summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst Connie Jones-Steward met with administrator Lavatha Oliver to conduct the annual/required inspection. The meeting commenced at 10: AM. The following was observed. This is three bedroom, 2 bathroom home located in the City of Glendale. There are currently 2 clients in placement There are no bodies of water, no security bars on windows, no firearms and no fireplaces. There were working smoke/carbon monoxide detectors in the bedrooms and in the hallway In the kitchen area LPA Jones-Steward observed a food supply that meets Title 22 requirements. LPA also observed an electric stove, a fully charged fire extinguisher, and a locked box containing knives and forks. Hot water temperature in kitchen and bathrooms was 105 degrees. There was a covered trash can in kitchen. The menu was posted in accordance with regional center guidelines which specify a separate menu for each child. All bedrooms have a single bed with firm mattresses and linens in good condition. There is the required drawer and closet space for each client. All windows were tested and found to be operational. There was a complete first aid kit on the premises. Client records and medications were reviewed and found to be compliant. LPA will review staff records and conduct interviews at a future date. The last disaster drill was conducted in July 2023. The facility was cited under Health & Safety Code 1565(c) and Title 22 84063(a)(10)

met_with: Lavatha Oliver, Administrator


state: CA

facility_name: BELLA VISTA ZOOK HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
On Sept. 11, 2024, Licensing Program Analyst Connie Jones-Steward conducted an annual continuation inspection. LPA Jones-Steward reviewed four staff files, the employee work schedule and the job descriptions section of the program statement. LPA verified that the staff whose files were reviewed met the requirements of Title 22. LPA Jones-Steward and administrator Lavatha Oliver discussed Title 22 requirements regarding the facility manager position. LPA also conducted two staff interviews. No deficiencies were cited on this date.

report_type: Facility Evaluation

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On September 11, 2024, LPA Jones-Steward delivered the plan of correction letters for the deficiencies cited on April 5, 2024.

met_with: Lavatha Oliver, administrator


summary: Facility Evaluation

raw_content:
Narrative:
On May 21, 2025 at 9:30am Licensing Program Analyst (LPA), Justine Armstrong made an unannounced visit to the Facility Bella Vista Zook House for the purpose of conducting a Annual/Required visit. Lpa J. Armstrong met with Facility Administrator, Lavatha Oliver who granted access into the facility and a tour of the facility was conducted. The facility is licensed to provide care and supervision to three (3), developmentally disabled male children, ages 6-17 years old, ambulatory only. There are no bodies of water on the premises. On this day the census is three(3) children. This is a one-story home equipped with three bedrooms, two bathrooms, living room, kitchen, dining area, laundry room, medication room/ Office, garage and outdoor space. The home is set up as follows: Bedroom #1, Bedroom #2 , Bedroom #3: all are equipped with one full size bed, adequate drawers, closet space, and lighting in the room. Bathrooms: There is a total of two bathrooms in the facility. All bathrooms were checked and were in operating conditions. The faucets that are used by the clients were tested and . Hot water was tested and found to be between 105-120 degrees Report continued on LIC809-C. (F). Living Room: There is a table, with two sofa chairs, and a TV mounted on the wall. Furniture seems to be in good conditions. Kitchen: There is a stove/oven with four (4) burners, all working at this time. There is a microwave and refrigerator/freezer. The food service in the home is adequate with perishable/nonperishable food supplies and a Fire Extinguisher. Dining Area: There is a table with six (6) chairs where clients can sit to eat their meals. This area also has important documents posted such as emergency disaster numbers, Facility License, and personal rights poster. Hallway: There are two (2) hallway closest one when entering the facility and another at the end of facility in the back next to the bathroom. The cleaning solutions and laundry detergent are made inaccessible to the children and are stored/ locked in a closet to the right when entering the facility front door. The other hallways stores extra linen. Laundry Room: Is located to the left side when walking down the hallway. The laundry room can be entered from the inside of the facility and outside. Laundry room is kept locked at all times and a Fire Extinguisher. Medication Room/OFFICE: The medication room is kept locked at all times and only staff administering medications have access to the medications. The medication room is also used as a staff office it has a desk, computer, locked file cabinet. Garage: The garage can be accessed through the backyard of the facility and is currently being used as an office space with desks and computers for staff, storage space, a deep freezer with extra nonperishable food, and locked file cabinets, Fire Extinguisher. Backyard: LPA J. Armstrong observed an outdoor seating area. The trash cans have lids on and is free of any debris. Overall, the home appears to be clean, safe, sanitary, and in good repair. The home has a first aid kit stored inside a locked cabinet in the medication/office room. There is a working telephone line available for clients to use. LPA tested the fire alarm/carbon monoxide alarm both was in working order. Report continued on LIC809-C. The following was discussed with the facility Administrator: Based on LPA interviews and record reviews and evidence obtained, the Facility is issued a citation in accordance with the Group Home Licensing Standards, Chapter Division 6 the Facility cited for violation of California Code of Regulations, as stated in Title ILS 84065 (d) Personnel Requirements: The licensee shall designate at least one facility manager to be present at the facility at all times when children are present... this poses an potential health, health and safety, or personal rights. An exit interview was conducted, a Plan of Correction was discussed, and a copy of the report was provided to the facility

visit_type: Annual

met_with: Lavatha Oliver


summary: Facility Evaluation

raw_content:
Narrative:
On September 9, 2025 at 10:00 am Licensing Program Analyst (LPA) Justine Armstrong and Licensing Program Manager (LPM) Enrique Hernandez conducted an Informal Meeting with the Administrator Lavatha Oliver, the Supervisor Kim Commodore, and the Licensee Ann Hamilton in regards to Bella Vista Zook, Bella Vista Wyoming, Bella Vista Evergreen, and Bella Vista Maple House. The meeting was conducted at El Segundo Local Unit Children Residential Regional Office located at Continental Blvd El Segundo, CA 90245. The purpose of the meeting was to discuss the facility concerns. El Segundo Children Residential has concerns on the following things: Facility Manager Requirements Uncleared Plan of Corrections Communication expectations Recommendations: The department recommends that the Licensee submit the Facility Manager documents and an updated LIC 500. It is important to communicate with the License Program Analyst, J. Armstrong, when requesting an extension to correct any plans of correction. Ensuring that the Facility Manager is on schedule and available during crises is crucial. Additionally, the Facility Manager or Licensee should be present at the facility during unannounced visits from Community Care Licensing. The Licensee must comply with Title 22 regulations and the requirements set by Community Care Licensing (CCL). A copy of the Technical Support Program brochure was provided to help providers improve their compliance. A copy of this report was provided to the Licensee.


facility_name: BELOVED'S HOME

summary: Facility Evaluation

raw_content:
Narrative:
At 11:17AM, Licensing Program Analyst (LPA) Madi Fremont traveled to the home above for the purpose of conducting an unannounced Required Annual Inspection. LPA met with Licensee/Administrator Amy Andes, who helped facilitate this inspection. Currently in care at 4 ambulatory clients. At the time of this inspection, 4 clients and 3 staff were present in the home. LPA toured the facility inside and out. The home is single-storied with two double occupancy bedrooms, and two staff bedrooms. All client bedrooms were equipped with comfortable furnishings which included ample storage space for clients' belongings, desks and chairs, and twin sized beds. Each bedroom has a closet with sliding doors or curtains for extra storage space. The home has a family room which is equipped with couches and chairs for clients. The kitchen was observed to be clean and free of hazards or chemicals. The weekly menu was posted in the kitchen. LPA observed at least 2 days of perishable foods and 7 days of nonperishable foods. Chemicals and cleaning supplies are kept locked in a cabinet that is inaccessible to clients. No firearms on the premises. Facility had a supply of emergency food items in the garage. All medications are kept in a locked cabinet. Facility as 4 first aid kits with all required supplies. Fire extinguisher was observed in the kitchen, and all carbon monoxide and smoke detectors were tested and observed to be functional. Client bathrooms were clean and furnished with hygiene supplies for each client. LPA observed extra linens in a cabinet in the hallway. Client bathroom faucet measured 111.6 degrees Fahrenheit, and kitchen faucet measured 114.9 degrees Fahrenheit. Thermostat was set to 72 degrees Fahrenheit. Facility license, emergency plan, personal rights, client grievance policy, floor plan, and staff schedule are prominently posted. Sharps are kept locked and inaccessible to clients. (Continued on Lic809-c) The facility has a staff room that is kept locked and inaccessible to clients. Staff room has 2 beds for staff breaks. LPA toured the backyard and observed it to be free from hazards. . LPA observed a sitting area in the backyard with a table, chairs, and an umbrella. The backyard is surrounded by a wooden fence with locked gates. The facility has a centralized AC unit in the side yard which is kept gated at all times and inaccessible to clients. No bodies of water on the premises. All walkways were free from debris or hazards. All window screens are in good condition. The facility has a fireplace which is not in use, and has a grate that acts as a barrier to keep the fireplace inaccessible to clients. Facility has comfortable furnishings, accommodations, and ample lighting. All client and staff records are complete with all of the required documentation. Each client and staff has their own separate binder of all required documents. Each psychotropic medication was observed to have its own Psychotropic Medication Administration Record (PMAR), as well as individual Centrally Stored Medication Destruction Records (CSMDR). All medications counted were consistent with these records. At this time, no deficiencies were observed or cited. An exit interview was conducted, and a copy of this report was emailed to Licensee/Administrator Amy Andes, whose signature on this form confirms receipt.

met_with: Licensee/Administrator Amy Andes


summary: Facility Evaluation

raw_content:
Narrative:
On Friday 03/25/2022, Licensing Program Analyst (LPA) Alyssa Ng made an unannounced inspection to conduct an annual required inspection. LPA met with House Manager Ailene (Bobbie) Vivar . Later on, Amelia Andes and Renato Andes, Administrators arrived. The facility has a census of two clients. Both clients were doing their online schooling. LPA was unable to interview residents in care but both clients seemed to be in good spirits. The CARE Inspection Tool was used to conduct the inspection. The facility and grounds are clean, tidy, and free of obstructions. There are no hazards on the premises and no firearms, per Administrator. Bedrooms are double-occupancy, and beds have clean linens and mattress pads. There is enough storage for residents' personal belongings. Food is of good quality, within date, and stored properly. First aid kit was observed to be complete. Room temperature was maintained at a comfortable temperature within permitted range. Water temperature measured at 117.5 which is in the permitted range. LPA conducted 2 confidential staff interviews. The backyard is surrounded by a wooden fence. The facility has a centralized AC unit in the side yard which is kept gated at all times and inaccessible to clients. No bodies of water on the premises. All walkways were free from debris or hazards. All window screens are in good condition. The facility has a fireplace which is not in use, and has a grate that acts as a barrier to keep the fireplace inaccessible to clients. Facility has comfortable furnishings, accommodations, and ample lighting. All client records complete with all of the required documentation. Each client and staff has their own separate binder of all required documents. Each psychotropic medication was observed to have its own Psychotropic Medication Administration Record (PMAR), as well as individual Centrally Stored Medication Destruction Records (CSMDR). All medications were consistent with these records. -------------Cont. On Lic 809c-------------- Resident and staff records were observed to be complete and the facility in compliance, with only the following exceptions: Complaint procedures were not posted in the facility and was not accessible for staff and clients and their authorized representatives. LPA advises per CCR regulation, 84072.2(a)(3), complaint procedures must be posted in the facility within clear view of clients and their authorized representatives. Emergency Intervention Staff training logs were not up to date. Licensee assured LPA that staff have done the training but did not file in the binder. LPA advises per CCR regulation, 84365(d)(1)(a), Licensee will print and post complaint procedures and shall be posted in a location which is accessible to children and their authorized representatives. At this time, 2 deficiencies were cited. An exit interview was conducted, and a copy of this report was emailed to Licensee/Administrator Amy Andes, whose signature on this form confirms receipt.

met_with: Amelia Andes


summary: Facility Evaluation

raw_content:
Narrative:
On 3.22.2023 at 11: AM, Licensing Program Analyst (LPA) Alyssa Ng made an unannounced inspection to conduct an annual required inspection. LPA met with Amelia Andes and Renato Andes, Administrator and Facility Manager. The facility has a census of two clients. Both clients were present during the time of the inspection. Safety precautions were used such as temperature reading, sanitizing of the hands, mask wearing, and social distancing. The CARE Inspection Tool was used to conduct the inspection. The facility and grounds are clean, tidy, and free of obstructions. There are no hazards on the premises and no firearms, per Administrator. There were two client bedrooms and two staff bedrooms. All bedrooms are single occupancy, and beds have clean linens and mattress pads. There is enough storage for residents' personal belongings. Food is of good quality, within date, and stored properly. First aid kit was observed to be complete. Room temperature was 68 degrees and was maintained at a comfortable temperature within permitted range. Water temperature measured at 116.6 which is in the permitted range. LPA conducted 2 confidential client and 2 staff interviews. At 11: AM, LPA Ng toured the backyard. The backyard is currently under construction. Both clients in care do not have access to the backyard. LPA Ng asked Administrator Amy Andes how the clients are able to play outdoors and Administrator stated that they have a park a block away and often do walks around the community. All client records complete with all of the required documentation. Each client and staff has their own separate binder of all required documents. Each psychotropic medication was observed to have its own Psychotropic Medication Administration Record (PMAR), as well as individual Centrally Stored Medication Destruction Records (CSMDR). All medications were consistent with these records. Resident and staff records were observed to be complete and the facility in compliance. Facility is in the process of converting to an Adult Residential Facility. Administrator/Licensee is waiting for the backyard to be complete and will notify LPA Ng when the application is submitted. At this time, 0 deficiencies were cited. An exit interview was conducted, and a copy of this report was left with Licensee/Administrator Amy Andes, whose signature on this form confirms receipt.

met_with: Amy Andes


summary: Facility Evaluation

raw_content:
Narrative:
On 3/22/2024 at 10: AM, Licensing Program Analysts (LPAs) Jasmine Cardeno and LPA George Karkazis made an unannounced visit to Beloved's Home to conduct a required annual inspection. LPA Cardeno and LPA Karkazis met with Facility Administrator, Amy Andes, who helped facilitate the inspection. The Facility Beloved's Home has a census of two clients. Both clients were present during the time of the inspection. The CARE Inspection Tool was used to conduct the inspection. At the start of the inspection, LPA Cardeno and LPA Karkazis conducted a walk-through of the facility, both inside the home and outside of the home. The facility and grounds are clean, tidy, and free of obstructions. There were two client bedrooms and two staff bedrooms. All bedrooms are single occupancy, and beds have clean linens and mattress pads. LPA Cardeno and LPA Karkazis observed centrally stored medications maintained in a locked cabinet kept secure in the kitchen area. Sharps and toxic chemicals were also kept locked away and secured in a cabinet in the garage. There is at least one-week supply of nonperishable food and a two-day supply of perishable foods. The Facility Beloved's Home is maintained at 70 degrees Fahrenheit and the hot water temperature measures at 115 degrees Fahrenheit, which the temperatures are both within range. Four records of staff members were reviewed to be complete and the facility in compliance. Two client records were reviewed and appeared to be complete with sufficient information. Each psychotropic medication was observed to have its own Psychotropic Medication Administration Record (PMAR) and all medications were consistent with these records and up to date. LPA Cardeno conducted two confidential client interviews and one staff interview. LPA Cardeno discussed the following with Facility Administrator, Amy Andes: to maintain communication with Community Care Licensing that Beloved's Home is currently being renovated including the bathroom. LPA Cardeno issued a Technical Assistance regarding the discussion above and provided Community Care Licensing contact information for Beloved's Home to maintain contact with Community Care Licensing. An exit interview was conducted and a copy of this report was given to Facility Administrator, Amy Andes, whose signature on this form confirms the receipt.

met_with: Amy Andes, Facility Administrator


facility_name: BETHANY'S HOUSE

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Lidia Tinoco conducted an unannounced visit to the Bethany Christian STRTP in order to deliver the findings of the above allegations and met with Steven Toal. The above allegation was referred to Community Care Licensing for investigation. The investigation included an inspection of the Facility, interviews, and a review of facility and children's records. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation occurred. Therefore, the allegation is UNSUBSTANTIATED at this time. A copy of this report was discussed and provided to Steven Toal along with appeal rights. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Lidia Tinoco LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

report_type: Complaint Investigation

met_with: Steven Toal

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On June 7, An unannounced annual inspection was conducted by LPA (Licensing Program Analyst) Lidia Tinoco at Bethany's House Group Home. LPA met with Administrator Steven Toal and inspected the facility, inside and out. Centrally stored medications are maintained in a locked cabinet. Sharps and Toxic chemicals are kept locked. The facility has a written emergency disaster plan. All facility smoke detectors were tested and appear to be in appropriate working order, fire extinguishers are properly charged. The facility has pull fire alarms. Individual beds were observed with appropriate clean linens and are in good repair. There is at least one-week supply of nonperishable and a two-day supply of perishable foods. The facility is maintained at 75 degrees. Facility has cameras in common areas of the facility. LPA conducted Staff and Client interviews. Administrator is present at the facility a minimum of 20 hours a week. Appropriate staff/client ratios were verified during this inspection. The facility employs Social Workers and 1 backup Social Worker, 1 facility manager, 6 direct care staff, 4 part time direct care staff, 1 child care provider as well as additional ancillary positions including a teacher and medical coordinator. Licensee has obtained National Accreditation through COA. The Accreditation is valid through 03/21/2025. Two type B Deficiencies and One type A deficiency were issued on todays date. A copy of this report and appeal rights were left at the facility at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On June 13, An unannounced annual inspection was conducted by LPAs (Licensing Program Analysts) Lidia Tinoco and Reyna Martinez at Bethany's House Group Home. LPA met with Administrator Steven Toal and inspected the facility, inside and out. LPA's discussed deficiencies from June 7, 2022 and staff ratios. LPA's reviewed Staff files and Client Files and conducted Client Interviews. No deficiencies were observed or cited. A copy of this report was provided at the end of the visit.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA), Lidia Tinoco traveled to Bethany's House in Modesto for the purpose of conducting a Case Management regarding an incident reported on 3/30/2023. LPA Tinoco met with Administrator, Miriam Castellon. LPA Tinoco discussed the incident as well as the outcomes. The Administrator reported that the staff member in question was placed on leave pending test results. After failing to provide appropriate results it was decided to terminate the staff member. Administrator also states that none of the clients reported being aware of the incident and were not affected or involved. LPA Tinoco discussed reporting expectations with Administrator. No Deficiencies were cited on this Case Management. A copy of this report provided at the conclusion of the inspection.

met_with: Miriam Castellon


summary: Facility Evaluation

raw_content:
Narrative:
On April 12, An unannounced annual inspection was conducted by LPA (Licensing Program Analyst) Lidia Tinoco at Bethany's House Group Home. LPA met with Administrator Miriam Castellon and inspected the facility, inside and out. Centrally stored medications are maintained in a locked cabinet. Sharps and Toxic chemicals are kept locked. The facility has a written emergency disaster plan. All facility smoke detectors were tested and appear to be in appropriate working order, fire extinguishers are properly charged. The facility has pull fire alarms. Individual beds were observed with appropriate clean linens and are in good repair. There is at least one-week supply of nonperishable and a two-day supply of perishable foods. The facility is maintained at 75 degrees. Facility has cameras in common areas of the facility. LPA reviewed Staff Files and Client Files. Administrator is present at the facility a minimum of 20 hours a week. Appropriate staff/client ratios were verified during this inspection. The facility employs Unit Supervisor, Assistant Supervisor, Lead Youth Counselor, 1 full time direct care staff, 2 part time direct care staff, 1 full time child care provider as well as additional ancillary positions including a teacher and medical coordinator. Licensee has obtained National Accreditation through COA. The Accreditation is valid through 03/31/2025. One Type B Deficiency was observed and cited. A Technical Assistance was provided. A copy of this report was provided at the end of the visit.


summary: Facility Evaluation

raw_content:
Narrative:
On April 20, An annual continuation inspection was conducted by LPA (Licensing Program Analyst) Lidia Tinoco at Bethany's House Group Home. LPA met with Administrator Miriam Castellon. LPA Conducted Staff and Client Interviews. LPA also observed the repairs of the plan of correction issued on 4/12/23. No Deficiencies observed or cited on todays visit. A copy of this report was provided at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On April 8, An unannounced annual inspection was conducted by LPAs (Licensing Program Analysts) Lidia Tinoco and Miriam Flores at Bethany's House Group Home. LPAs met with Assistant Director Shelli Prosser and inspected the facility, inside and out. On March 22, 2024, Program Director informed Community Care Licensing that since March 31, 2024 the contract with ORR has not been renewed and the decision to become non-operational has been made. At this time there are no staff or clients at the facility. The facility has the ability to maintain medications centrally stored in a locked cabinet. Sharps and Toxic chemicals are kept locked. The facility has a written emergency disaster plan. All facility smoke detectors were tested and appear to be in appropriate working order, fire extinguishers are properly charged. The facility has pull fire alarms. Individual beds were observed with appropriate clean linens and are in good repair. There are no perishable foods available and a week supply of nonperishable foods. Facility has cameras in common areas of the facility. Licensee has obtained National Accreditation through COA. The Accreditation is valid through 03/31/2025. No Deficiencies were cited on today's visit. A copy of this report was provided at the end of the visit.

met_with: Shelli Prosser


summary: Facility Evaluation

raw_content:
Narrative:
On June 28, An unannounced annual inspection was conducted by LPA (Licensing Program Analyst) Lidia Tinoco and Complaint Specialist (CS), Charles Kinney at Bethany's House Group Home. LPA's met with Sandra Hiatt and inspected the facility, inside and out. Centrally stored medications are maintained in a locked cabinet. Sharps and Toxic chemicals are kept locked. The facility has a written emergency disaster plan. All facility smoke detectors were tested and appear to be in appropriate working order, fire extinguishers are properly charged. The facility has pull fire alarms. Individual beds were observed with appropriate clean linens and are in good repair. There is at least one-week supply of nonperishable and a two-day supply of perishable foods. The facility is maintained at 70 degrees. Facility has cameras in common areas of the facility. Administrator Sandra Hiatt is present at the facility a minimum of 20 hours a week, as verified by staff schedule and interviews. Appropriate staff/client ratios were verified during this inspection. The facility employs Social Workers, 2 facility managers and 7 direct care staff as well as additional ancillary positions including a teacher and medical coordinator. Licensee has obtained National Accreditation through COA. The Accreditation is valid through 03/21/2025. 6 records of personnel/ staff members were reviewed to ensure staff meet regulatory requirements. All personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. Personnel Files are maintained on-site. 6 records of clients were reviewed. This agency is being cited for violation of the Title 22 regulation section 80087(a). Deficiencies were cleared during inspection.

met_with: Sandra Hiatt


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analysts (LPAs) Lidia Tinoco and Cynthia Galindo traveled to Bethany's House Group Home for the purpose of conducting an unannounced Case Management and met with Joyce Gee. LPA's addressed the Emergency Intervention Plan (EIP) that must be submitted every 6 months. The department has not received any Bianual Review Plan. LPAs referred the agency to 84322(h)(2)(A-C) which provides detailed information about the requirements of the EIP Review. LPA's also addressed that the requested documentation for a change of Administrator has not been received since the initial request on August 2022. LPAs provided the agency with a list of the required documents for the Administrator Change. The agency is being cited on 84064.3(j)(1) Administrator Recertification Requirements and 84322(h)(2)(A-C) Emergency Intervention Plan. A copy of this report was provided at the conclusion of the inspection along with appeal rights.

met_with: Joyce Gee


facility_name: BLUE DIAMOND REENTRY

summary: Facility Evaluation

raw_content:
Narrative:
On June 2, 2025, at 3:00 pm, Licensing Program Analysts (LPAs) Charmaine Linley, Gilbert Marquez, and Licensing Program Manager (LPM) Ann Valenzuela met with Stephanie Hall and Oneisha James for Component II Orientation via Microsoft Teams Meetings. The facility stated they will have the Ring doorbell outside of the facility and LPA will be sending the information needed, per Children's Residential Provider Information Notice 24-09 to include in the Program Statement and on the facility sketch: Program Statement Updates Licensees who are using - or who intend to use - video cameras must update their program statements to add the following information: (1) Where video cameras are - or will be - located. (2) The purpose of the video cameras. (3) How children and authorized representatives will be informed of the location of video cameras and their purpose. (4) How licensees will work with placing agencies to address situations in which a child objects to video cameras. (5) How video cameras will be used in a trauma informed manner. (6) Whether video cameras will be livestreamed only or recorded. (7) If recorded, who will have access to the recordings and how will the recordings be stored and safeguarded. LPA sent a copy of the LIC 184, LIC 281, LIC 9106, Care Tools Pre-licensing form, and CRP PIN 24-09 to assist with the revisions needed to the application via email. A copy of this report was provided to the applicant via email along with the signed Orientation form indicating Component II has been completed. A copy of this report will be placed in the facility file.

met_with: Stephanie Hall and Oneisha James


summary: Facility Evaluation

raw_content:
Narrative:
On the date listed above, Licensing Program Analyst (LPA) Charmaine Linley conducted Component III Group Homes via Microsoft TEAMS with Stephanie Hall and Oneisha James. A copy of the handout was emailed prior to Component III and the Pre-Licensing Inspection is scheduled for October 7, 2025, at 10:00 am. A copy of this report was emailed to Oneisha James for a signature and a copy of the signed report will be placed in the facility file.

met_with: Oneisha James and Stephanie Hall


summary: Facility Evaluation

raw_content:
Narrative:
On October 7, 2025, at 10:05 am, Lensing Program Analyst (LPA) Charmaine Linley, arrived at the facility to conduct a pre-licensing inspection of the facility. The facility was inspected inside and out with Facility Administrator, Oneisha James, and Director of Operations, Stephanie Hall. The home is a single-story residence. The facility consists of one living room, one family room, two bathrooms, one dining room and one kitchen. The two- car garage is located next to bedroom #5 (staff office) and leads to the driveway. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris. There is adequate indoor and outdoor activity space. The living room has a sectional couch with enough seating for four people. The dining room has a table and chairs with enough seating for four people. The living room has board games available for the client's use. The family room is furnished with one couch and one love seat with enough seating for four people. The facility has a working cellular phone for use with the passcode indicated on the back of the phone. The kitchen is equipped with operable appliances, kitchen utensils, pot, pans and dishes. The facility had a seven day supply of non-perishable food. The kitchen's appliances were tested and were observed to be in working order. The facility's smoke detectors were tested and observed to be in working order. There are seven smoke detectors, one in the family room, one in the hallway, and one in each individual bedroom. There is one carbon monoxide detector that is located in the hallway. The carbon monoxide detector was tested and observed to be in working order. Fire extinguisher is properly charged and serviced. There is one fire extinguisher located on the wall next to the front door. *** The facility has a fully equipped first aid kit and first aid manual stored in the staff office. There are no guns or weapons in the facility as stated by the Administrator. Medications are locked and centrally stored in a locked cabinet in the Staff Office. Disinfectants and cleaning solutions were stored in a locked cabinet in the garage. Sharp knives were made inaccessible and stored in a locked box under the kitchen sink behind a locked door. The staff files will be stored in the locked cabinet in the staff office. The client files will be maintained in a locked file cabinet in the dining room. The following required posted items were observed accessible to clients: Fire Clearance, Grievance Procedures, Visitation policies, Emergency Disaster Plan and current menu. The bedrooms are set up as follows: Bedroom #1 will be occupied by one resident; has one King bed, all required linen, mattress is in good condition. There is one bathroom in this bedroom. Bedroom #2 will be occupied by one resident; has one Full bed, all required linen, mattress is in good condition. Bedroom #3 will be occupied by one resident; has one Full bed, all required linen, mattress is in good condition. Bedroom #4 will be occupied by one resident; has one Full bed, all required linen, mattress is in good condition. Bedroom #5 is the staff office, does not have a bedroom or dresser in the bedroom and no clients will be living in this bedroom. Bedrooms are arranged so that no more than two clients share a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is a locked shed that stores supplies and yard tools. Corrections to be made: At 10:33 am, LPA checked the hot water temperature in the kitchen and it was measured at 128 degrees, *** which is not within regulatory requirements. The water temperature was adjusted and was not able to be measured within regulatory requirements during the inspection. Administrator will take a video of them conducting the water temperature that will be within regulatory requirements, between 105 and 125 degrees and will send via email to LPA by 5:00 pm. Based on the facility pre-licensing inspection review, no deficiencies were noted at the time of inspection. Upon Licensing Program Manager's final review, the license will be provided. An exit interview was conducted, and a copy of this report was given to the facility. A copy of this report will be placed in the facility file.

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On January 28, 2026, at 3:00 pm, Licensing Program Analyst (LPA) Matthew Dorantes, arrived unannounced at the facility to conduct a post-licensing inspection of the facility. The facility was inspected inside and out with Facility Director, Stephanie Hall. The home is a single-story residence. The facility consists of one living room, one family room, two bathrooms, one dining room and one kitchen. The two- car garage is located next to bedroom #5 (staff office) and leads to the driveway. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris. There is adequate indoor and outdoor activity space. The living room has a sectional couch with enough seating for four people. The dining room has a table and chairs with enough seating for four people. The living room has board games available for the client's use. The family room is furnished with one couch and one love seat with enough seating for four people. The facility has a working cellular phone for use. The kitchen is equipped with operable appliances, kitchen utensils, pot, pans and dishes. The facility had a seven day supply of non-perishable food and no current supply of perishable foods. The facility was reminded to maintain a two-day supply of perishable foods once receiving children in care. The kitchen's appliances were tested and were observed to be in working order. The facility's smoke detectors were tested and observed to be in working order. There are seven smoke detectors, one in the family room, one in the hallway, and one in each individual bedroom. There is one carbon monoxide detector that is located in the hallway. The carbon monoxide detector was tested and observed to be in working order. Fire extinguisher is properly charged and serviced. There is one fire extinguisher located on the wall next to the front door. ***Next page continued on LIC 809-C*** The facility has a fully equipped first aid kit and first aid manual stored in the staff office. There are no guns or weapons in the facility as stated by the Facility Director. Medications are locked and centrally stored in a locked cabinet in the Staff Office. Disinfectants and cleaning solutions were stored in a locked cabinet in the garage. Sharp knives were made inaccessible and stored in a locked box under the kitchen sink behind a locked door. The staff files will be stored in the locked cabinet in the staff office. The client files will be maintained in a locked file cabinet in the dining room. The following required posted items were observed accessible to clients: Fire Clearance, Grievance Procedures, Visitation policies, Emergency Disaster Plan and current menu. The bedrooms are set up as follows: Bedroom #1 will be occupied by one resident; has one King bed, all required linen, mattress is in good condition. There is one bathroom in this bedroom. Bedroom #2 will be occupied by one resident; has one Full bed, all required linen, mattress is in good condition. Bedroom #3 will be occupied by one resident; has one Full bed, all required linen, mattress is in good condition. Bedroom #4 will be occupied by one resident; has one Full bed, all required linen, mattress is in good condition. Bedroom #5 is the staff office, does not have a bedroom or dresser in the bedroom and no clients will be living in this bedroom. Bedrooms are arranged so that no more than one client is inside of a room. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There is a locked shed that stores supplies and yard tools. ***Next page continued on LIC 809-C*** The hot water was measured by LPA Dorantes and was at a temperature of 130.5 degrees Fahrenheit which is not within regulatory requirements. LPA informed facility director to ensure a water temperature of 105-120 degrees Fahrenheit prior to receiving children in care. Based on the facility inspection and the current census being zero, LPA Dorantes did not review any staffing or client files at the time of this inspection and there are no deficiencies cited at this time. LPA informed the Licensee to notify the Department at the time of receiving their first client in care. The Department will return to conduct staff and client file reviews at the facility. An exit interview was conducted. A copy of the report was discussed and provided along with appeal rights to the facility. A copy of this report will be placed in the facility file.

met_with: Facility Director


facility_name: BLUME BEHAVIORAL HEALTH

summary: Facility Evaluation

raw_content:
Narrative:
On September 9, 2025, at 10:00AM Licensing Program Analyst (LPA) Rosslyn Gray arrived at the above facility for the purpose of conducting a Pre-Licensing inspection for BLUME BEHAVIORAL HEALTH Group Home located W 230TH PLACE CA 90505. A health and risk assessment were conducted. LPA met with the (S1) and S2 who granted access and provided a tour of the entire physical plant. The facility is seeking a license to provide care and supervision for six (6) clients ages 12-17, ambulatory only. Currently there are no children in placement. The Group Home Overview: LPA-Gray observed the following during the inspection: This is a 2-story stucco grey house facility located in a residential neighborhood. There is a two (2) car garage adjacent to the right of entrance, utilized for storage and has an additional freezer to store. The driveway has parking space for two vehicles and there is a mounted basketball court observed to be in good condition. A description of the vehicle utilized to transport clients will be provided later date to be inspected to be operating in good condition. Outdoor Area: Adjacent to the right of entrance, there is a locked gate that leads to the side of the house to the backyard. LPA observed all windows, screens, and blinds from the inside and outside of the facility were observed to be in good condition. The passageways and porches are unobstructed. The activity space is free of hazard materials and debris. The backyard is covered with grass, a flowerbed and plants along the side of the brick wall. The patio furniture is equipped with a grey table and two-seater grey chair and six (6) tomato color chairs. The licensee plans to equip the back yard with appropriate recreational age items. The water shut off valve is in the front; the main air conditioning/central heat unit and gas are located on the right side of the house; electrical shut-off valves located on the right side of the house. The tank-less Hot Water Heater is in the garage. LIC- Page 1 of The facility large trash cans are located on the right-hand side of the facility. Therapy office: is in the backyard, equipped with a file cabinet, an operating telephone, medical supplies, and two (2) small refrigerators utilized to store the clients' prescribed medications. There is a central air conditioner and a sliding vertical window and horizontal blinds with a view of the back yard. LPA observed a hard wired interconnected combined smoke detector and carbon monoxide detector; tested to be operable. 1st Level: Entrance to the front door, bookshelf/display shelf, large drawer, laundry closet, equipped with a stacked white washer and dryer. The laundry detergent, chemical and cleaning supplies are stored in a locked closet on the 1st floor adjacent to the exit to the garage. Living Room: The Living Room is fully furnished with one (1) hunter green sofa, three (3) black lounge chairs, 1 medium sized round table and two small round tables. There is a 65' television securely mounted on the wall and entertainment center. There is a double door sliding glass door that leads to the back yard. Staff Office is located to the left of the exit. This room is used as office space and accessible to staff only, to serve as a private setting for and for conducting private interviews. There is a hunter green two (2) seated sofa, file cabinet, a printer, desk, two sided sliding glass closet door, two (2) vertical windows and horizontal blinds (i.e view of the back yard); and two (2) small vertical window and horizontal blinds (i.e view of the right side of the house), observed to be in good condition; locked file cabinets to store the medication logs, devices, and medication boxes. The First Aid Kit is also located in this room. It was observed to be equipped with the required items inside (age-appropriate, scissors, tweezers, thermometer, and gauzes, antiseptic, and First Aid Manual Guide. The facility telephone was observed to be operable. Clients will be permitted to use the telephone unless restricted by their authorized representatives. Kitchen: The kitchen was observed to be clean and organized. LPA observed ample perishable and nonperishable food items, and a dish washer. The six (6) burners gas stove is centered on the kitchen counter; the oven and microwave are separated from the stove adjacent to the double door refrigerator and freezer. The Fire Extinguisher is mounted on the wall. Kitchen cleaning supplies, liquids, hand soup, disinfectants and sharp knives are locked in a cabinet inaccessible in the staff office. Lic- Page 2 of Dining Area: The dining area consists of six (6) chairs and a large round table. All posting requirements were met, (i.e food menu posted in the kitchen and common area); regulations, personal rights (posted at the entrance of the kitchen); facility sketch (posted in every room); The LIC 610C Emergency Disaster Plan for Children's Residential Facilities are laminated posted on the wall at the entrance dining area. Bedroom #1 is currently unoccupied. It is located to the right of the entrance adjacent to bathroom #1 and the on site facility school. It is equipped with two (2) Full-size beds, comfortable mattresses, clean linen, blankets and pillows, two (2) clothing hampers. There is one sliding door closet, a dresser drawer with six (6) drawers. There is adequate lighting, window screens, vertical windows and horizontal blinds observed to be in good condition. Bathroom #1 is located to the right of the entrance side adjacent to bedroom #1 and the school. It is equipped with one (1) toilet, and one (1) sink, a shower, and a small sliding glass vertical window, observed to be in good condition. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. On site Facility School: This is a large room, equipped with a large school desk( mounted on the wall), eight (8) chairs, multiple-supply cabinets to store various school and art supplies, 8 laps tops for six (6) for clients and two (2) for staff). Bathroom #2 this bathroom is utilized for clients and staff; equipped with a glass door walk-in shower, (1) toilet, one (1) sink, one (1) large mirror, a large wooden closet, and four (4) sliding vertical windows observed to be in good condition. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. 2nd Floor: To the right of the front door entrance there is a wooden staircase that leads to the 2nd floor. At the top of the stairs to the right is a bookshelf, storage cabinet, and a vertical window, with a window screen observed to be in good condition. Lic- Page 3 of Bedroom #2 is currently unoccupied. It is the 1st bedroom straight forward at the top of the stairs. It is designed like a loft, equipped with two (2) full sized beds, comfortable mattress, clean linen, blankets and pillows. The six (6) drawer dresser drawer is mounted inside the open closet with ample space for two (2) clients. There is adequate lighting, vertical windows, horizontal blinds and window screens were observed to be in good condition. Bedroom #3 is currently unoccupied. It is adjacent to right of bedroom # It is designed like a loft, equipped with one (1) full sized bed and one (1) twin sized bed, comfortable mattress, clean linen, blankets and pillows. The six (6) drawer dresser drawer is mounted inside the open closet with ample space for two (2) clients. There is adequate lighting, vertical windows, horizontal blinds and window screens were observed to be in good condition. Bathroom #3 is equipped with a glass door walk-in shower, (1) toilet, one (1) sink, one (1) large mirror, a large wooden closet, and four (4) sliding vertical windows observed to be in good condition. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. In addition, outside of the bedroom and bathroom there is ample cabinet space, closet space and storage space. The staff will accompany clients to local recreational facilities in the facility vehicle. Clients are accorded dignity in personal relationships with staff and others. The facility will operate within licensing conditions and limitations including capacity limitations. The Administrator ensured the facility will have a written plan of operation. Facility personnel are instructed to report violations of personal rights. The License will report changes in the plan of operation affecting service to clients and will report any injuries requiring medical treatment. The administrator will provide the Personnel Report (LIC 500) and confirm that the staff ratio presents for the six (6) clients in placement. The administrator ensured that all will have required criminal record clearance. DOJ, FBI and Child Abuse Response that will meet qualification. There were no deficiencies cited at this time. LPA concluded the Pre License Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Chief Operating Officer (COO) Alex Hawes on 09/09/ LIC- Page 4 of 4

met_with: Administrator Aida Shadfan & Chief Operating Officer (COO) Alex Hawes


summary: Facility Evaluation

raw_content:
Narrative:
On 3/18/2026, at 10:30 am, Licensing Program Analyst (LPA) Nestor Gomez arrived at the above facility, for the purpose of conducting an Annual Required Inspection. LPA Gomez met with Nina Hall who granted access to the facility. A health and risk assessment was conducted. The facility currently has a provisional license to provide care and supervision for six (6) clients ages 12-17, ambulatory only. During the time of inspection, LPA Nestor conducted an inspection of the following areas: Kitchen: located on the first floor. The kitchen is equipped with six (6) burners gas stove, microwave, dishwasher, oven, and a double door refrigerator with a freezer. The refrigerator contained ample food for children in care that included at least a two day supply of perishable foods. However, the facility did not have a weeks worth of non-perishable food. All appliances are in working order. The trash can in the kitchen was equipped with a lid. LPA observed that the food in the fridge was dated with stickers that only included the day of the week and not an actual date (i.e. Day, month, and/or year) Living Room: located on the first floor. This room is equipped with one (1) sofa, three (3) lounge chairs, and one small square table. There is a 65' television securely mounted on the wall and entertainment center. There is a double door sliding glass door that leads to the back yard. Dining Room: located on the first floor. This space is equipped with four (4) chairs and a large round table. Continue on 809-C (Page 1) Bedroom #1: located on the first floor, adjacent to Bathroom #1. This bedroom is currently occupied by C1 and C3. The bedroom is equipped with two (2) Full-size beds, comfortable mattresses, clean linen, blankets and pillows, two (2) clothing hampers. There is one sliding door closet, a dresser drawer with six (6) drawers. There is adequate lighting, window screens, vertical windows and horizontal blinds observed to be in good condition. Bedroom #2: located on the second floor. This bedroom is currently occupied by C4. It is designed like a loft, equipped with two (2) full sized beds, comfortable mattress, clean linen, blankets and pillows. The eight (8) drawer dresser drawer is mounted inside the open closet with ample space for two (2) clients. There is adequate lighting, vertical windows, horizontal blinds and window screens were observed to be in good condition. Bedroom #3: located on the second floor. This bedroom is currently occupied by C2. It is designed like a loft, equipped with one (1) full sized bed and one (1) twin sized bed, comfortable mattress, clean linen, blankets and pillows. The eight (8) drawer dresser drawer is mounted inside the open closet with ample space for two (2) clients. There is adequate lighting, vertical windows, horizontal blinds and window screens were observed to be in good condition. Bathroom #1: located on the first floor adjacent to bedroom #1. This bathroom is equipped with one (1) toilet, and one (1) sink, a shower, and a small sliding glass vertical window, observed to be in good condition. Bathroom #2: located on the first floor. Used by both staff and clients. This bathroom is equipped with a glass door walk-in shower, (1) toilet, one (1) sink, one (1) large mirror, a large wooden closet, and four (4) sliding vertical windows observed to be in good condition. Continue on 809-C (Page 2) Bathroom #3: located on the second floor. This bathroom is equipped with a glass door walk-in shower, (1) toilet, one (1) sink, one (1) large mirror, a large wooden closet, and four (4) sliding vertical windows observed to be in good condition. Onsite Facility School: This is a large room, equipped with a large school desk (mounted on the wall), eight (8) chairs, multiple-supply cabinets to store various school and art supplies, and eight (8) laps tops (six (6) for clients and two (2) for staff). Staff Office: located on the first floor. Accessible to staff only. Used as a private setting to conduct interviews. This room is equipped with two (2) seated sofa, file cabinet, a printer, and a desk. There are locked file cabinets to store the medication logs, devices, and medication boxes. The First Aid Kit is also located in this room. It was observed to be equipped with the required items inside (age-appropriate, scissors, tweezers, thermometer, and gauzes, antiseptic, and First Aid Manual Guide. The facility telephone was observed to be operable. Laundry space: The washer and dryer is located to the right of the front door in a closet. Therapy Office: Located in the backyard. This room is equipped with a file cabinet, an operating telephone, medical supplies, and two (2) small refrigerators utilized to store the clients' prescribed medications. There is a central air conditioner and a sliding vertical window and horizontal blinds with a view of the back yard. LPA observed a hard wired interconnected combined smoke detector and carbon monoxide detector; tested to be operable. Backyard: This space is covered with grass, a flowerbed and plants along the side of the brick wall. The patio furniture is equipped with a grey table and two-seater grey chair and six (6) tomato color chairs. Continue on 809-C (Page 3) Additional Observations: The water temperature at the kitchen sink was tested and measured at 106 degrees Fahrenheit which meets licensing regulations. The cleaning supplies are locked and stored under the kitchen sink and the upstairs supply closet. Sharps are stored in the staff office which remains locked. There are two (2) fire extinguishers located in the kitchen and upstairs hallway. LPA observed the carbon monoxide/smoke detectors to be in working order when tested by the licensee. LPA observed that the licensee did not post any of the required postings. LPA observed the facility sketch posted by the front door. LPA observed all windows, screens, and blinds from the inside and outside of the facility were observed to be in good condition. The passageways and porches are unobstructed. The activity space is free of hazard materials and debris. The water shut off valve is in the front; the main air conditioning/central heat unit and gas are located on the right side of the house; electrical shut-off valves located on the right side of the house. The tank-less Hot Water Heater is in the garage. Vehicles: LPA Nestor inspected one (1) facility vehicles in total. Chevrolet Traverse (Black) with current registration that expires in 9/20/2026. Insured by Manufactures Alliance Insurance Company that expires in 4/29/2026. Vehicles are in good condition with no issues. Staff Interview: LPA Nestor conducted two (2) staff interviews with S6 and S4. Client Interview: LPA Nestor conducted two (2) client interviews with C1 and C2. LPA Nestor will return to complete the inspection. There were no deficiencies observed or cited at this time. A copy of this report was reviewed and provided to facility administrator (FA).

met_with: Behavioral Technician - Nina Hall


summary: Facility Evaluation

raw_content:
Narrative:
On 4/2/2026, at 9:12 am, Licensing Program Analyst (LPA) Nestor Gomez arrived at the above-mentioned facility for the purpose of verifying the completion of the required corrections related to the physical plant deficiencies identified during the post-licensing inspection conducted on 3/18/2026. LPA Gomez met with Behavioral Technician (S4), Madison Decker, who granted access to the facility. The following deficiencies were identified and cited on 3/18/2026: Citation: CCR 84009(a) Posting of License Requirement: The license shall be posted in a prominent, publicly accessible location in the facility. Original Finding: LPA observed that the license was not posted at the time of the inspection. Correction Verified on // 4/2/26: LPA observed the license to be placed in the kitchen. Citation: CCR 84072(a) Personal Rights Requirement: Each facility licensed to provide foster care for six or more children shall post a listing of a foster child's rights, consistent with WIC 16001.9(a) and subsection (d). Original Finding: LPA observed that the personal rights were not posted at the time of the inspection. Continue on 809-C (Page 1) Correction Not-Verified on visit // 4/2/26: S3 stated that they were going to install a wooden frame with Plexiglass in the living room, but it was going to be ready either later today (4/2/2026) or tomorrow (4/3/2026). Citation: CCR 84072(a)(1) Personal Rights Requirement: Facilities must use material developed by the Office of the Foster Care Ombudsperson to meet the posting requirement for foster child rights. Original Finding: LPA observed that the material developed by the Office of the Foster Care Ombudsperson was not posted at the time of the inspection. Correction Not-Verified on visit // 4/2/26: S3 stated that they were going to install a wooden frame with Plexiglass in the living room, but it was going to be ready either later today (4/2/2026) or tomorrow (4/3/2026). Citation: CCR 84076(c)(1) Food Supplies Requirement: Facilities shall maintain staple nonperishable foods for one week and fresh perishable foods for two days. Original Finding: LPA observed that the facility did not have a minimum of one week of nonperishables. Correction Verified on //4/2/2026: LPA observed a weeks worth of non-perishables for children in care. Citation: CCR 84075(b) Centrally Stored Medications Requirement: All prescribed medications must be centrally stored as provided in Section 80075(j), except certain personal medications listed in 84072(d)(29)-(30). Continue on 809-C (Page 2) Original Finding: LPA observed that prescribed medication was stored in a safe in the garage and a file cabinet in the staff office. Correction Verified on //4/2/2026: LPA observed that the medication was centrally stored in a locked cabinet in the staff office. Citation: CCR 84072.2(a)(3) Complaint Procedures Requirement: Complaint procedures shall be posted in a location accessible to children and their authorized representatives. Original Finding: LPA observed that the complaint procedures were not posted in an accessible location. Correction Verified on //4/2/2026: LPA observed the complaint procedures to be posted in the kitchen. LPA Gomez conducted a walkthrough of the physical plant and confirmed that the facility completed 4 out of the 6 required corrections associated with the above citations. Exit interview was conducted with the S3 and a copy of this report was emailed to the Facility Administrator. End of Visit (Page 3)

met_with: Behavioral Technician - Madison Decker


summary: Facility Evaluation

raw_content:
Narrative:
On January 17 2025 at 9: AM Licensing Program Analyst (LPA) Rosslyn Gray arrived at the above facility for the purpose of conducting Pre-Licensing inspection. BLUME BEHAVIORAL HEALTH Group Home located Patronella Ave.Torrance CA 90504. A health and risk assessment were conducted. LPA met with the (S1) who granted access to the facility.The facility is seeking a license to provide care and supervision for six (6) females clients ages 12-17, ambulatory only. Currently there are no children in placement. LPA-Gray observed the follow during the inspection: The Group Home Overview: This is a 2-story 3) semi-white house facility located on left corner in a cul-de-sac residential neighborhood. There is two (2) car garage entrance from the outside and inside exit through the dining area. The driveway has parking space for six (6) vehicles. Currently there is not a vehicle utilized to transport the clients. The CEO/Administrator will provide information about the company vehicle later to be inspected to be operating in good condition. The facility large trash cans are located on the right hand side of the facility. LPA observed a hard wired interconnected combined smoke detector and carbon monoxide detector; tested to be operable. There is living room, office/therapy room, recreational/multipurpose, kitchen, dining room, educational room and a private room. LPA observed three (3) Fire Extinguishers located in the kitchen, dining area and on the 2nd floor at the top of the stairs mounted on the wall in the hallway. LPA observed a working telephone at the entrance and in the staff office. Clients will be permitted can use the telephone unless restricted by authorized representatives. All posting requirements were met,(i.e food menu posted in the kitchen and common area); regulations, personal rights (posted at the entrance of the kitchen); facility sketch (posted in every room); The LIC 610C Emergency Disaster Plan for Children's Residential Facilities are laminated posted on the wall at the entrance dining area.LIC- Page 1 of Storage room The laundry detergent, chemical and cleaning supplies are stored in a locked closet on the 1st floor adjacent to the exit to the garage. There is a additional small storage area adjacent to the indoor garage exit and is locked for safety and security. There is an exit door to the right adjacent to the storage closet that leads to the garage. 2nd Floor Laundry Room: Located adjacent to the quite room, equipped with a Samsung white washer and dryer unit. Bedroom#1: Is equipped with one two (2) Full-size beds, comfortable mattress, clean linen, blankets and pillows. There are one sliding door closets, adequate dresser drawer space for 2 client There is adequate lighting, window screens, vertical blinds observed to be in good condition. Bathroom #2 is located in this bedroom. It is equipped with a full size bathroom that has (1) toilet, one (1) sink, one (1) shower and a window with proper vitalization, observed to be in good condition. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Bedroom #2 is currently unoccupied. It is equipped with one (1) full sized bed and and one (1) twin bed, comfortable mattress, clean linen, blankets and pillows. There are one (1) sliding door closet and two dresser drawers for each client, adequate lighting, window screens, vertical blinds, observed to be in good condition. Bedroom #3 is currently unoccupied. It is equipped with one (1) full sized bed and one (1) twin sized bed, comfortable mattress, clean linen, blankets and pillows. There are two tall white closets, and two dresser drawers for each client, adequate lighting, window screens, vertical blinds, observed to be in good condition. Bathroom Jack N Jill between bedroom #2 and #3. Will be monitored by staff to ensure clients privacy. It is equipped with two sinks, a toilet, shower and a bathtub, observed to be in good condition. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Privacy Room is located on the left side, will prep with chairs, sofa and a beanbag and age appropriate electronic games. LIC- Page 3 of Inside/Outdoor Area: LPA observed all windows, screens, and blinds from the inside and outside of the facility were observed to be in good condition. The passageways and porches are unobstructed. The activity space is free of hazard materials and debris. Patio furniture is equipped with a hightop 4 seated table, recreational equipment bing bag, large sized Janga, basketball, football etc. There shed that extra clothing, food water, luggage and other supplies. The main air conditioning/central heat unit is located on the back side of the house and electrical utilities, shut-off valves for gas is located on the right side of the house. Thee tank-less Hot Water Heater is located in the garage. 1st Level: Living Room: The Living Room is fully furnished with two (2) sofas, a pink sofa chair, two(2) white end tables. There is a 65' television securely mounted on the wall and entertainment center. Therapy Room/Staff Office#1: located directly to the left of the front door entrance. This room is used as office space and accessible to staff only, to serve as private setting for therapeutic services and for conducting private interviews. There are locked file cabinets to store the medication logs, medical devices, medication boxes and a small refrigerator that is utilized to store the clients prescribed medications. The First Aid Kit is also located is this room. It was observed to be equipped with the required items inside (age-appropriate, scissors, tweezers, thermometer, and gauzes, antiseptic, and First Aid Manual Guide. Kitchen: The kitchen was observed to be clean and organized. LPA observed ample perishable and nonperishable food items, a portable white rack for fruit and grains. It is equipped with a six (6) burners gas stove, a two (2) sided sink, double door refrigerator with bottom freezer and a Fire Extinguisher mounted on the wall. Kitchen cleaning supplies, liquids, hand soup, disinfectants and sharp knives are locked in a cabinet inaccessible in the staff office. Dining Area: The dining area consists of six (6) chairs and a large table, bookshelf/cabinet to store supplies. There are two (2) separate kitchen counter chairs and a Fire Extinguishers mounted on the wall. Bathroom # Identified as the staff bathroom is locate on the left side adjacent to inside garage exit door. It is a half size equipped with one (1) toilet, and one (1) sink, observed to be in good condition. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. LIC- Page 2 of Recreational/Multipurpose Room This is a large room, equipped with 3 portable school desk, a supply cabinet to store various school and art supplies, 8 laps tops (six for clients and 2 for staff). There full sized walk in bathroom utilized for clients and staff. (1) toilet, two (2) sinks, two mirrors, two large walk in closets, a glass door walk in shower, Jacuzzi tub, and a window with proper vitalization, observed to be in good condition. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. The staff will accompany clients to local recreational facilities in the facility vehicle. Clients are accorded dignity in personal relationships with staff and others. The facility will operate within license conditions and limitations including capacity limitations. The Administrator ensured the facility will have the written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. The administrator will provide the Personnel Report (LIC 500) and confirmed that the staff ratio presents for the six (6) clients in placement. The administrator ensured that all will have required criminal record clearance. DOJ, FBI and Child Abuse Response that will meet qualification. There were no deficiencies cited at this time. LPA concluded the Post License Inspection. An exit interview was conducted, and a copy of this report was left at the facility with the Chief Executive Officer/ Administrator Basel Shadfan on 01/17/ LIC- Page 4 of 4

met_with: Basel Shadfan Chief Executive Officer/ Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On May 16, 2025 at 9: AM Licensing Program Analyst (LPA) Rosslyn Gray and Aimee Moratalla arrived at the above facility for the purpose of conducting Pre-Licensing inspection. BLUME BEHAVIORAL HEALTH Group Home located Patronella Ave.Torrance CA 90504. A health and risk assessment were conducted. LPA met with the (S1) who granted access to the facility. The facility is seeking a license to provide care and supervision for six (6) male clients ages 12-17, ambulatory only. The current census is 5. LPA-Gray observed the follow during the inspection: The Group Home Overview: This is a 2-story semi-white house facility located on left corner in a cul-de-sac residential neighborhood. There is two (2) car garage entrance from the outside and inside exit through the dining area. The driveway has parking space for six (6) vehicles. Currently is one vehicle utilized to transport the clients. Make and model Chevy Truck Vehicle Registration Expiration date 10/02/2025 inspected to be operating in good condition. The facility large trash cans are located on the right hand side of the facility. LPA observed a hard wired interconnected combined smoke detector and carbon monoxide detector; tested to be operable. There is living room, office/therapy room, recreational/multipurpose, kitchen, dining room, educational room and a private room. LPA observed three (3) Fire Extinguishers located in the kitchen, dining area and on the 2nd floor at the top of the stairs mounted on the wall in the hallway. LPA observed a working telephone at the entrance and in the staff office. Clients will be permitted can use the telephone unless restricted by authorized representatives. All posting requirements were met,(i.e food menu posted in the kitchen and common area); regulations, personal rights (posted at the entrance of the kitchen); facility sketch (posted in every room); The LIC 610C Emergency Disaster Plan for Children's Residential Facilities are laminated posted on the wall at the entrance dining area. LIC- Page 1 of Recreational/Multipurpose Room This is a large room, equipped with 3 portable school desk, a supply cabinet to store various school and art supplies, 8 laps tops (six for clients and 2 for staff). There full sized walk in bathroom utilized for clients and staff. (1) toilet, two (2) sinks, two mirrors, two large walk in closets, a glass door walk in shower, Jacuzzi tub, and a window with proper vitalization, observed to be in good condition. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. The staff will accompany clients to local recreational facilities in the facility vehicle. Clients are accorded dignity in personal relationships with staff and others. The facility will operate within license conditions and limitations including capacity limitations. The Administrator ensured the facility will have the written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. The administrator will provide the Personnel Report (LIC 500) and confirmed that the staff ratio presents for the six (6) clients in placement. The administrator ensured that all will have required criminal record clearance. DOJ, FBI and Child Abuse Response that will meet qualification. Staff Records Review: LPA reviewed two (2) staff records stored in individual personnel file/binders. Clients Records Review: LPA reviewed three (3) clients records which met qualification. Staff Interviews: LPA conducted a confidential interview with one (1) on duty staff. Client Interviews: LPA conducted confidential interviews with three (3) of the five (5) clients according to the census, available and willing to be interviewed. There were no deficiencies cited at this time. LPA's concluded the Post Licensing Inspection. An exit interview was conducted, and a copy of this report was left at the facility the Chief Operating Officer Alex Hawes 05/16// Inside/Outdoor Area: LPA observed all windows, screens, and blinds from the inside and outside of the facility were observed to be in good condition. The passageways and porches are unobstructed. The activity space is free of hazard materials and debris. Patio furniture is equipped with a hightop 4 seated table, recreational equipment bing bag, large sized Janga, basketball, football etc. There shed that extra clothing, food water, luggage and other supplies. The main air conditioning/central heating unit is located on the back side of the house and electrical utilities, shut-off valves for gas is located on the right side of the house. The tank-less Hot Water Heater is located in the garage. 1st Level: Living Room: The Living Room is fully furnished with two (2) sofas, a green sofa chair, two(2)round tables. There is a 65' television securely mounted on the wall and entertainment center. Therapy Room/Staff Office#1: located directly to the left of the front door entrance. This room is used as office space and accessible to staff only, to serve as private setting for therapeutic services and for conducting private interviews. There are locked file cabinets to store the medication logs, medical devices, medication boxes and a small refrigerator that is utilized to store the clients prescribed medications. The First Aid Kit is also located is this room. It was observed to be equipped with the required items inside (age-appropriate, scissors, tweezers, thermometer, and gauzes, antiseptic, and First Aid Manual Guide. Kitchen: The kitchen was observed to be clean and organized. LPA observed ample perishable and nonperishable food items, a portable white rack for fruit and grains. It is equipped with a six (6) burners gas stove, a two (2) sided sink, double door refrigerator with bottom freezer and a Fire Extinguisher mounted on the wall. Kitchen cleaning supplies, liquids, hand soup, disinfectants and sharp knives are locked in a cabinet inaccessible in the staff office. Dining Area: The dining area consists of six (6) chairs and a large table, bookshelf/cabinet to store supplies. There are two (2) separate kitchen counter chairs and a Fire Extinguishers mounted on the wall. Bathroom # Identified as the staff bathroom is locate on the left side adjacent to inside garage exit door. It is a half size equipped with one (1) toilet, and one (1) sink, observed to be in good condition. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. LIC- Page 2 of Storage room The laundry detergent, chemical and cleaning supplies are stored in a locked closet on the 1st floor adjacent to the exit to the garage. There is a additional small storage area adjacent to the indoor garage exit and is locked for safety and security. There is an exit door to the right adjacent to the storage closet that leads to the garage. 2nd Floor Laundry Room: Located adjacent to the quite room, equipped with a Samsung white washer and dryer unit. Bedroom#1: is occupied by two (2) clients Is equipped with one two (2) Full-size beds, comfortable mattress, clean linen, blankets and pillows. There are one sliding door closets, adequate dresser drawer space for 2 client There is adequate lighting, window screens, vertical blinds observed to be in good condition. Bathroom #2 is located in this bedroom. It is equipped with a full size bathroom that has (1) toilet, one (1) sink, one (1) shower and a window with proper vitalization, observed to be in good condition. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Bedroom #2 is occupied by (1) client. It is equipped with one (1) full sized bed and and one (1) twin bed, comfortable mattress, clean linen, blankets and pillows. There are one (1) sliding door closet and two dresser drawers for each client, adequate lighting, window screens, vertical blinds, observed to be in good condition. Bedroom #3 is occupied by two (2). It is equipped with one (1) full sized bed and one (1) twin sized bed, comfortable mattress, clean linen, blankets and pillows. There are two tall white closets, and two dresser drawers for each client, adequate lighting, window screens, vertical blinds, observed to be in good condition. Bathroom Jack N Jill between bedroom #2 and #3. Will be monitored by staff to ensure clients privacy. It is equipped with two sinks, a toilet, shower and a bathtub, observed to be in good condition. The water temperature measured within safe temperatures, at not less than 105 and did not exceed 120 degrees Fahrenheit. Privacy Room is located on the left side, prep with two (2) chairs, sofa and a beanbag and age appropriate electronic games. LIC- Page 3 of 4

met_with: Alex Hawes Chief Operating Officer


summary: Facility Evaluation

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On August 27, 2025, at 10:00AM Licensing Program Analyst (LPA), Rosslyn Gray met for Component III of the application process for BLUME BEHAVIORAL HEALTH Group Home located at Patronella Ave. Torrance CA, 90504 was held at the Children's Residential Regional Office in El Segundo. Attending Component III were the following individuals: Administrator Aida Shadfan and Licensing Program Analyst (LPA), Rosslyn Gray. The objectives of Component III meeting were to familiarize applicants with general Group Home Rules and Regulations to prepare the Licensee to maintain and operate their facilities, provide information to avoid potential problem areas, to provide a clear description of Licensing Program Analyst's (LPA) role in operation of facility, and to provide clear description of Civil Penalties. LPA-Gray discuss the client's Personnel Records, to be documented, retained, maintained, available and posted at the facility for inspections, discussed the gender population and specific problems and issues of operating a Group Home, such as, reporting requirements, personnel requirements, supervision, intake issues, compatibility, removal/discharge, complaint procedures, transportation, health services, food, allergies, hygiene, gender hygiene products, visitation, personal property, searches, community sensitivity, Electronic Files to store records, ensure the client ratio is based on staff to behavior that may include increasing staff to provide proper supervision, staff training that also include administer of medication and who will be responsible for administering medication. LPA discussed who will ensure the Technicians are aware of the clients triggers and the reason for their placement and need to provide a Grievance Box for the clients to report anonymous issues and concerns. LPA discussed the procedure of notification when an unusual incident occurs and documented LIC 624 that includes details of who what when, where and how the incident occured. LPA discussed prudent parenting and if the client is resistant to care and or are forced, how will the facility get the clients to buy in. LPA concluded Component III meeting, signed the Orientation/Application Process Certificate of Completion and a copy of this report was provided to the Administrator Aida Shadfan

met_with: Administrator Aida Shadfan


summary: Facility Evaluation

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Narrative:
On 02/19/2026, at 9:46 am, Licensing Program Analyst (LPA) Nestor Gomez arrived at the above facility, for the purpose of conducting an Annual Required Inspection. LPA Gomez met with Matthew Villarreal who granted access to the facility. Chief Operating Officer (S2), Alex Hawes, provided a tour of the facility. A health and risk assessment were conducted. The facility currently has a provisional license to provide care and supervision for six (6) male clients ages 12-17, ambulatory only. The current census is 5. This is a 2-story semi-white house facility located on left corner in a cul-de-sac residential neighborhood. There is two (2) car garage entrance from the outside and inside exit through the dining area. The driveway has parking space for six (6) vehicles. During the time of inspection, LPA Nestor conducted an inspection of the following areas: Kitchen: equipped with a refrigerator, dishwasher, microwave, and an air fryer. The kitchen contained ample food for children in care that included both perishable and non-perishable foods. All appliances are in working order. The trash can in the kitchen was equipped with a lid. Dinning Room: This space contained a table with seven (7) chairs, and a ping pong table. Continue on 809-C (Page 1) Bedroom #1: located upstairs. This bedroom is currently occupied by C5. The bedroom is equipped with two (2) full-sized beds, two (2) dressers, two (2) laundry hampers, a closet and the beds had drawer space underneath. Bedroom #2: located upstairs. This bedroom is currently occupied by C2 and C3. The bedroom is equipped with one (1) twin bed, one (1) full-sized bed, one (1) dresser that clients split, one (1) side table, a closet and the beds have drawer space underneath. Bedroom #3: located upstairs. This bedroom is currently occupied by C1 and C4. The bedroom is equipped with one (1) twin bed, one (1) full-sized bed, one (1) dresser that clients split, one (1) side table, a closet and the beds have drawer space underneath. Bathroom #1: located downstairs by the dining room. This bathroom is equipped with a cabinet, sink, toilet and bathtub/shower. Bathroom #2: located upstairs adjacent to the master bedroom. This bathroom is equipped with a cabinet, two (2) sinks, toilet and bathtub/shower. Bathroom #3: located upstairs. This bathroom is equipped with a cabinet, sink, toilet and bathtub/shower. Bathroom #4: located upstairs. This bathroom is equipped with a cabinet, sink, toilet and bathtub/shower. Office space: located downstairs. This space contains a desk, coach, 3 chairs, water dispenser, medication cabinet, medication refrigerator. Therapy room: This space contains one (1) couch, one (1) sofa chair, and two (2) chairs. Hallway: The storage cabinets in the hallway contain board games. Educational room/multipurpose room: This space is equipped with three (3) tables, nine (9) chairs, whiteboard, two (2) sofa chairs and is mainly used for educational purposes. Continue on 809-C (Page 2) Garage: this space is used for contraband, storage, extra freezer and extra refrigerator, extra hygiene supplies, extra emergency supplies and linens. Laundry Room: This space contains a washer and dryer. S2 stated that all the detergent and supplies are stores in the garage. Backyard: This space is equipped with a grill, storage shed that contains outdoor sport equipment, outdoor seating that seats seven (7) and a table with four (4) chairs. Additional Observations: The water temperature at the kitchen sink was tested and measured at 110 degrees Fahrenheit which meets licensing regulations. The cleaning supplies are stored in a storage closet between the stairs and bathroom #1. Sharps are stored in the garage in a box. There are two (2) fire extinguishers located in the dining area and by the upstairs hallway. LPA observed the carbon monoxide/smoke detectors to be in working order when tested by the licensee. LPA observed all required posting. LPA observed a working telephone in the staff office. S2 stated that client and staff files are kept on Paylocity. There are five (5) cameras on the facility that cover the outside of the home. S2 stated that the clients are provided with a chef that cooks all their meals in the home. S2 stated that clients have their own personal cup and use paper plates. Vehicles: LPA Nestor inspected (1) one facility vehicles in total. Chevrolet Traverse (Black) with current registration that expires in 9/30/2026. LPA was unable to check the insurance information at the time of the inspection. Vehicle is in good condition with no issues. Staff Interview: LPA Nestor conducted two (2) staff interview with S1 and S2. Client Interview: LPA Nestor conducted three (3) client interviews with C1, C3, and C4. LPA Nestor will return to complete the inspection. There were 4 deficiencies observed and cited at this time. See 809-D A copy of this report was reviewed and provided to FA and S2.

met_with: Matthew Villarreal - Mental Health Technician


summary: Facility Evaluation

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On 3/5/26, at 10:17 am, Licensing Program Analyst (LPA) Nestor Gomez arrived at the above-mentioned facility for the purpose of verifying the completion of the required corrections related to the physical plant deficiencies identified during the annual inspection conducted on 2/19/2026. LPA Gomez met with Mental Health Technician (S1), Matthew Villarreal, who granted access to the facility. LPA Gomez conducted a walkthrough of the facility and reviewed relevant documentation to confirm compliance. The following deficiencies were identified and cited on 2/19/26: • CCR 84009(a): Posting of License The license shall be posted in a prominent, publicly accessible location in the facility. Finding: License was posted in the staff office, which is not publicly accessible. • CCR 80075(g)(1)(F): Health-Related Services - First Aid Supplies Tweezers are required as part of the first aid supplies. Finding: Licensee did not have tweezers in their first aid supplies. Continue on 809-D (Page 1) • CCR 84076(b): Food Service - Posted Weekly Menu Written menus shall be posted weekly in an area accessible to the staff and children. Finding: Licensee did not have a weekly menu posted in the facility. • CCR 84072.2(a)(3): Complaint Procedures Complaint procedures shall be posted in a location accessible to children and their authorized representatives. Finding: Licensee did not have complaint procedures posted in an accessible location. LPA Gomez conducted a walkthrough of the physical plant and confirmed that the facility completed required corrections associated with the above citations.


summary: Facility Evaluation

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Narrative:
On 4/8/2026 at 12:40 pm, Licensing Program Analyst (LPA) Nestor Gomez and Licensing Program Manager (LPM) Kevin Sauk arrived at the above-mentioned facility for the purpose of verifying the completion of the required corrections related to the physical plant deficiencies identified during the random annual inspection conducted on 3/5/2026. LPA Gomez met with Staff (1), Alex Hawes, who granted access to the facility. The following deficiencies were identified and cited on 3/5/2026: Citation: GH Chapter 5, Personal Rights 84072(d)(13) Requirement: To make, send, and receive confidential telephone calls and other electronic communications, unless prohibited by court order. Original Finding: Interviews revealed that clients are not given confidential phone calls because staff remain present during clients' phone calls. Correction Verified on //4/8/2026: LPA received the documents for the new phone policy and the updated program statement. Continue on 812-C (Page 1) Citation: Gen Chapter 1, Food Service 84076(a)(22) Requirement: Tableware, tables, dishes, and utensils shall be provided in the quantity necessary to serve the clients. Original Finding: Licensee only provides one cup to the clients with their name written on the cup. Correction Verified on //4/8/26: LPA observed that the licensee obtained more cups for clients in care. Citation: Gen Chapter 1, Food Service 80076(a)(1) Requirement: All food shall be selected, stored, prepared and served in a safe and healthy manner. Original Finding: LPA observed food items that were open in the fridge that were not properly stored or contained dates of when used/open. Correction Verified on //4/8/26: LPA observed proper food storage in the facility. Citation: GH Chapter 5, Food Service 84076(c)(1) Requirement: Maintain one week of staple nonperishable foods and two days of fresh perishable foods on the premises. Original Finding: LPA did not observe a weeks worth of nonperishables Correction Verified on //4/8/26: LPA observed that licensee obtained one weeks worth of nonperishables food items for children in care. Citation: CCR 80066(a)(10), Personnel Records Requirement: Personnel file must contain a health screening as specified in Section 80065(g). Original Finding: LPA observed that S1 and S3 did not have a health screening on file. Continue on 812-C(Page 2) Correction Verified on //4/8/26: LPA observed the health screening for S1 and S3. LPA also observed the health screening for the remainder of the employees. Citation: CCR 80066(a), Personnel Records Requirement: Licensee shall ensure that complete and up-to-date personnel records are maintained for each staff member. Original Finding: Licensee failed to maintain staff files. There was no documentation regarding staff qualifications and personnel records were not up to date. Correction Verified on //4/8/26: LPA observed the updated staff files. Citation: CCR 84365(d)(1), Emergency Intervention Staff Training Requirement: Documentation of training received must be maintained in each staff member's personnel record. Original Finding: Licensee did not maintain a record of staff training for each staff member. Correction Verified on //4/8/26: LPA observed the staff trainings. Citation: CCR 80026(h), Safeguards for Cash Resources, Personal Property, and Valuables Requirement: Licensee shall maintain accurate records of client cash resources, personal property, and valuables entrusted to their care. Original Finding: Licensee did not have a log to keep track of client personal property. Correction Verified on //4/8/26: LPA Gomez observed the client's personal property records. LPA Gomez conducted a walkthrough of the physical plant and confirmed that the facility completed all required corrections associated with the above citations. End of Inspection (Page 3)


summary: Facility Evaluation

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Narrative:
On February 15, 2024, 10AM, Component II of the application process for BLUME BEHAVIORAL HEALTH Group Home located PERKINS LANE, REDONDO BEACH CA, 90278 was held at the El Segundo Children's Residential Regional Office in El Segundo. Attending Component II were the following individuals: Christina Kiesselbach, Compliance Specialist, Devon Wayt,Compliance Specialist, Basel Shadfan Chief Executive Officer/ Administrator and Licensing Program Analyst (LPA), Rosslyn Gray. The purposes of this Component II meeting were to review the incomplete application and Program Statement, to resolve any outstanding concerns that may have existed. The following incomplete application forms were discussed at the meeting: Personnel Report (LIC 500), Group Home Hour Administrator certificate and by-laws. The Gender Population to identify the gender for this facility. The CEO determined that the above facility will provide care and supervision for male; Transportation; Needs and Services; Personal Rights that include, Visitation, Phone calls, Allowances, Discipline policy, Removal and/or Discharge Procedures; Neighborhood Complaint Procedures. The applicants were informed of the Health and Safety Code stated policy and requirements regarding the overconcentration of residential care facilities which are separated by a distance of 300 feet or less from another residential facility unless approval is obtained from the city or county in which the facility will be located. The applicant CEO/Administrator agreed to provide a Business License and a letter of approval from the city on a city letter. The applicants were advised of the following revision and/or corrections needed to the application and/or Program Statement: Sections 1-29 of the Program Statement was reviewed and discussed. Revisions are due February 29, 2024. The Pre-Licensing inspection has been scheduled for Thursday March 7, 2024 at 9: AM. A copy of this report was provided to Basel Shadfan Chief Executive Officer(CEO)/Administrator.