facility_name: SUGAR BOWL HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 09/24/ Licensing Program Analyst (LPA) Wendy Brown met with Summer Walker, the applicant representative for a Component II Meeting. During the meeting we discussed the administrator qualifications, the population to be served as well as various components of the Plan of Operation and Program Statement per the Department review.

met_with: Summer Walker - Applicant Rep


state: CA

facility_name: SUMMERPLACE INC.

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
The confidential interviews conducted did not collaborate the allegation. The placement agency social worker indicated having no concerns with the facility. There was no corroborating information obtained through interviews nor review of records to confirm the allegation. Based on the interview and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited.

Investigation Findings:
13On November 30, 2021 at 8: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Cabral met with Case Manager Raylene Reyes. During the course of the investigation, LPA Cabral interviewed three facility staff, two clients and attempted to interview one on 7/14/21. LPA interviewed one client on 11/18/21 (see Confidential Names Form LIC 811 dated November 30, 2021). LPA Cabral interviewed one county social worker on 7/14/21 and attempted to interview three county social workers on 7/14/21. LPA Cabral reviewed the facility's incident reports, and Emergency Intervention Plan. The facility staff denied the allegation that facility staff did not prevent client from AWOLing. The facility staff indicated clients are supervised at all times. Staff will attempt to redirect, follow and call law enforcement when clients AWOL from the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Deborah A Santos LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Summerplace INC.FACILITY NUMBER: VISIT DATE: 11/30/2021

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

report_type: Complaint Investigation

met_with: Raylene Reyes, Case Manager

complaint_status: unsubstantiated


raw_content:
Narrative:
Page Staff denied the allegation. Staff#2 stated client#1 was on the swing and it did break, but they provided immediate medical attention for the client and notified the CSW immediately. Client#1 stated she did fall from the swing and was provided medical attention. She also stated using the swing on different occasions. Administrator stated the swing set had been at the facility for about 30 years and stated they did not see anything wrong with it. She stated after the incident the swing was thrown out. Witnesses stated the incident happened and did not see anything wrong prior to the incident. Statements obtained from interview conducted with social worker revealed no concerns regarding the allegation. Social worker stated the incident was reported to her right after it happened and child was provided medical services immediately. Based on information gathered from interviews conducted and records reviewed the allegation were unsubstantiated. Although the allegation may have happened or are valid the standard of the preponderance of evidence was not met. A copy of this report and confidential names form were provided to the above mentioned facility representative. Exit interview conducted. No deficiencies were cited.

Investigation Findings:
On September 8, 2023 at 11:30AM, Licensing Program Analyst (LPA) Pedro Ramos conducted a follow up complaint inspection. During the inspection LPA met with Tina Klock, Administrator. The purpose of the inspection was to deliver findings for the above-mentioned complaint allegation. During the course of the investigation LPA conducted interviews with three clients, two staff on 6/8/23 (see LIC 811 dated 9/8/23). In addition, LPA conducted a file review on 6/8/23. LPA obtained copies of staff contact information, incident reports and client information. It was alleged staff did not provide safe equipment for children resulting in a child's injury. (Continued on Page 2) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Pedro Ramos LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Summerplace INC.FACILITY NUMBER: VISIT DATE: 09/08/2023

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

met_with: Tina Klock, Administrator


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Continue from page 1 . . . The staff denied the allegation and stated that the staff directed the clients to stop the behavior while in the vehicle. The information indicated that the staff was driving the clients back to the facility (GH) and were in a stop light when a client threw the headphone hitting the staff and then hit another client in the front sit. The information indicated that a client on the back sit hit another client in the back sit a couple of times but was told to stop by the staff driving the vehicle. The information indicated that the client stopped the behavior in the vehicle and there were no other incident on the way to the GH. Other information indicated that the vehicle was waiting at a stop light and was surrounding traffic around the GH vehicle and the incident only took place while the vehicle was stopped at the red light which lasted a few minutes. The confidential interviews revealed conflicting statements about the allegation. There was information that indicated that clients were being taken back to the GH and two of the clients were talking about school when a third client became aggressive because the client thought that the other clients were talking about her. The confidential interviews indicated that the client threw a pair of headphone and hit a client in the front while hitting a client on the back sit a few times. There was information saying that the staff told the clients to calm down and to get along while other information indicated that the staff did not say anything to the aggressive client. Other information indicated that the staff kept driving and other information indicated that the staff slowed down while driving and locked the door to the vehicle. Additional information indicated that the incident lasted about two minutes and the client came down while other information indicated that it was not sure of how long was the incident. The County Social Workers indicated having no concerns with the care and supervision in the GH and indicated that the GH follows up with the clients. Two of the clients in the incident were interviewed and a third one was not available to give a statement. Based on the interviews and records reviewed, the allegation is found to be unsubstantiated. Although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove the allegation. Copies of LIC9099, LIC9099C, LIC811 and Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On October 06, 2023, Licensing Program Analyst (LPA) Heriberto Perez conducted a follow-up complaint inspection to the above facility and met with Elizabeth Meyer, MFT-T. The purpose of the inspection was to deliver the revised finding for the above complaint allegation. During the course of the investigation, LPA interviewed three clients and one staff on 07/21/23, LPA interviewed one staff via telephone on 09/26/23, LPA interviewed County Social Worker (CSW2) and one staff via telephone on 09/27/23 and LPA interviewed County Social Worker (CSW) via telephone on 09/28/23 (see Confidential Names Form LIC 811 dated October 06, 2023). LPA also reviewed documents including but not limited to Client's Need and Service Plans, Special Incident Reports (SIR), other documents and Law Enforcement report. It was alleged Staff did not intervene in an altercation between minors. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Heriberto Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Summerplace INC.FACILITY NUMBER: VISIT DATE: 10/06/2023

met_with: Elizabeth Meyer, MFT-T


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
The facility later received notification that the identified staff did not have a criminal record clearance so the staff was not hired. Facility records reviewed show that the identified staff was associated to the facility but no documentation of either a criminal record clearance or exemption was found in the identified staff's file, as required by the Department. A review of Guardian records show that the identified staff is "not eligible." Based on the above information, the preponderance of evidence standard has been met, therefore, the allegation is substantiated. A deficiency citation is issued under California Code of Regulations (CCR) Section 80065(i)(1) Personnel Requirements - Prior to employment or initial presence in the facility, all employees and volunteers subject to a criminal record review shall obtain a California clearance or a criminal record exemption as required by law or Department regulations. The facility is being issued a civil penalty due to criminal background check violations prescribed by California Health and Safety Code section 1522, 1568.09, 1569.17, or 1596.871. As a result, a civil penalty of $100 per person per day for a maximum of 4 days is being assessed. A total of $400 is being assessed. A deficiency citation is also issued under CCR 80066(a)(12)(B) Personnel Records - The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. For employees that are required to be fingerprinted pursuant to Section 80019, each personnel record shall contain documentation of either a criminal record clearance or exemption. These violations pose an immediate health, safety, and personal rights risk to clients in care. A Plan of Correction was discussed with the facility representative. An exit interview was conducted, and copies of the following licensing reports were provided: LIC 9099, LIC 9099-C, LIC 9099-D, LIC421BG and LIC Confidential Names Form. Appeal rights forms were provided and explained.

Investigation Findings:
13On May 23, 2024 at 12:07PM, Licensing Program Analyst (LPA) Irene Yamamoto conducted an unannounced complaint inspection at the facility. LPA met with the facility representative named above. The purpose of the inspection is to deliver the finding for the above allegation. The investigation into the allegation includes the following: On 3/26/24, LPA conducted the 10-day inspection and reviewed the identified staff's file. Copies of the current LIC Personnel Report and LIC Register of Clients were obtained, as well as pertinent documents from the identified staff's file. Interviews were conducted with multiple staff between 3/26/24 to 4/26/24. It was alleged that staff did not have a criminal record clearance. Confidential interviews revealed that the identified staff was in the process of being hired and completed four days of training at the facility on 2/26/24, 2/27/24, 2/28/24 and 3/4/24. The training included shadowing other staff at the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Irene Yamamoto LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Summerplace INC.FACILITY NUMBER: VISIT DATE: 05/23/2024

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

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Unsubstantiated - 3 allegations

raw_content:
Narrative:
Continue.... On 10/29/2024, LPA conducted a review of the Short Term Residential Therapeutic Program's (STRTP's) complaint history and reviewed documents obtained from other agencies, Personnel Reports for the STRTP, Initial Needs and Services Plan (NSP) for Client (C1), a 30-Day Treatment Plan and NSP Review for C1. On 11/01/2024, LPA obtained and reviewed a Client (C1) Face Sheet - dated 10/23/2024 and a Detention Report - dated 07/08/2024, from the County of San Bernardino, Superior Court of California. On October 23, 2024, the Department received a complaint alleging that a staff (S1) spoke inappropriate to a minor in care, and staff (S1) smelled like alcohol while cooking around a minor in care. The complaint also alleged that S1 grabbed a vape pen out of her purse and displayed it to minors in care. LPA's investigation revealed that due to conflicting statements gathered from the interviews via phone call and in person, the preponderance of evidence standard has not been met, therefore the above allegations is found to be UNSUBSTANTIATED. A signed copy of this report was provided to the Facility Representative. Exit interview conducted. No deficiencies cited at this time. Appeal rights provided to STRTP.

Investigation Findings:
13On November 19, 2024, at 10:15 a.m., Licensing Program Analyst (LPA) Christopher J. Williams conducted a follow-up inspection at Summerplace, Inc. Short Term Residential Therapeutic Program (STRTP) for the purpose of delivering findings on the above allegations. LPA met with Laverne Dubose, Executive Director. LPA's investigation consisted of phone interviews with the Reporting Party (RP), Previous Client (C2) on 10/25/2024, Previous Staff (S3) on 11/05/2024, and Facility Manager (S4) on 11/07/2024. On 10/29/2024, LPA interviewed the Executive Director (S2), Client (C1) and Head of Services/Mental Health (S1) (See LIC811 - Confidential Names list dated 11/19/2024) in person, after conducting a walkthrough of the STRTP. On 10/29/2024, LPA also conducted 1 collateral visit to complete an interview with client (C3) at her high school. Continue on next page.... UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Christopher J Williams LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Summerplace INC.FACILITY NUMBER: VISIT DATE: 11/19/2024

Allegations:
- UnsubstantiatedEstimated Days of Completion:
- Unsubstantiated Estimated Days of Completion:
- Unsubstantiated Estimated Days of Completion: 27

met_with: Executive Director, Laverne Dubose


raw_content:
Narrative:
The staff denied the allegations and stated clients are schedule to see their doctor or are taken to urgent care if needed. The staff stated that the minor was taken to urgent care when the minor needed to go. The staff stated that medication is picked up at the pharmacy when ready or wait until the pharmacy calls back to report the medicine is ready. The staff stated that there was not inappropriate comments made to the minor and the minor was only encouraged to stay in the facility and follow the program. The confidential interviews revealed contradicting statements. There was statements indicating that the allegations did happened to the minor and other statements indicated the the allegation did not happened or were not aware if it did. The County Social Workers for the minor stated having no concerns with the care and supervision in the facility. There were no witnesses and LPA did not find corroborating evidence to substantiate the allegations. Based on the interviews and records reviewed, the allegations are found to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove the allegations. Copies of LIC9099, LIC9099C, LIC811 and Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On May 23, 2025, Licensing Program Analyst (LPA) Heriberto Perez conducted a follow-up complaint inspection to the above facility and met with Carmela Anderson, Case Manager. The purpose of the inspection was to deliver the revised finding for the above complaint allegations. During the course of the investigation, LPA interviewed two staff and two clients in the facility on 02/18/25, LPA conducted telephone interview with County Social Worker (CSW), two staff and one client on 05/20/25 (see Confidential Names Form LIC 811 dated May 23, 2025). LPA also reviewed documents including but not limited to Client's rooster, staff Personnel Report, Client's Need and Service Report, Special Incident Reports (SIR), Medical Reports and other documents. It was alleged Staff did not seek medical attention for minor, Staff did not pick up minors medication from the pharmacy and Staff made inappropriate comments towards minor. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Heriberto Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Summerplace INC.FACILITY NUMBER: VISIT DATE: 05/23/2025

met_with: Carmela Anderson, Case Manager


raw_content:
Narrative:
On 3/20/25 the Department received a complaint alleging staff did not provide adequate supervision to a client while in care. It was alleged that client is engaging in inappropriate interactions with unknown adults while on AWOL. Based on the record review, including investigative reports from other agencies, confidential interviews, and additional information gathered the allegation was not corroborated. All parties interviewed indicated the facility staff will be attempted to redirect, counsel and provide alternatives when clients are attempting to AWOL from the facility. Staff will call law enforcement, write incident reports and call social workers when clients AWOL from the facility. Based on the interviews and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On June 12, 2025, at 9: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Cabral met with the facility manager Townana Bryant. During the investigation, LPA Cabral interviewed two facility staff (S1 & S2) and attempted to interview four clients (C1, C2, C3, C4) on 3/25/25 (see Confidential Names Form LIC 811 dated June 12, 2025). LPA reviewed incident reports, needs and service plan (NSP), CFT meeting notes, police report and client's safety plan. LPA interviewed one county social worker (CSW) on 4/8/25. LPA reviewed the other agency's investigative report, response notice and client interview. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Summerplace INC.FACILITY NUMBER: VISIT DATE: 06/12/2025

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

met_with: Townana Bryant, Facility Manager


raw_content:
Narrative:
On 5/12/25 the Department received a complaint alleging staff spoke inappropriately to youth while in care and youth was not accorded dignity in their relationships with staff. Based on the record review, including investigative reports from other agencies, confidential interviews, and additional information gathered the allegations were not corroborated. All parties interviewed indicated the facility staff attempt to redirect, counsel and provide alternatives to clients. Staff interviewed denied speaking to client inappropriately and youth was not accorded dignity in their relationships with staff. Clients interviewed denied the allegations. Client#1 was not available to provide a statement as she was AWOL. Social worker stated client did not disclose any concerns to her. Based on the interviews and records reviewed the allegation is/are found unsubstantiated. Although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the allegation. Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On October 9, 2025, at 10: AM Licensing Program Analyst Pedro Ramos (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegation. LPA Ramos met with Stephanie Watkins, Head Of Service to disscuss the findings. During the investigation, LPA Ramos interviewed four facility staff (S1, S2, S3, S4) and interviewed 2 clients (C2,C3) on 10/9/25 (see Confidential Names Form LIC 811 dated October 9, 2025). LPA reviewed incident reports, needs and service plan (NSP), and client's safety plan. LPA interviewed one county social worker (CSW) on 5/20/25. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tira Logan LICENSING EVALUATOR NAME: Pedro Ramos LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200a Monterey Park, CA Facility Name: Summerplace INC.FACILITY NUMBER: VISIT DATE: 10/09/2025

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

met_with: Stephanie Watkins, Head Of Service


summary: Facility Evaluation

raw_content:
Narrative:
On 08/31/21 at 10: AM, Licensing Program Analyst Pamela Silva conducted a follow-up visit to the above facility and met with the facility's Case Manager, Raylene Reyes. The purpose of the inspection is to amend the deficiency cited on the LIC 809D dated 06/23/21. During an annual inspection on 06/23/21, a deficiency for criminal record clearance was issued to the facility. A Deficiency and Penalty Review dated 08/24/21 resulted to the dismissal of the said deficiency and civil penalty. Therefore, this report amends the LIC 809D dated 06/23/21 voiding the criminal record clearance deficiency and the accompanying $500 civil penalty. A copy of this report was provided to the facility representative.

report_type: Facility Evaluation

visit_type: Case Management

met_with: Raylene Reyes


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Dina Camara, conducted a case management inspection on September 28, 2021 at 12: PM based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code section 1538.7. 4 out of Direct Care Staff and 5 out of 5 youth files as identified on the LIC 811 confidential names dated September 28, 2021, were reviewed. 3 out of Direct Care Staff and 3 out of 5 youth were interviewed. The Plan of Correction including policies and procedures were reviewed A copy of this report was discussed and provided to Tina Klock, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 06/20/22 at 9: AM, Licensing Program Analysts (LPA) Zeyda Loera conducted an unannounced Annual Required inspection at the Short Term Residential Therapeutic Program (STRTP). LPA met with Administrator Tina Klock and Case Manager Raylene Reyes. The facility is licensed to provide services to six (6) female clients ages 10-17 and non-minor dependents. There are currently five (5) clients in placement. Physical Plant At 10:15 am, LPA and Administrator Ms. Klock started the tour of the facility. LPA observed the facility license, Emergency Disaster Plan, Child's Personal Rights, Activity Schedule and facility Menu posted on the board. There were perishable foods in refrigerator and freezers enough for two days and non- perishable foods in the walk-in pantry enough for seven days consumption of the clients in care. All the confidential files are locked in the staff office. The cleaning solutions and cleaning were locked inside a cabinet in the hallway. The smoke/carbon monoxide detectors were tested and working. The first aid kit was complete. Each client is supplied with personal hygiene products. Each bedroom has two (2) single beds equipped with clean linens. The hot water temperature was 118 degrees Fahrenheit when checked using a digital thermometer All exits and hallways were observed to be free and clear of hazards and obstruction. Client Records At 12:30pm, LPA started reviewing three client records. The client records contain required information including, but not limited to, consent forms, court orders, needs and services plan, medical assessment, safeguards for cash resources, personal property and valuables, education records, and personal rights forms. Staff Records At 1:30pm, LPA reviewed three staff records. The staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training in the personnel file. The administrator meets the required qualifications and/or experience. The facility manager meets the requirements. Administration Facility's program statement, emergency intervention log is current and available for review. The Emergency Disaster Plan has not been updated per Provider Information Notice (PIN) 21-03-CRP. An exit interview was conducted and copy of LIC 809, LIC 809C and LIC 811 were provided to the administrator. No deficiency citation issued at the time of the inspection.

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
On June 22, 2023, at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an unannounced annual/required inspection at the facility. Lead Child Care Worker, Andrea Lujan let LPA inside the facility. Case Manager /Supervisor Towana. Bryant arrived shortly. The administrator was not available at the time of the inspection. The has current Mental Health Program Approval (MHPA) and CARF Accreditation. The facility is licensed to provide services to 6 female clients ages 12-17 and Non -Minor Dependents (NMD). There are six clients in placement currently. Physical Plant At 9: AM LPA and Lead Child Care Worker Lujan toured the facility. LPA observed the facility license, Emergency Disaster Plan, Activity Schedule, and facility menu posted on the board. There were perishable foods in the refrigerator and freezer enough for two days and non- perishable foods in the walk-in pantry enough for seven days consumption of the clients in care. All the confidential files and sharp objects were observed locked inside a cabinet in the staff office. The cleaning solutions were locked inside the cabinets in the garage. The smoke/carbon monoxide detectors were tested and working. The first aid kit was complete. Each client is supplied with personal hygiene products. There were extra towels and linens for the clients. Each bedroom has single beds equipped with clean linens. The hot water temperature was 111.4 degrees Fahrenheit when checked using a digital thermometer. All exits and hallways were observed to be free and clear of hazards and obstruction. The home is safe sanitary and in good repair. Staff Records At 10: AM, LPA reviewed five staff records. The staff subject to criminal records review have been fingerprinted and cleared. There is documentation of the required education and experience requirements and training in the personnel file. The administrator meets the required qualifications and/or experience. The facility manager meets the requirements. LPA interviewed 2 staff. Client Records At 12: PM, LPA started reviewing six client records. The client records contain required information including, but not limited to, consent forms, court orders, needs and services plan, medical assessment, safeguards for cash resources, personal property and valuables, education records, and personal rights forms. LPA interviewed one client. An exit interview was conducted and copy of LIC 809, LIC 809C, LIC 809D and LIC 811s were provided to the administrator. Deficiency citations were issued at the time of the inspection.

met_with: Towana Bryant


summary: Facility Evaluation

raw_content:
Narrative:
On October 12, 2023 at 9: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez made a case management inspection to the facility and met Tina Klock, Administrator. The purpose of the case management was to follow up on the Special Incident Report (SIR) the Department received regarding physical altercation between two clients. On 09/19/23, the Department received the SIR dated 09/13/23 regarding the incident. The SIR stated that two clients had physical altercation when one client (C1) grabbed from client (C2) a laptop. The staff was present at the time of the incident, and redirected the clients however, C2 pushed C1, and the latter retaliated hitting C1 on the eye. They both had scratches on the arm. No medical attention needed and both clients refused it. The clients were separated and the therapist and met with the clients to address the issue. At the time of the inspection, LPA spoke to Administrator Klock regarding the incident. She stated that they talked to the clients about the incident and both clients tell their story. The clients patched up things and no similar incidents that happened after that. LPA suggested to Administrator Klock ways to report reportable incidents within 24 hours from the occurrence of the incident either by faxing, emailing to or calling in the incident to Community Care Licensing. No deficiency citation was issued at the time of the inspection. A copy of LIC 809 and LIC 811 were provided to the administrator

met_with: Tina Klock


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPAs) Timika Martin and Pamela Silva 02/21/24 at 9:30AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPAs met with Tina Klock, Administrator and inspected the facility inside and out. LPAs reviewed two (2) of child's record and three (3) of staff personnel files on site at the facility. LPAs reviewed two (2) of child's psychotropic medications and medication records. LPAs interviewed two (2) staff on site to discuss the facility's policies and procedures of operation. LPAs will conduct interviews at a later date due to no clients being available during the time of inspection. LPA provided a copy of this licensing report to Administrator, Tina Klock. No deficiencies are being cited at this time. LPAs conducted exit interview with Administrator, Tina Klock.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On June 27, 2024, at 9: AM, Licensing Program Analyst (LPA) Timika Martin conducted an unannounced Annual Inspection at the facility and met with Towana Bryant, Case Manager. LPA stated the purpose of the inspection to the STRTP representative. The facility is licensed to provide services to 6 female clients ages 10-17 and Non -Minor Dependents (NMD). There are six (6) clients in placement currently. This STRTP is a single level house located in a residential neighborhood. The facility consists of 3 bedrooms, 2 bathrooms, staff office, living room, kitchen, dining area, laundry room, 2 car- garage, and backyard. LPA obtained and reviewed the following updated documentation: -LIC Personnel and client roster - Emergency Interventions/Disaster Drills -MHPA Certificate (Expired on May 23, 2024 and is in pending status) - CARF Accreditation -LIC 610C -Activity Calendar -Food Menu -Board minutes The annual inspection consisted of the following seven (7) domains: physical plant, operations, disaster preparedness plan, emergency intervention, staffing, core-therapeutic services and client files. All seven (7) domains were reviewed during today's visit: physical plant, staff files, client files, operations, emergency intervention, core-therapeutic services and disaster preparedness plan. LPA and lead childcare worker toured the facility. LPA observed the facility license, Emergency Disaster Plan, Activity Schedule, and facility menu posted. There were perishable foods in the refrigerator and freezer enough for two days and non- perishable foods in the walk-in pantry enough for seven days consumption of the clients in care. All the confidential files and sharp objects were observed locked inside a cabinet in the staff office. The cleaning solutions were locked inside the cabinets in the garage. The smoke/carbon monoxide detectors were tested and working. The first aid kit was complete. Each client is supplied with personal hygiene products. There were extra towels and linens for the clients. Each bedroom has single beds equipped with clean linens. The hot water temperature was 112 degrees Fahrenheit when checked using a digital thermometer. All exits and hallways were observed to be free and clear of hazards and obstruction. The home is safe, sanitary and in good repair. LPA reviewed five (5) staff files and five (5) client files. LPA conducted interviews with two (2) staff. A deficiency citation is being issued under CCR 80019 (e) Criminal Record Clearance - All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility. This violation poses an immediate health, safety, and personal rights risk to clients in care. A Plan of Correction was discussed with the facility representative. An exit interview was conducted, and copies of the following licensing reports were provided: LIC 809, LIC 809-C, LIC 809-D, LIC421BG and LIC Confidential Names Form. Appeal rights forms were provided and explained.

Deficiencies:
80019(e): Criminal Record Clearance

(e) All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall prior to working, residing or volunteering in a licensed facility

met_with: Towana Bryant, Case Manager


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analysts (LPAs) Juliet Robles, Pamela Silva and Olena Maico on 01/24/25 at 9: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA Robles met with Laverne Dubose, Interim Administrator and inspected the facility inside and out. LPA reviewed 1 of child's records and 3 of staff personnel files on site at the facility. LPA reviewed 1 of child's psychotropic medications and medication records. LPA will conduct interview at a later date due to no clients being available during the time of inspection. LPA interviewed 2 of staff on site to discuss the facilities policies and procedures of operation. LPA provided a copy of this licensing report to Ms. Dubose, Administrator. No deficiencies are being cited at this time. A Technical Advisory was issued (see LIC 9102). LPA conducted exit interview with Ms. Dubose, Administrator.

met_with: Laverne Dubose


summary: Facility Evaluation

raw_content:
Narrative:
On March 20, 2025, at 11: AM Licensing Program Analyst (LPA) Timika Martin conducted an unannounced follow up case management inspection at the facility mentioned above and met with Facility Manager, Towana Bryant regarding Special Incident Reports (SIRs) dated February 26, 2025, and February 27, 2025 submitted to Community Care Licensing (CCL) on March 3, 2025, along with Special Incident Reports (SIRs) dated February 26, 2025, and February 27, 2025. The SIR dated February 26, 2025, indicated that C1 was on an unauthorized absence from the STRTP. The SIR indicated that C1 was able to exit the facility by using a sliding door to the backyard, then left out of the East gate. S1 saw that C1's Instagram account was open on the computer, read messages between C1 and 30-year-old male and saw that C1 provided the male with the facility address. S1 and replied informing the 30-year-old male of C1's age and reported that information to law enforcement and CCL (reference confidential names form LIC 811 dated March 20, 2025). The SIR dated February 27, 2025, indicated that C1 was on an unauthorized absence from the STRTP. During the time of the unauthorized absence, S2 member from Corona Transit Center called to inform S2 that he witnessed C1 is in his presence, witnessed C1 orally copulating an adult male in their elevator and the adult male ran away. The SIR indicated that S2 informed management and picked up C1. Both SIRs indicated that C1, left the facility due to not having access to the facility computer. During the inspection, LPA Martin conducted a tour of the facility, reviewed and requested copies of C1's needs and services plan, school information, current Special Incident Reports (SIRs), C1's safety plan and CFT meeting notes. LPA requested staff contact information, staff shift schedule and the STRTPs unauthorized absences polices and procedures, and facility rules for computer use. During the inspection, LPA conducted an interview with facility manager. Based on records reviewed and interviews, the STRTP is following reporting requirements, unauthorized absences policies/procedures and ensuring client to staff ratios are maintained. An exit interview was conducted, and a copy of the report was left with the FFA representative listed above. No additional follow up is needed at this time.


summary: Facility Evaluation

raw_content:
Narrative:
On August 28, 2025, at 11: AM Licensing Program Analyst (LPA) Timika Martin conducted an unannounced follow up case management inspection at the facility mentioned above and met with Administrator, Laverne DuBose regarding a Special Incident Report (SIR) dated August 9, 2025, that was submitted to Community Care Licensing (CCL) on August 13, 2025. The purpose of the inspection is to address the incident below that was not reported to the CCL in a timely manner. The SIR indicated that C1 disclosed to the facility clinician of sexual abuse/assault by her ex-boyfriend and his friend while under the influence of mushrooms and alcohol. Based on a record reviewed, C1 recalls waking up to the two males "touching her weirdly" and seeing blood and bruising in her genitals upon waking up. C1 denied reporting the incident to law enforcement or any adult. C1 refused to report the incident. The facility clinician reviewed the limitations for confidentiality with the client and offered to report the incident collaboratively. The STRTP did not report this incident to CCL within the initial 24 hours. This is a violation of regulations California Code of Regulations, Title 22, Division 6, Section 80061 (b)(1)(E) Reporting Requirements. An exit interview was conducted and a copy of this report, LIC 811 and appeal rights were discussed and left with Administrator, Laverne DuBose whose signature on this form confirms receipt of these documents.

met_with: Administrator, Laverne DuBose


summary: Facility Evaluation

raw_content:
Narrative:
On 06/23/21 at 8: AM, Licensing Program Analysts (LPAs) Pamela Silva and Zeyda Loera conducted an unannounced Annual Required inspection at the Short Term Residential Therapeutic Program (STRTP). LPAs met with Administrator Tina Klock and Case Manager Raylene Reyes. The facility currently has a provisional STRTP license. The STRTP's Mental Health Program Application is pending approval. The facility is licensed to provide services to six (6) female clients ages 10-17 and non-minor dependents. There are currently six (6) clients in placement. This STRTP is a single level house located in a residential neighborhood. The facility consists of 3 bedrooms, 2 bathrooms, living room, kitchen, dining area, laundry room, 2 car- garage, and backyard. At 9: AM, LPAs along with Case Manager Raylene Reyes conducted a walk- through of the entire grounds and observed the overall maintenance and operation of the facility. PHYSICAL PLANT Overall, the facility is clean, safe and sanitary. All passageways are unobstructed, and all doors open freely. There are no bodies of water in the facility. There are no firearms or ammunition in the facility. The hot water temperature is maintained between 105 and 112 degrees (F). Temperature in clients' rooms are maintained between 68 and 85 degrees (F). All sinks, showers and toilets were clean and in working order. The fire extinguishers are fully charged. Carbon monoxide and smoke detectors were tested and observed to be operable. The last fire drill was conducted on 05/23/21. CARE & SUPERVISION The staff to client ratio at the time of inspection is 1: 2. Facility has non-perishable food items for at least one week and perishable food items for at least two days. A review of weekly menu indicates that facility provides nutritious meals and snacks. Medications are locked in the closet hallway and accessible only to employees supervising stored medications. First Aid Kit was readily available and complete. Disinfectants, cleaning solutions and other hazardous items are kept inaccessible to clients in a locked cabinet. Knives and other sharps were observed to be locked in a cabinet in the hallway. PERSONAL RIGHTS Facility posts license, client's personal rights, foster youth rights, ombudsman poster. Facility maintains a suggestion box for clients in the living room to utilize. Facility has their daily activity schedule and meals posted. CLIENT RECORDS LPA reviewed all six (6) client records. Facility maintains client cash resources, personal property, and valuables. Client records contain authorization for medical care, admission agreement and copies of the current appraisal & needs service plan. All medications are recorded and logged. Psychotropic medications have current JV220 court order, medical consent authorization is current and is available for review. STAFF RECORDS LPA reviewed four (4) randomly selected personnel records. One (1) out of the four (4) staff did not have DOJ/FBI clearance or exemption, Child Abuse Index Check clearance and/or association. Facility personnel meet staff qualifications and training requirements. Administrator's CPR/First Aid Certification was not current. Staff files contain the Mandated Reporter/Acknowledgement Form. ADMINISTRATION Facility's program statement, emergency intervention log is current and available for review. The Emergency Disaster Plan has not been updated per Provider Information Notice (PIN) 21-03-CRP. The Administrative Organization LIC308 needs to be updated (see Advisory Note LIC9102). LPA was provided with current LIC500 and current Board Meeting Minutes.. At 12: PM, LPAs interviewed one (1) client and two (2) staff members present during the inspection. Based on the facility inspection and file reviews this date, LPAs observed deficiency for an uncleared staff working in the facility. Facility staff assumed that they followed new Guardian Background Check procedures. A Civil Penalty has been issued for 5 days at $100 per day, for a total of $500 (see LIC809-D). Administrator's CPR/First Aid Certification was not current (see LIC809-D). An exit interview was conducted, and a copy of this report, along with LIC 809, LIC 809C, LIC 809D, LIC9102, LIC 858, LIC 859 and appeal rights were provided to Administrator Klock.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Juliet Robles on 05/24/23 at 9: AM. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA Robles met with Tina Klock, Administrator and inspected the facility inside and out. LPA reviewed two (2) of child's records and two (2) of staff personnel files on site at the facility. LPA reviewed two (2) of child's psychotropic medications and medication records. LPA interviewed two (2) of staff on site to discuss the facilities policies and procedures of operation. LPA was unable to interview children currently prescribed psychotropic medications due to clients were in school at the time of inspection. During the inspection the LPA observed deficiencies (see attached 809D), plan of corrections was discussed, and appeal rights were provided. LPA provided a copy of this licensing report to Tina Klock, Administrator.


facility_name: SUMMIT RANCH

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Shikya Belfield conducted an unannounced inspection at the above facility on 6/15/2023 at 11: AM. The purpose for this inspection is to inform the facility representative of the findings for the above allegations. Based on confidential interviews, observations, and obtained documentation to include but not limit; incident reports, copies of staff files, grocery receipts, photos taken by LPA Belfield, and copies of client files, it was confirmed that facility failed to report incidents to the department as required. Facility cited on 5/2/2023 for violation of ILS section 80061(a). LPA was given plan of correction on 6/15/2023 ( training was completed on 5/23/2023). Based on observations and obtained documentation, it was confirmed that the facility did not have a good quantity of food for the clients in care and on at least two occasions 24 to 30 day periods went by without grocery shopping being done. The preponderance of the evidence has been met, facility cited for violation of ILS section 87076(c)(1) Food Service as described on the following page 9099D. An exit interview was conducted and of copy of this form along with appeal rights was left with Brandon Patterson. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Shikya Belfield LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. First Street, Ste. This is an official report of an unannounced visit/investigation of a complaint received in our office on 04/25/2023 and conducted by Evaluator Shikya Belfield COMPLAINT CONTROL NUMBER: 26-CR- FACILITY NAME:SUMMIT RANCHFACILITY NUMBER: ADMINISTRATOR:ABIGAIL ANOKWURUFACILITY TYPE: ADDRESS: W EDMUNDSON AVETELEPHONE: (408) 256- CITY:MORGAN HILLSTATE: CAZIP CODE: CAPACITY:6CENSUS: DATE: 06/15/ UNANNOUNCEDTIME BEGAN: 11: AM MET WITH:Brandon PattersonTIME COMPLETED:02: PM 9Staff are not receiving sufficient training INVESTIGATION FINDINGS: 13Licensing Program Analyst (LPA) Shikya Belfield conducted an unannounced inspection at the above facility on 6/15/2023 at 11: AM. The purpose for this inspection is to inform the facility representative of the findings for the above allegations. Based on confidential interviews, observations, and obtained documentation to include but not limit; incident reports, copies of staff files, grocery receipts, photos taken by LPA Belfield, and copies of client files, Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that staff are not receiving sufficient training. Therefore this allegationis Unsubstantiated. There were no violations cited for this allegation. An exit interview was conducted and a copy of this report was left with facility manager Brandon Patterson. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Shikya Belfield LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 26-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. First Street, Ste. FACILITY NAME: SUMMIT RANCHFACILITY NUMBER: 435390048

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: Brandon Patterson


summary: Complaint Investigation - Substantiated - 3 allegations

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Shikya Belfield conducted an unannounced inspection at the above facility on 9/13/2023 at 12: PM. The purpose for this inspection is to inform the facility representative of the findings for the above allegation. LPA met with Terea Roush who assisted with the inspection. Based on confidential interviews and supportive documentation to include but not limit staff communication and financial documentation, it was determined that the facility failed to pay employees on time on more than one occassion. Therefore this allegation is Substantiated. Facility cited for violation of the Interim Licensing Standards section 87063(a)(3) Accountability as described on the following form LIC9099D. An exit interview was conducted a copy of this form will be sent to Licensee Daniel Mahan. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Shikya Belfield 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 26-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. First Street, Ste. FACILITY NAME: SUMMIT RANCHFACILITY NUMBER: 435390048

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- Estimated Days of Completion: 90

met_with: Teresa Roush


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Shikya Belfield conducted an unannounced inspection at the above facility on 9/13/2023 at 12: PM. The purpose for this inspection is to inform the facility representative of the findings for the above allegation. LPA met with Teresa Roush who assisted with the inspection. Based on confidential interviews and the facility's inability to provide proof of mental health records or notes, it was determined that the facility does not provide mental health services to clients in care. Facility cited for violation of Interim licensing standards section, 87089.1(a) Mental Health, as described on the following page LIC D. Based on observation by LPA Belfield of the staff schedule, it was observed that the facility hired and had present a live in staff. Facility was cited on 7/31/2023 for violation of California Code of Regulations, Title 22, Section 80019(e)(1) Criminal record clearance. An exit interview was conducted a copy of this form will be sent to Teresa Roush Licensee Daniel Mahan. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Carolyn Flynn LICENSING EVALUATOR NAME: Shikya Belfield 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 26-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. First Street, Ste. FACILITY NAME: SUMMIT RANCHFACILITY NUMBER: 435390048

Allegations:
- SubstantiatedEstimated Days of Completion:
- Estimated Days of Completion:
- Estimated Days of Completion: 90


summary: Facility Evaluation

raw_content:
Narrative:
On August 10, 2022 at 9:30am, Licensing Program Analyst (LPA) Monica Pavia conducted an announced pre-licensing inspection of the facility. LPA met and toured the facility with Abigail Anokwuru, Administrator, Suzanne Lopez, Facility Manager, Karen Rivera, direct care staff, and Dave Detmers, facility maintenance. This Short-Term Residential Therapeutic Program is a one story facility located in a residential area. The facility consists of 3 client bedrooms and 1 client bathroom, living and dining areas, kitchen, laundry area, gym, and recreation room. The facility is clean, safe, sanitary, and in good repair. All passageways are unobstructed and all doors open freely. There is a pool on the facility premises, and meets safety standards. Fire arms are not allowed on the facility premises. At the time of visit, the following was observed: Fire extinguishers are throughout the house. Smoke detectors are throughout the house and operational. Carbon monoxide detectors are located in the hallway, outside of the client bedrooms. Each bedroom has a bed, clean linens, and adequate drawer/cabinet space. Facility has a fire clearance. First aid kit was observed. Hot water temperature measured at 110 degrees Fahrenheit. There is a donation room that has an extra bed, to be used for COVID positive isolation only. Staff records will be kept at Advent's main office in San Jose, and will be readily available for review. Client files locked in the office. Medications will be centrally stored and locked in the pantry. Disinfectants and other toxic materials will be locked in the hallway closet. Extra supply of feminine hygiene products are locked in the hallway closet. Extra bedding and towels are kept unlocked, in the hallway closet. There is a space utilized for a gym, with gym equipment. All gym equipment is in working order. Knives and sharps will be kept locked in the staff office. Site location has a live in staff bedroom and bathroom that is kept locked, and meets prelicensing requirements. Head of Services (HOS) for this location is Shannon Combs. Site location already has cameras installed. Cameras are ok to leave installed, while waiting for regulations to be written. Licensee keeps video footage for a maximum of 30 days. CCL will need access to camera video footage, at all times. Licensee agrees to meet current County safety guidelines. This property is ready for licensure, once their Plan of Operation/Program Statement (POO/PS) is approved. LPA Pavia will notify licensee, once POO/PS is approved and facility is licensed. Component II: LPA Pavia discussed with the following, with Administrator: - Administrator on site required hours - facility core services and support - facility emergency intervention plan

visit_type: Prelicensing

met_with: Abigail Anokwuru


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shikya Belfield made an unannounced inspection to the above facility on 9/13/2023 at 11: AM. The above facility had a plan for closure on 8/23/2023. When LPA Belfield arrived at that the above facility it was observed to have no clients or staff inside. the facility was observed to be no longer operating at this home / address. LPA Belfield concluded the inspection. A copy of this report will be sent to Licensee Daniel Mahan.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shikya Belfield made an unannounced case management inspection to the above facility on 1/6/2023 at 10: AM. LPA Belfield met with Tonya Ivanov and staff Genesis Flores, who assisted with the inspection. The purpose for this inspection is to discuss the information regarding an incident report received by the department. According to the incident report, C1 (see LIC 811 dated 1/6/2023) left the facility without permission and during the process of them leaving, staff denied them access to their personal belongings. This is a violation of the client's personal rights. Facility being cited for violation of Interim Licensing Standards (ILS) Section 87072 (c)(6)(C) Personal Rights. LPA Belfield discussed a recent incident that occurred at the facility and the incident report has not been submitted. This incident involved C2 (see LIC 811 dated 1/6/2023) who is no longer placed with the facility. LPA Belfield will discuss the incident with the facility upon receipt of the incident report. An exit interview was conducted and copy of this report along with appeal rights will be sent to administrator Abigail Anokwuru and staff Tonya Ivanov.

met_with: Tanya Ivanov


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA's) Shikya Belfield conducted an unannounced inspection on 1/6/2023 at 10:40 am and met with Tanya Ivanov, who assisted with the inspection. The facility is licensed for a capacity of 6 ambulatory children, ages 7-17 and Non-Minor dependents. There are currently no client present in the facility. During this inspection, the entire facility was toured. The facility and grounds are in good repair, and free of obstructions. There is adequate indoor activity space and materials. Chemicals are stored in a locked closet. Locked cabinet where centrally stored medications are kept was observed. Individual beds are in good repair, mattresses and pillows were observed. Bedrooms are accommodating of all required furnishings and storage. Adequate food storage space observed. Sufficient food supply was observed upon inspection, as of todays date there are no clients in the facility. A discussion was had regarding the quantity of food supply for the facility. Weekly menu is posted in the kitchen. Fire extinguishers were observed as well as the facility license, client rights, and activity calendar. A review was conducted of 2 client and 3 staff files. During a walk through of the facility LPA observed that there are cameras that observe the public areas of the facility. Facility will submit a waiver request to the department by 1/11/2023. During a review of client files it was observed that 2 out of 2 clients, were missing documents such as needs and services plan, consent forms, immunization records, and admissions agreement. Facility cited for violation of Interim Licensing Standards Version 4, Section 87068. Needs and Services Plan and 87068. Intake Procedures. During a review of staff files, it was observed that staff associations had not been completed. Advisory issued. S1, S2, ( see LIC 811 dated 1/6/2023). An exit interview was conducted with staff Tonya and staff Genesis. A copy of this report along with appeal rights will be sent to Administrator Abigail and staff Tonya.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shikya Belfield, Licensing Program Manager (LPM) Carolyn Flynn, and LPA Monica Povia, conducted an announced case management meeting with the above facility on 1/12/2023 at 10: AM virtually on Microsoft Teams . Present from the facility are, Licensee Daniel Mahan, Administrator Abigail Anokwuru, Shannon Combs, Michelle Jimenez, Tereasa Roush and Faith Byrd. The purpose of this meeting is to address concerns the department has observed with the program's operations. During a post licensing inspection conducted on 1/6/2023, LPA Belfield met with Staff Tanya Ivanov and Genesis Flores. During this inspection the following concerns were observed by LPA Belfield: Client files were missing forms and information including Admission agreements, needs and service plans, and consent forms. staff are not informed of STRTP regulations. Incident reports show that clients personal rights are being violated on at least two occasion. Facility is operating outside of their plan of operation / program statement by, not ensuring that staff receive the proper training topics to work in the Short-Term Residential Treatment Program, not utilizing trauma informed practices as outlined in the Interim Licensing Standards (ILS) and the program statement, not following proper intake procedures, not following program crisis protocol, and conduct that poses an immediate risk to health, safety, or personal rights. During the post licensing inspection conducted on 1/6/2023, LPA Belfield discussed with Staff an incident that occurred on 1/4/2023. This incident involved C1 (see lic 811 dated 1/12/2023) was removed from the facility by law enforcement. After this discussion and review of the incident report received on 1/10/2023, it was confirmed the conduct of the facility resulted in the client causing property damage and being removed by the police. The facility is being cited for violation of ILS, version 4, section 87072 (c) Personal rights, welfare and institution code subsection (a)(7). Facility is assessed a civil penalty. An exit interview is conducted and a copy of this report will be sent to licensee Danial Mahan and administrator Abigail Anokwuru, with a read receipt and request for signature to be returned to the department by close of business 1/13/2023.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shikya Belfield, Licensing Program conducted an unannounced case management inspection with the above facility on 5/2/2023 at 9: AM. Present during this inspection is one client and one staff, assistant facility manager Nancy Lustre and facility manager Brandon Patterson arriced to the facility during the inspection. The purpose of this inspection is to discuss conduct a case management regarding recent concerns with the facility. LPA Belfield communicated with facility manager Mark Carpenter, as well as administrator Abigail A. There were also email communication with Licensee Danial M. and HR director Teresa R. During these communications LPA Belfield requested facility documents on 4/25/23, 4/26/23, and 4/27/23. Although on 4/28/2023 one document was sent to the this LPA, no other communication or requested documents were received by LPA. Facility is cited for violation of Interim Licensing Standards, Section 87044(c) Inspection Authority, as described on the attached LIC D. Based on confidential interviews and obtained documentation to include but not limit; incident information and police logs, the facility failed to report incidents to the department as required. Facility cited for violation of Interim Licensing Standards, Section 80061(a) Reporting Requirements, as described on the attached form LIC D. During a staff file review, LPA observed that S1 ( see lic 811 dated 5/2/2023) did not have a health screen completed in their file. Facility cited for violation of California Code of Regulations, Title 22, division Six, Section 80065(g)(1) Personnel Requirements, as described on the attached LIC D. An exit interview was conducted and a copy of this report along with appeal rights will be sent to facility manager Brandon Patterson and administrator Abigail Anokwuru.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shikya Belfield, Licensing Program conducted an unannounced case management inspection with the above facility on 6/15/2023 at 11: AM. Present during this inspection is one client and three staff. Facility manager Brandon Patterson assisted during the inspection. During confidential interviews it was confirmed that the facility administrator is not present in the facility for the minimum requirement of hours in an STRTP. Facility cited for violation of Interim Licensing Standards, section 87064(b)(1) ADMINISTRATOR QUALIFICATIONS AND DUTIES as described on the following form LIC 809D. An exit interview was conducted and a copy if this form was left with Facility Manager Brandon Patterson.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shikya Belfield, Licensing Program conducted an unannounced case management inspection with the above facility on 7/20/2023 at 9: AM. Present during this inspection were four staff see LIC811 dated 7/20/2023. Assistant Facility Manager Nancy Lustre assisted with the inspection. The purpose of this inspection is to follow up with the facility regarding the program operations. This program is licensed as a Short Term Residential Therapeutic Program (STRTP) to serve clients ages 7 to 17 and Non minor Dependents. The Interim Licensing Standards require that all referrals made to an STRTP be kept in a log and that an assessment be completed to determine program eligibility. Based on a review of the facilities program statement and confidential interviews conducted, the program is confirmed to be operating out of compliance with the licensing regulations and their program statement by not accepting STRTP eligible clients and not conducting assessments for determination. The program does not have a record of referrals received for placement's. Facility cited for violation of Interim Licensing Standards, Section 87068.1(b) Intake procedures and 87068.05(b) Admission Determination Procedures, as described on the following page LIC 809D. During a review of guardian system, LPA Belfield observed that the maintenance person (MM) was not associated to the facility however they were criminally record cleared. HR Teresa R. was able to associate MM while LPA was in the facility. An exit interview was conducted and a copy of this report along with appeal rights will be sent to Assistant facility Manager Nancy Lustre, Facility Manager Brandon Patterson, and administrator Abigail Anokuwru.

met_with: Nancy Lustre


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Shikya Belfield, Licensing Program conducted an unannounced case management inspection with the above facility on 5/2/2023 at 11: AM. Present during this inspection is one client and two staff, S1 and facility manager Brandon Patterson The purpose of this inspection is to discuss conduct a case management regarding uncleared individuals working in the facility. Based on a review of staff schedules and observations by LPA Belfield in the facility on 7/20/2023 and 7/31/2023, the facility staff (S1, S2, see LIC 811 date 7/31/2023) who are working in the facility and have not been criminally record cleared, S1 is also a live in staff. Facility is being cited for violation of the California Code of Regulations, Title 22, Division Six, Section 80019(e)(1) Criminal Record Clearance as described on the following page 809D. A civil penalty is being assessed. An exit interview was conducted and a copy of this form along with Appeal Rights will be sent to Facility manager Brandon Patterson and Administrator Abigail Anokwuru.

met_with: Brandon Paterson


facility_name: SUMMITVIEW CHILD AND FAMILY SERVICES

summary: Facility Evaluation

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Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an unannounced inspection visit to the administrative offices for Summitview Child and Family Services on 7/28/21 at 1: PM and met with Haley Randle, Director of Residential Programs to discuss three incident reports for this facility. LPA informed Ms. Randle that the visit is related to three incident reports. The first report is dated 5/23/21 regarding C1 (see LIC811 dated 7/28/21) who reportedly is engaging in a relationship with an unidentified male, age 19. LPA informed Ms. Randle that additional information is needed on this issue and Licensing is questioning if the agency did their due diligence in reporting this information to law enforcement, child protective services or any other agency as required according to the Mandated Reporting Policy? Ms. Randle states that the agency did contact the biological mother and did obtain additional information that was not provided in the report sent to Licensing. Ms. Randle shall ensure that the report is updated with the additional information and resubmitted to Licensing. The second report is dated 5/24/21 and is related to C2 attempting to have an inappropriate conversation with another youth about two other youth in the facility. When staff intervened in this conversation, C2 alerted facility staff that two youth were engaging in inappropriate touching and possible sexually inappropriate boundaries between these two other youth. The report does not detail who the clients involved are, what steps the facility staff were taking to ensure the safety of youth or what the outcome of the incident were. LPA asked that Ms. Randle provide additional information and resubmit this incident report to ensure that all details and information are on the report as required. The third report is dated 5/25/21 and this is related to C3 and S1 having "inappropriate conversations through social media (Twitter)". LPA informed Ms. Randle that the report states that there were attached documents but that the report was not accompanied by any additional documents. LPA asked Ms. Randle what those documents were and it was reported that the actual conversation between C3 and S1. LPA did request that the attachments be provided to Licensing in addition to the internal investigation conducted by the agency. In addition, LPA has already requested S1's entire employment file as a result of an incident at another facility for this agency. Ms. Randle states that in her opinion, there are items that S1 may have deleted from the conversation in an effort to show that the conversation was not inappropriate. Ms. Randle states that the agency policy regarding contact between staff and clients is that it must be approved through management prior to conversing with youth and that staff cannot, at any time, ask youth for their social media contact(s). Requests of this nature must be initiated by the youth and a team discussion and approval provided prior to contact with youth but staff employed by the agency. S1 violated this policy and was terminated by the agency. Exit interview conducted and document provided.

met_with: Haley Randle, Director of Youth Residential Programs


summary: Complaint Investigation - Substantiated

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Narrative:
LPA also advised the facility that maintaining the exterior of the home free of leaves and other natural debris may deter rodents from entering as well as regular sweeping of walkways and porches around the facility. As a result of the interviews conducted and discussion with the administrative staff, the complaint that licensee did not keep the facility free of rodents or other vermin is Substantiated at this time meaning Facility was cited for violation of California Code of Regulations, Title Division Six, Regulation 80087(a): Buildings and Grounds as the facility shall be maintained clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. Exit interview was conducted with Ms. Gleason and documents were provided.

Investigation Findings:
13Licensing Program Analyst (LPA) Tamara Hill made an unannounced inspection of the facility on 7/28/21 at 11: AM and met with staff, Megan Campagna. LPA toured the outside of the facility on this date but did not enter the facility due to COVID positive protocol. LPA attempted to interview one vocal youth about the situation but youth declined to interview with Licensing. LPA interviewed two staff persons during the inspection. LPA was informed that staff have seen signs of rodents in the house as mouse droppings were found around the canned food supply in the home and staff reported that evidence was found in one of the bathrooms in that mouse droppings were found in a bathroom drawer over a week prior to this inspection. While the staff at the facility cleaned the evidence left in the bathroom and pest control has been out and placed traps outside the home as seen by the LPA during the exterior inspection, the facility may need to do more to ensure that mice are not able to gain access to the home. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Tamara Jensen-Hill 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: SUMMITVIEW CHILD AND FAMILY SERVICES - AGAPEFACILITY NUMBER: VISIT DATE: 07/28/2021

met_with: Megan Campagna, Staff


summary: Complaint Investigation - Substantiated

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Narrative:
Staff working at the facility attempted to get S1 to return to the facility with C1 once it was observed that S1 was no longer visible by the staff. Another staff accompanied by another client walked down the driveway in the direction that it was thought that S1 and C1 had walked in and rustling was heard in the woods. C2 allegedly saw S1 and C1 on the ground together. C1 initially told staff and clients that nothing happened because C1 didn't want to get into trouble but later stated that S1 and C1 did have sex in the woods as suspected and that it was not all consensual. While Investigators with the Department and Detective from El Dorado County Sheriff's Office did attempt to make contact with S1, S1 would not agree to an interview and would not agree to a meeting to discuss the allegation. S1 informed the investigators and detective that S1 would need to contact their attorney to discuss and get back to the investigators. As of the finalization of the complaint, S1 had not come forward to schedule a meeting of any kind. Based on information obtained and interviews conducted by the Investigations Branch, the allegation that a staff sexually abused a minor while in care is SUBSTANTIATED meaning the "preponderance of the evidence" standard has been met. The facility is being cited for Personal Rights section 87072(c)(11) as the licensee shall ensure that each child is accorded the personal rights specified in Welfare and Institutions Code Section 16001.9, including the right to be free of physical, sexual, emotional, or other abuse as it pertains to S1 engaging in a sexual relationship with a client while in the facility. The facility is also being cited for Conduct Inimical as described in Health and Safety Section 1568.092(a)(2) as the department may prohibit any person from... continuing the employment of, or allowing in a licensed facility, or allowing contact with clients of a licensed facility by, any employee...who has Engaged in conduct that is inimical to the health, welfare, or safety of either an individual, in or receiving services from the facility, or the people of the State of California as this pertains to S1 engaging in sexual contact with a client in the facility. The facility was advised that this matter is being referred to our Legal Department for further review and additional legal action. In addition, this citation shall be reviewed for Enhanced Civil Penalties as applicable. Exit interview conducted with Ms. Gleason and documentation and appeal rights were provided via email.

Investigation Findings:
13Licensing Program Analyst (LPA) Tamara Hill made an unannounced complaint inspection on 8/26/22 at AM and met with Anna Gleason, Chief Executive Officer to discuss the findings of the complaint allegation as stated. LPA informed Ms. Gleason that the investigation included an initial inspection by the Investigations Branch, Investigators Joseph Balarie and Melissa Bennett. During the initial inspection and throughout the investigation, staff and clients were interviewed and documents relevant to the complaint investigation were provided to the investigators. The allegation that staff sexually abused a minor while in care is related to an incident that took place at the facility on 5/12/2022 involving S1 and C1 (see LIC811 dated 8/26/22). During this incident, it was observed that C1 and S1 disappeared while together from staff and camera view for approximately 26 minutes while on a walkabout outside of the facility. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Tamara Jensen-Hill 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: SUMMITVIEW CHILD AND FAMILY SERVICES - AGAPEFACILITY NUMBER: VISIT DATE: 08/26/2022

met_with: Anna Gleason, Chief Executive Officer


facility_name: SUMMITVIEW CHILD AND FAMILY SERVICES - AGAPE

summary: Facility Evaluation

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Narrative:
Licensing Program Analyst, Kate Mensah conducted a Case Management Inspection on July 21, 2021, at 11: AM, based on the number of relevant law enforcement contacts reported by the facility, pursuant to Health and Safety Code Section 1538.7. 4 out of Direct Care Staff and 6 out of 6 youth files as identified on the LIC Confidential Names dated July 21, 2021, were reviewed. 2 out of the Direct Care Staff and 3 out of 6 youth were also interviewed. The Plan of Operation including policies and procedures were reviewed.

met_with: Alaisha Jackson


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an unannounced inspection visit to the administrative offices for Summitview Child and Family Services on 7/28/21 at 1: PM and met with Haley Randle, Director of Residential Programs to discuss an incident reports for this facility. LPA informed Ms. Randle that the visit is related to an incident report dated 5/31/21 involving C1, S1 and S2 (see LIC811 dated 7/28/21) where C1 was complaining of knee pain. When staff attempted to suggest to C1 some self help remedies for the pain, C1 rejected the suggestions and instead took the house phone and went outside to make an unauthorized phone call. C1 was supervised while outside by S2. S1 unplugged the phone from inside the facility to prevent C1 from making any calls. When the call could not be made, C1 entered the facility angry and screaming about the phone not working and S1 responded to C1 that it was because C1 did not show the staff the number dialed and because C1 was attempting to have an unauthorized call. C1 demonstrated to staff that they had dialed 911. LPA advised Ms. Randle that instead of S1 speaking to C1 in a trauma informed manner and attempting to de-escalate youth, S1 was very antagonistic and provoking toward C1. LPA reminded Ms. Randle that the facility staff need to be reminded about the obligation to approach youth in a trauma informed manner and speak to youth in a way that would de-escalate situations and not cause more trauma or escalate youth. Ms. Randle states that she was not even aware of the incident and that she would look further into this issue and provide an update regarding this incident. LPA requested that the update, counseling note or other documentation related be provided to LPA by 8/11/21. Exit interview conducted and document provided.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Tamara Hill and Mary Shelton made an unannounced annual inspection on 10/15/21 at 11: AM and met with Eryn Dixon, STRTP Administrator, who assisted with the inspection. LPAs Hill and Shelton conducted a walk-through of the facility inside and out. There were no clients present during the inspection due to school and company barbecue happening at their school location. LPAs observed four client bedrooms, two bathrooms during the inspection. LPAs Hill and Shelton inspected and/or reviewed the following: Postings of facility license, Personal Rights Poster Disinfectants/Cleaning solutions were inaccessible Refrigerator Temperature was at or below 45 degrees F and Freezer Temperature at or below 0 degrees Nonperishable Foods for one week and fresh perishable for foods two days minimum were present Menu was present and but not posted Working telephone was present Carbon monoxide detectors and Smoke Detectors were functioning First Aid Kit was present but missing tweezers Common Room (living room) was available as was a separate room for relaxing Dining area with enough seating was present and in good condition Medication was centrally stored, locked/inaccessible LPAs did not observe a staff office area as the agency believes that the staff should be present with the clients in care and not in the office doing administrative work with clients present. All relative documentation is locked an inaccessible to clients in care. Hot Water was between 105 -120 degree F Fire Extinguisher was observed to be last inspected on 2/15/ Toilets, wash basin, bath and shower fixtures appeared to be in good repair, no leaks and delivering hot water. LPAs observed there to be soap and paper towels available in the bathrooms. Laundry Facilities were available and LPAs observed posted assigned washing days for clients. Bedrooms appeared to be clean and organized with required linen and furnishings Motor Vehicle was observed to have working seat belts, lights and adequate tires. Facility appeared to be free of vermin LPAs observed no citations during the physical plant inspection and no citations were issued for the physical plant of the facility. Exit interview conducted and documentation provided to the facility.

met_with: Eryn Dixon, STRTP Administrator


summary: Facility Evaluation

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Narrative:
Licensing Program Analysts (LPAs) Tamara Hill and Mary Shelton made an unannounced annual continuation inspection on 10/27/21 at 10: AM to the Non Public School location and met with Haley Randle, Director of Youth Residential Programs. The purpose of the visit was to continue the annual inspection started on 10/15/21 and interview clients and review client and staff documents. The facility did inform LPAs that all of their client and staff files are electronic and did work on providing LPAs access to the electronic databases. While LPAs waited for the access to review documentation, LPAs interviewed clients. LPAs spend the entire time at the agency interviewing clients and did not review staff or client documents. LPA Hill informed the agency that in order to conclude the annual inspection, it would take another inspection date on another day in order to conduct the file reviews necessary to complete the annual review for the facility. LPA reminded the agency that the visit must be unannounced. Exit interviewed conducted and document was provided. Hard copy signature was obtained via email as most the staff had already left or were leaving for the day.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analysts (LPAs) Tamara Hill and Jennifer Baca made an unannounced case management visit on 12/20/21 at 9: AM and met with Haley Randle, Director of Youth Residential Programs to discuss an incident report. LPAs conducted the case management inspection at the school site located at Placerville Drive, Placerville and interviewed four youth related to an incident that took place at the facility on 11/30/21. The incident involved the four youth (C1, C2, C3 and C4 - see LIC811 dated 12/20/21) and S1. The incident involves staff and youth getting into a confrontation that lead to S1 being advised by another staff (S2) to not return inside the house and S1 subsequently left the facility while the youth were escalated and continued in an escalated state for the evening. LPA did advise the agency that additional case management is needed at this time and that LPA shall return another day to continue this case management. No citations were issued during the case management on this day.


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Tamara Hill made an unannounced collateral inspection on 6/9/22 at 9: AM to the administrative office located at Placerville Drive, Placerville to discuss incident reports. LPA discussed the following incident reports while at the administrative office: 5/2/22 - C1 appeared to have been targeting a staff (unclear as to what staff) and it does not appear in the report that staff removed themselves knowing that C1 was targeting them. LPA discussed with CEO that in writing the reports, if staff are switched out then it need to be articulated. If the staff targeted in this incident did not remove themselves, the staff should be cognizant of the target and in the future remove themselves when a youth appears to be targeting them. 4/23/22 - C2 allegedly snorted a substance but the substance was never defined in the report. C2 informed staff that it was a substance that came from a previous client but there is no indication that the substance was searched for or if C2 was ever asked if there was more "substance". 4/19/22 - C2 was involved in two restraints at the facility and as written, both incidents appear to be unnecessary restraints. LPA informed Ms. Gleason that Licensing is looking at restraints and the "eminent danger" presented when restraining a youth in care. LPA informed Ms. Gleason that the reports need to articulate the danger(s) presented that warrant a restraint when they do happen. 4/15/22, C1 attempted to leave a classroom while at the school site and were stopped by staff resulting in youth being violent and aggressive towards various staff in the classroom and additional staff that came to support the incident. LPA cautioned Ms. Gleason on stopping youth when they are leaving as this may be a personal rights violation. In addition, it was discussed that there are alternatives to youth being physically stopped including assigning a staff to walk about the property with youth. 3/5/ C3 was placed in a restraint to keep youth from jumping out of a window on a second level of the facility after breaking into a locked storage cabinet in the garage and being able to obtain razors. Staff held on to C3's wrists to get items from C3. LPA again cautioned the use of restraints in an unauthorized manner. 3/5/ C4 was found in a bathtub "unconscious" and when pulled out by staff, it took C4 a minute to respond. C4 was taken to the local emergency room and subsequently returned to the facility. When discussing the incident, CEO states that she learned that youth never lost consciousness, per the doctor. LPA informed CEO that any and all additional information needs to be put in the full report. 3/2/ C3 was again placed in a restraint to keep youth from exiting the house through the bedroom window. LPA cautioned CEO about the incident in that it does not appear that there was an eminent danger to the youth that would justify the use of restraints. 3/1/ C4 was on the roof of the house and staff were "collecting couches" as described in the incident report. LPA questioned what this meant and CEO states that to the best of her knowledge, it means that staff were putting couches together to break a youth's fall/jump from the roof. LPA indicated that there was no discussion of de-escalation techniques used to get youth to come of the roof and not jump. 2/28/ C4's room was searched due to how C4 "was presenting" and due to disclosure of using substances while in their home but this is not a justification for a search. LPA advised Ms. Gleason that searches need justification and consent. There is also no indication that parent/guardian was consulted. Later on this date, C4 attempted to leave the facility but was restrained; no indication this was necessary. 9/10/ C5 did a "smiley" piercing while in the facility; there's no indication when this happened and no indication that staff asked C5 about when it happened or what was used to do the piercing. LPA asked Ms. Gleason if there was more information about how this could happen without staff being aware. In general, LPA also discussed with Ms. Gleason the need to ensure that all reports are complete. LPA also advised that some of the full reports just need additional information to indicate that the staff are being proactive in preventing additional issues; i.e. one youth making calls to get someone to pick them up at the facility but not indicating what staff are doing for additional support or assistance. LPA also discussed accompanying youth when needed to do a walk-about on the property of the school or the facility grounds. There were incidents where youth were struggling and staff would not allow them to leave and other times where youth were struggling and staff allowed them to leave unattended. In both incidents, it was a struggle for the staff and clients. LPA advised that it is necessary to be consistent with the youth in order to maintain supervision and be consistent. LPA also discussed being thorough in the reports and providing additional information it the 24 hour reports being sent. Reports should include when medical is needed or not, contacting therapists when necessary, indicating what interventions or supports are utilized when youth indicate self-harm, what youth are doing (other than just stating "engaged in self harm"), use of restraints when there is not an eminent threat or danger, staff indicating completion of Suspected Child Abuse Report when disclosures are made by the youth in care, indicating reasons for and what is found when a room search is needed/warranted. Also discussed during the inspection on this date was the licensing fees that are all confused and not appropriated correctly. LPA did advise that the agency provide details about the fee assessments via email so that discussion can be held with the Department's Accounting Unit to appropriate the fees paid appropriately. LPA did ask additional information be provided for the following incidents regarding allegations with staff: 11/30/ LPA asked for clarification on this incident involving two staff and four youth in the facility. LPA requested any/all follow up regarding S1 having to be told by S2 to "remove herself and stay outside". LPA observed that the incident report indicates that S1 yelled at C6 "Do not touch me" when C6 pushed S1 back with their body. 11/29/ LPA requested additional information regarding alleged misconduct of S1 where S1 may have provided a vape pen to C4. LPA asked if there was an internal investigation regarding the incident and, if so, LPA requested a copy of the internal investigation conducted. 5/31/ C5 alleged that a staff had provided "vape juice" to a youth in the facility (staff not identified). LPA is requesting a copy of the investigation conducted. End of incident report review and exit interview conducted with Ms. Gleason.

met_with: Anna Gleason, CEO


summary: Facility Evaluation

raw_content:
Narrative:
On 11/9/22 at 9L AM, Licensing Program Analyst (LPA) Tamara Hill conducted a case management inspection and met with Haley Randle, Director of Youth Residential Programs to assess an Enhanced Civil Penalty for a violation of Personal Rights Section 87072(c)(11) The licensee shall ensure that each child is accorded personal rights specified in Welfare and Institutions Code Section 16001.9, including the right to be free of physical, sexual, emotional, or other abuse. The staff member of the Short Term Residential Therapeutic Program (STRTP) engaged in inappropriate sexual acts with a minor client of the STRTP. On August 26, 2022, LPA Tamara Hill delivered findings for a complaint investigation regarding the allegation that "staff sexually abused a minor while in care". Based on information gathered during confidential interviews it was determined the allegation of sexual abuse is substantiated. A staff member sexually abused a minor in care. This abuse is conduct inimical to the health, morals, welfare, or safety of clients in the STRTP. The Department has determined that the Enhanced Civil Penalty is warranted for the physical abuse of a minor while in the care of the STRTP. The violation does meet the definition of Physical Abuse per Health & Safety 1548(e)(2); Physical Abuse to include Sexual Abuse as defined in Penal Codes section 11165.1(b) (1)-(2) describes sexual assault as including penetration, oral copulation, intrusion by one into the genitals of another, and intentional touching for purpose of sexual arousal or gratification. Pursuant to the Enhanced Civil Penalty Law, Health & Safety Code section 1548(f)(1)(C) the Department will be issuing an Enhanced Civil Penalty of $2500. An exit interview was conducted with Ms. Randle, and appeal rights were discussed and provided to the facility.