was provided to Supervisor, Chelsea Dailey.

Investigation Findings:
13On June, 24, 2024 at approximately 10: AM, Licensing Program Analyst (LPA) Farhaan Sarangi arrived unannounced at Paradise Adolescent Homes and met with Supervisor, Chelsea Dailey for the purpose of delivering findings. During the investigation, LPA Sarangi reviewed the agency's file at the licensing office, including the complaint history, criminal background check and facility personnel report summary. LPA conducted interviews with all appropriate parties. Based on interviews conducted, the allegations above cannot be substantiated because there were inconsistent statements made throughout the course of the investigation process. LPA conducted a confidential interview on June 17, 2024, and learned that after the surgery the doctor warned pain to the surgical area. In addition, during the interview, it was disclosed that smoking took placed which irritated the surgical wound and led to the discomfort. (Report continued on LIC 9099C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Farhaan Sarangi 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PARADISE ADOLESCENT HOMESFACILITY NUMBER: VISIT DATE: 06/24/2024

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

met_with: Supervisor, Chelsea Dailey


raw_content:
Narrative:
Based on evidence obtained and confidential interviews conducted during the investigation process the allegations above cannot be substantiated due to conflicting statements. 6 out of 7 confidential interviews stated that the client is provided adequate food services and that meals are prepared for the client at scheduled times and whenever they are ready to eat. 5 out of 7 confidential interviews stated staff do not open clients mail if it is addressed under the clients' name. 7 out of 7 confidential interviews also state that the facility does ensure that it is free of pests by having a pest control service visit the home every 2 months. Receipts were received for that service. Although the allegations may have happened or may be valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. Exit interview conducted, copy of this report and the Appeal Rights were discussed and provided to the licensee. Based on evidence obtained and confidential interviews conducted during the investigation process the allegation above has been substantiated. 4 out of 7 confidential interviews stated that a former client residing in the home was able to obtain the other client's package, open it, and keep the phone that was inside. Staff were unable to retrieve the phone due to the client keeping it on their person. During that time the staff office was accessible to the client and that is how they were able to obtain the package that didn't belong to them. Based on LPAs observations and interviews which were conducted and records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. Interim Licensing Standards are being cited on the attached LIC 9099D. Exit interview conducted, copy of this report and the Appeal Rights were discussed and provided to the licensee.

Investigation Findings:
13On November 15, 2024 at 11:32am Licensing Program Analysts (LPAs) Tatyana Shulz made an unannounced visit to deliver findings to the above Short Term Residential Therapeutic Program (STRTP) and met with Administrator, Carol Ayers. Prior to the meeting LPA Buchannan, conducted the 10-day inspection of the facility on 8/23/2024. No deficiencies were cited during that inspection. LPA Buchannan requested, the staff roster, staff schedule, staff training hours, pest control work orders, grocery receipts, and a copy of the food menu for the month of August. LPA Shulz requested resource contacts for staff and other parties involved. LPA Buchannan conducted 1 interview and LPA Shulz attempted 2 interviews and conducted 7 interviews between 8/23/2024-11/06/2024. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Rosa Rodriguez LICENSING EVALUATOR NAME: Tatyana Shulz 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 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION SACRAMENTO CRP RO, GOETHE ROAD, SUITE FACILITY NAME: PARADISE ADOLESCENT HOMESFACILITY NUMBER: VISIT DATE: 11/15/2024

met_with: Adminisrator- Carol Ayers


facility_name: PARADISE HOME

raw_content:
Narrative:
In an interview with W1 on 02/24/2021, W1 stated that during a recent provider meeting for C1 on 02/17/2021, W8 had reported that C1 was regularly smoking marijuana as part of their coping skills when they were depressed or feeling anxious. Per W1, W8 continued by saying C1 was allowed to take daily 10 minute walks in the neighborhood to smoke marijuana outside, and didn't see a need to make C1 stop because it was the only coping skill C1 had. In interviews with C1, C2, W2, W3, W4, W5, W6, W7, W8, and W9, all interviewees stated that smoking was never allowed inside or outside of the facility, and that staff would never grant permission for a client to smoke marijuana as a coping mechanism. C2 stated they had never seen C1 smoking in the home, has never heard of it being an issue at the home, and stated the clients were not allowed to smoke as a coping skill. W2 and W3 both stated they had never heard of any complaints of inappropriate behavior or drug use at the home. W2, W7, and W8 all stated they were aware that C1 smokes marijuana, but that C1 had never done it on facility property and it would not be permitted. C1 denied this allegation, stating they never smoked inside or outside of the facility. In regard to W1's statement that W8 reported C1 was smoking in the facility as a coping skill, W8 stated this was false, that smoking was not allowed even for coping. W8 denied telling anyone they had given C1 permission to smoke, and that C1 was allowed to go on walks but not for the purpose of smoking. W7 and W4 both stated that marijuana paraphernalia had been found once during a room search of C1's room, but confirmed C1 had never smoked in the home. W5 also conducted an investigation into this incident for their own agency, and found the allegation to be unfounded based on interviews with staff and clients. During this investigation, there was insufficient evidence to substantiate that staff allowed C1 to smoke marijuana. C1 initially disclosed that facility staff allowed them to smoke in the backyard, but later declined to speak further on the matter because they stated it was untrue. Although the allegation "Staff is allowing a minor to smoke marijuana while in care" may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated. At this time, no deficiencies were observed or cited. An exit interview was conducted, and a copy of this report was emailed to Sabrina Shelton, whose signature on this form confirms receipt.

Investigation Findings:
13At 11:01AM, Licensing Program Analyst (LPA) Madi Fremont traveled to Paradise Home STRTP for the purpose of conducting an unannounced Complaint Investigation Inspection. LPA met with Care Coordinator Sabrina Shelton, who helped facilitate this inspection. Currently in care are 3 ambulatory clients. (Please reference LIC811 - Confidential Names dated 09/10/2021) On 02/19/2021, the San Jose Children's Residential Program Regional Office received a complaint for Paradise Home with one allegation: "Staff is allowing a minor to smoke marijuana while in care." This complaint was assigned to LPA Fremont and was investigated by Investigator Dinah Watkins of Community Care Licensing's (CCL's) Investigations Branch (IB). (CONTINUED ON LIC9099-C) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Helga Wong LICENSING EVALUATOR NAME: Madeleine Fremont LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: PARADISE HOMEFACILITY NUMBER: VISIT DATE: 09/10/2021

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

visit_type: Complaint Investigation

met_with: Care Coordinator Sabrina Shelton