summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Gilbert Gutierrez made an unannounced Annual/Required inspection to the above facility on 4/19/23 at 9: A.M. and met Facility Manager Roberto Perez. Administrator, Ricardo Montes arrived shortly. Currently there are 3 clients placed in the facility. At the time of the inspection only one client is at the facility. The annual inspection consisted of the following domains: -Physical Plant -Operations -Disaster Preparedness -Emergency Intervention -Core Therapeutic Services -Client Records -Staffing LPA started the tour of the facility with staff at 9: A.M.and observed the following: the posted license, emergency disaster plan, client's personal rights. The medications, cleaning solutions and knives were locked inside the cabinets in the kitchen inaccessible to the clients. There were perishable foods enough for 2 days and non-perishable foods enough for client's consumption for a weeks and fruits in a basket in the kitchen counter. However, there were items observed past their best by dates and not labeled and dated inside the pantry. There were opened food items in the freezer not labeled and dated also. The cleaning supplies and medications are locked inside separate cabinets in the kitchen.The first aid kit is complete. Each bedroom has one twin bed, drawers and closet space. The beds have clean sheets and linens. There were extra towels in the bathrooms, linens inside the bedrooms for the clients. The smoking/ carbon monoxide detectors were tested and in working order. The hot water temperature in the bathroom was tested using a digital thermometer and registered 114.9 degrees Fahrenheit. All confidential files of clients were stored locked inside a cabinet. There was no pool or bodies of water observed in the premises. All passageways and grounds were free of any obstructions. At the time of this inspection the facility was observed to be clean, safe and in good repair. The facility employs 12 staff and there were 3 clients currently in placement. LPA randomly selected 5 staff files and 3 client files for review. A review of staff records on 04/19/23 indicates that all facility staff or other individuals who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. Two staff were and one client interviewed. An exit interview was conducted and copy of the licensing reports was provided to the facility. A deficiency citation was issued at the time of this inspection.

met_with: Ricardo Montes


state: CA

facility_name: PARK HOUSE

summary: Facility Evaluation

raw_content:
Narrative:
On 4/17/24 at 9: A.M, Licensing Program Analyst (LPA) Gilbert Gutierrez made an un-announced Annual/Required inspection to the above facility and met Administrator, Ricardo Montes. Currently there are three clients placed in the facility. No clients present in the facility when LPA arrived. Physical Plant The tour of the facility started at 9: AM with a staff and administrator. LPA observed the following: the posted license, emergency disaster plan, client's personal rights. The medications, cleaning solutions and sharp objects were locked inside the cabinets in the kitchen, inaccessible to the clients. There were perishable foods enough for 2 days and non-perishable foods enough for client's consumption for a week. There were fruits in the fruit basket on the kitchen counter. The first aid kit is complete. Each bedroom has one twin bed, drawers, and closet space. The beds have clean sheets and linens. There were extra towels in the bathrooms, and extra linens inside the bedrooms of the clients. The smoke/ carbon monoxide detectors were tested and in working order. The hot water was tested using a digital thermometer and registered a temperature at 114 degrees Fahrenheit. All confidential files of the clients were stored locked inside a cabinet. There was no pool or bodies of water observed in the premises. All passageways and grounds were free of any obstructions. At the time of this inspection the facility was observed to be clean, safe and in good repair. Client Records LPA reviewed three client records. All client records are available to LPA to inspect, audit upon demand. Client records contain required information including, but not limited to, consent forms, needs and services plan, medical assessment, safeguards for cash resources, personal property and valuables, personal rights forms, and medication administration records (MAR). No clients were interviewed. Staff Records LPA reviewed six staff records. All staff subject to criminal records review have been fingerprinted and cleared. There was documentation of the required education and experience requirements and training in the personnel file. The administrator and facility managers meet the required qualification and/or experience requirements. LPA interviewed two staff. No deficiency citations issued at the time of the inspection. A copy of the LIC 809, LIC 809C, and LIC 811s were provided to the administrator.

report_type: Facility Evaluation

visit_type: Annual


summary: Facility Evaluation

raw_content:
Narrative:
On April 16, 2025, Licensing Program Analysts (LPAs) Angelina Garibaldo and Claudia Portillo conducted an unannounced inspection at the facility. LPAs met with the representative above. The purpose of the inspection was to conduct a Case Management - unannounced Annual/Required Inspection. Census: Clients (3) 1 minor and NMDs 1 staff was interviewed. Clients are on spring break and went to an outing. One client in non-verbal. LPA obtained and reviewed the following updated documentation: · LIC Personnel, Client roster · LIC C Emergency Disaster Plan · Fire Clearance · Board Minutes Annual compliance Review consists of the following domains: physical plant, operations, disaster preparedness plan, emergency intervention plan, staff files and client files. An exit interview was conducted, and a signed copy of this report was provided to the facility representative along with the LIC 809, LIC809D, and 1 technical violation were provided.

visit_type: Case Management

met_with: Ricardo Montes- Administrator


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Angelina Garibaldo conducted an unannounced Annual inspection at the above-named facility on April 22, 2026, at 9: AM. LPA met with Ricardo Montes, Administrator. This facility is licensed to ages 6-17 years who are developmentally disabled; Licensed to serve 1 non-ambulatory client with a capacity of 3. Currently home has 2 clients placed in the home by San Gabriel Pomona Regional Center and 1 placed by Tri-Regional Center Oxnard. LPA and Administrator toured the facility. LPA obtained and reviewed the following updated documentation: · LIC Personnel · LIC Client Roster · LIC C and Emergency Disaster Plan · Board of Directors report Annual compliance Review consisted of the following (7) domains: physical plant, operations, disaster preparedness plan, emergency intervention, staffing, client files and clients with special health care needs. Cont... Physical Plant: Administrator White gave the tour of the facility and LPA observed the following: a posted license, children's personal rights, emergency disaster plan, facility menu, activity schedule, staff, and grievance procedure. There were non-perishable foods for at least a week and perishable foods for at least two days. All medications, sharp objects, disinfectants, and cleaning solutions are locked inside the cabinets. The first aid kit is complete. Each bedroom has one twin bed, drawers, and closet space. The beds have clean sheets and linens. There were extra towels in the bathrooms, and extra linens inside the bedrooms of the clients. The smoke and carbon monoxide detectors were tested and working. The Emergency Disaster Mass Casualty Plan is current and available for review. The facility is clean, safe, sanitary, and in good repair. Staff Records: LPA reviewed 3 personnel records. All staff working in the facility have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Staff have current CPR and First Aid and annual training. Staff files are maintained locked inside a cabinet. Client Records: LPA reviewed 3 client records. The client records are available for review and are kept locked in the cabinet. An exit interview was conducted, and a signed copy of the LIC 809, LIC 809C, and LIC 811 were provided to the facility administrator. No deviancies were issued at the time of the inspection.


facility_name: PEACH LOVE INC

summary: Facility Evaluation

raw_content:
Narrative:
On November 19, 2025, at precisely 10: AM, the Component II application process for Peach Love INC. at the Community Care Licensing Division, at the Children's Residential Regional Office located in El Segundo. The meeting was attended by Licensing Program Analyst Justine Armstrong, License Program Manager Enrique Hernandez, and Licensee Tunisia Johnson. The primary objective of the Component II meeting was to thoroughly evaluate the submitted Group Home application for Peach Love INC., alongside the Program Statement. This included a discussion of the corrections needed and the concerns highlighted within the Program Statement. To ensure all issues were adequately addressed, LPA Armstrong scheduled a follow-up In-Person correction meeting for Tuesday, December 9, 2025, 9:00A.M at the El Segundo Regional Office for the Licensee to bring in the necessary revisions discussed in this meeting. At the conclusion of the meeting, a copy of the Component II Certificate of Completion was presented to Licensee Tunisia Johnson. LPA Armstrong thanked the Licensee, and a copy of this report was provided.

met_with: Tunisia Johnson


summary: Facility Evaluation

raw_content:
Narrative:
On December 2, 2025, at 3: PM, part two of Component II application process for Peach Love INC. was completed at the Community Care Licensing Division Children's Residential Regional Office located in El Segundo. The meeting was attended by Licensing Program Analyst Justine Armstrong and Licensee Tunisia Johnson. The primary objective of part two of the Component II meeting was to thoroughly evaluate the documents that needed to be resubmitted for the Group Home application and the Program Statement. This included a discussion of the correction and revisions that were made. The Licensee will email LPA Armstrong four documents that are still needed to complete the updates within the Program Statement. LPA Armstrong scheduled Component III meeting for Tuesday, December 9, 2025, 8: A.M via online. At the conclusion of the meeting, a copy of the Component II Certificate of Completion was presented to Licensee Tunisia Johnson. LPA Armstrong thanked the Licensee, and a copy of this report was provided.


summary: Facility Evaluation

raw_content:
Narrative:
On December 16, License Program Analyst (LPA) Justine Armstrong conducted an announced visit to conduct a Pre-Licensing Inspection at Peach Love Inc. Group Home located E. Collamer Drive, Carson CA 90746. During the visit, LPA met with the facility's Administrator Tunisia Johnson. Currently, there are no children in the home. This Group Home will be licensed for ambulatory minors between the ages of 11-17. The facility's interior and exterior was clean and free of debris, with no safety hazards observed. It consists of office space/private meeting space, four bedrooms, two bathrooms, one kitchen, a living room, one dining room, one den, and a garage. There are no bodies of water on the premises. The facility is equipped with central air and heat. The hot water was tested and found to be between 105-120 degrees Fahrenheit. Upon entering the home, there is a locked gate to access the front door, two chairs, one bench, and one camera. This is a spacious area for clients to use to get fresh air. Office: There is one office space located by the bathroom downstairs. This office is used for clients and staff. There is a desk, two chairs, one couch, and a locked six draw file cabinet that will be utilized for staff and client files, as well as medication (Report Continued of LIC809C ) Living Room: The living room features one couch and two small sofas all arranged on an open floor plan. There is one cabinet that can be utilized for staff sign-in sheets and activities for the clients and a non-operable fireplace.. A fire extinguisher is on the wall leading to the kitchen area Kitchen: The kitchen is large, clean, safe, and sanitary. It includes a working faucet, one refrigerator, five operational stove burners, a stackable oven, and a dishwasher. A weekly menu is posted inside the kitchen bulletin board cabinet space for staff and clients, and there is two trash can available. There were sufficient perishable and non-perishable food supplies for one week present. Additionally, the kitchen has an island that has four chairs and plenty of cabinet space. One fire extinguisher. Dining Room: The dining room is also located in the kitchen on the other side of the kitchen island. This space contains a sturdy table with six chairs, which accommodates the facility's capacity. Den/Lounge: The Den/lounge space is accessible through the kitchen. This space has two couches, one T.V, and an in-operable gas fireplace that is covered and inaccessible to clients. Bedrooms: There are four client bedrooms which are currently unoccupied. The first two client bedrooms (Bedroom #1 and Bedroom #2) are located downstairs and there are two bedrooms located upstairs (Bedroom #3 and Bedroom #4). Bedrooms #1, #2, and #3 all include one dresser, one night stand, a lamp and spacious closest space. Bedroom #4 has two full beds, two dressers, two night stands, and two separate closest spaces. (Report Continued of LIC809C ) Bedroom #3 and Bedroom #4 both have extra cabinet space for storage and have a joint bathroom that each room has access to from inside the bedroom. All bedrooms are equipped with a TV, clean linens, a warm blanket, and pillows on each bed. Bathrooms: There are two bathrooms Bathroom #1 is located downstairs, and Bathroom #2 is located upstairs. Bathroom #1 has a shower with one hand washing sink. Bathroom #2 has a shower with a bathtub and two hand washing sinks. Both bathrooms are equipped with a working toilet. Hallway/Stairs: There are two hallways, one downstairs and one upstairs. The downstairs hallway has locked cabinets utilized for client's medication. Inside the locked cabinet LPA observed the two first aid kits containing tweezers, scissors, a thermometer, sterile first-aid dressings, and band-aids. The second hallway upstairs has extra cabinet space with locks that can be utilized for extra storage or client's medication. Walking down the stairs midpoint is a locked storage closest that had cleaning chemicals, extra hygiene supplies, and laundry supplies. One fire extinguisher. Garage: The garage has a washer and dryer, another refrigerator, and games for clients. There is one camera in front of the garage and one fire extinguisher. There is also one table and four chairs.(Report Continued of LIC809C ) Backyard: The spacious backyard is free of debris and features a large play area for clients, along with two patio furniture sets, one patio umbrella, and a BBQ grill that sits on the side of the facility. The backyard has one camera pointing towards the sliding exit door. LPA observed a working carbon monoxide alarm and tested the smoke detector which are all in working order. There is also a gas, water, and power shut off located at the side of the home. The home is beautiful and well decorated. LPA advised the Administrator to get a fireplace cover for the non-operable fire place located in the living room, add another bed to bedroom #3 to be incompliance with the facility capacity of six, and to update the program statement adding the three exterior cameras as well facility map. LPA advised the Administrator to send a picture and the update to the program statement via email by Friday, December 19, 2025. An Exit interview was conducted, and a copy of the report was provided to the Administrator. There were no deficiencies cited at the time of visit.

visit_type: Prelicensing


summary: Facility Evaluation

raw_content:
Narrative:
On March 11, 2026 at 8: A.M. License Program Analyst (LPA) Justine Armstrong conducted an announced visit to conduct a Pre-Licensing Inspection at Peach Love Inc. Group Home located E. Collamer Drive, Carson CA 90746. During the visit, LPA met with the facility's Administrator Tunisia Johnson. Currently, there are no children in the home. This Group Home will be licensed for ambulatory minors between the ages of 11-17. Entering the home, there is a locked gate to access the front door. The facility's interior and exterior was clean and free of debris, with no safety hazards observed. It consists of office space/private meeting space, four bedrooms, two bathrooms, one kitchen, a living room, one dining room, one den, and a garage. There are no bodies of water on the premises. Office: There is one office space that are for clients and staff located by bathroom #1 downstairs. There is a desk, two chairs, one couch, one bookshelves, and a locked six draw file cabinet that will be utilized for staff and client files, as well as medication Living Room: The living room features one couch and two small sofas. There is one cabinet that can be utilized for staff sign-in sheets and activities for the clients and a non-operable fireplace. A fire extinguisher is on the wall leading to the kitchen area. A non-operable fireplace with a fireplace cover. (Report Continued of LIC809C ) Kitchen: The kitchen is spacious which also has an island that has four chairs and plenty of cabinet space. The kitchen spaces also includes a working faucet, one refrigerator, five operational stove burners, a stackable oven, and a dishwasher. A weekly menu is posted inside the kitchen bulletin board cabinet space for staff and clients, and there is two trash can available. There were sufficient perishable and non-perishable food supplies for one week present and one fire extinguisher. Dining Room: The dining room is located on the other side of the kitchen island space with six chairs, which accommodates the facility's capacity. Den/Lounge: The Den/lounge space is accessible through the kitchen. This space has two couches, one T.V, and an non-operable gas fireplace that is covered and inaccessible to clients. Bedrooms: There are four client bedrooms which are currently unoccupied. There are two bedrooms located upstairs and two downstairs. Bedrooms #1 and #2 has one full bed, Bedroom #3 has one full bed and one twin bed, and Bedroom #4 has two full bed all bedrooms include dresser,night stand, a lamp and spacious closest space for a total of six clients.. Bedroom #4 has two separate closest spaces for each client. Bedroom #3 and Bedroom #4 both have extra cabinet space for storage and have a joint bathroom that each room has access to from inside the bedroom. All bedrooms are also equipped with a TV, clean linens, a warm blanket, and pillows on each bed. Bathrooms: There are two bathrooms Bathroom #1 is located downstairs, and Bathroom #2 is located upstairs. Bathroom #1 has a shower with one hand washing sink. Bathroom #2 has a shower with a bathtub and two hand washing sinks. Both bathrooms are equipped with a working toilet.(Report Continued of LIC809C ) Hallway/Stairs: There are two hallways, one downstairs and one upstairs. The downstairs hallway has locked cabinets utilized for client's medication and two first aide kits.The second hallway upstairs has extra cabinet space with locks that can be utilized for extra storage or client's medication. Walking down the stairs midpoint is a locked storage closest that had cleaning chemicals, extra hygiene supplies, and laundry supplies and sharp objects will be kept locked inside. There is one fire extinguisher. Garage: The garage has a washer and dryer, another refrigerator, and games for clients. There is one camera in front of the garage and one fire extinguisher. There is also one table and four chairs. The also has outside furniture stored for future use. Backyard: The spacious backyard is free of debris and features a large play area for clients. There a BBQ grill that is on the side of the facility. The backyard has one camera pointing towards the sliding exit door. LPA observed a working carbon monoxide alarm and tested the smoke detector which are all in working order. There is also a gas, water, and power shut off located at the side of the home. The home is beautiful and well decorated. An Exit interview was conducted, and a copy of the report was provided to the Administrator. There were no deficiencies cited at the time of visit.


facility_name: PENNACLE FOUNDATION

summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Lisa Slusher and Licensing Program Manager (LPM) Lourey Bartolome travelled to the facility listed above to conduct an annual inspection. Facility has not accepted youth for placement since their licensure on 10/9/2020. The facility has a pending application for conversion to an STRTP. A letter was sent prior to this inspection outlining required program statement updates for conversion. Because the facility has not been occupied, they have had problems with vagrancy and "squatters". A garage in the rear of the facility was burned, and a significant amount of debris remains from that fire. Because of the age of the structure, special hazardous material removal has to be completed. Homeowner has had an individual staying in the property so that it would not be a target for vagrants. 1. With the exception of the garage debris, Facility Grounds are reasonably clean and free of debris or observable hazard. 2. Adequate indoor activity space and materials observed, and outdoor activity space was observed. 3. Chemicals were not observed to be locked at this time. 4. Procedures for Locked and centrally stored medications observed. 6. Adequate storage space observed. 7. Individual beds in good repair observed. 8. The house has 3 bedrooms, double occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings. 9. Adequate food storage space observed. Facility will add appropriate supply of foods upon placement of youth in the home. 10. Weekly menu not posted on this date, to be updated and posted when clients are placed. 11. Dining room equipped with large table and chairs accommodating of all clients. 12.Facility has two full restrooms, one for client use, one for staff use, both are operable. Facility is to ensure water measures between 105 and 120 degrees. Facility to submit a copy of Current Administrator Certificate and First Aid Card for Administrator Nikkia Rojas, copy of current lease agreement and Board meeting minutes for 2021-2022 by 3/17/22. A follow-up inspection will be required prior to facility accepting clients for placement.

met_with: Lawrence Thomas


summary: Facility Evaluation

raw_content:
Narrative:
On this date, a case management inspection is conducted by LPA (Licensing Program Analyst) Lisa Slusher. Met at the facility by Administrator Nikkia Rojas. Under the stipulation, the facility is subject to quarterly case management inspections. Discussed with facility Administrator the stipulation and order and conditions contained. The facility has not accepted clients at this location since the move from Watsonville in October of 2020 and is in the process of converting to an STRTP (Short Term Residential Therapeutic Program. The most recent program review paperwork was sent to the facility on 8/31/22. An annual inspection is also conducted on this date. Please see LIC 809 for this date.

met_with: Nikkia Rojas


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Lisa Slusher travelled to the facility listed above to conduct an annual inspection. Facility has not accepted youth for placement since their licensure on 10/9/2020. The facility has a pending application for conversion to an STRTP. A letter was sent prior to this inspection outlining required program statement updates for conversion. A virtual (Teams) meeting will be scheduled 1. Facility grounds inspected. A Technical Violation is issued for section 80087(a). A considerable amount of work is necessary in the back yard including the inaccessibility of a field which contains hazards as well as pipes sticking out of the ground, glass in the yard, boards and pipes sitting on the ground and a step out of a sliding glass door which is hazardous. 2. Adequate indoor activity space and materials observed, and outdoor activity space was observed. 3. Chemicals were not observed to be locked at this time. 4. Procedures for Locked and centrally stored medications observed. 6. Adequate storage space observed. 7. Individual beds in good repair observed. 8. The house has 3 bedrooms, double occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings. 9. Adequate food storage space observed. Facility will add appropriate supply of foods upon placement of youth in the home. 10. Weekly menu not posted on this date, to be updated and posted when clients are placed. ****Due to computer error, LPA could not print report at time of inspection, printed and sent to facility Administrator for signature via email***** 11. Dining room equipped with large table and chairs accommodating of all clients. 12.Facility has two full restrooms, one for client use, one for staff use, both are operable. Facility is to ensure water measures between 105 and 120 degrees. Facility to submit a copy of 2022 board meeting minutes to LPA via email prior to 9/8/22. A follow-up inspection will be required prior to facility accepting clients for placement.

met_with: Nikkia


summary: Facility Evaluation

raw_content:
Narrative:
On 12/20/22, Licensing Program Analyst (LPAs) Lisa Slusher and LPM Lourey Bartolome travelled to the facility listed above to conduct a quarterly case management inspection. This inspection will also serve as a prelicensing inspection for the conversion of the facility to an STRTP.. Facility Inspection conducted. Met at the facility by Administrator Nikkia Moton. A facility inspection was completed. 1. Facility Grounds inspected and are in need of the following maintenance and repairs prior to STRTP Licensure: Multiple hazards exist (metal pipes, exposed wires, a large amount of debris observed) 2. Outdoor space observed. Multiple hazards observed. Photos taken and will be provided to licensee by email . 3. Chemicals were observed on counters and in unlocked areas. . 4. Locked and centrally stored medications were discussed. Adequate storage space not observed. . 5. First aid kit complete with appropriate manual was present upon inspection. 6. Adequate storage space observed. 7. Individual beds in good repair observed. 8. The house has 3 bedrooms, double occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings. Adequate linens and supplies were not observed. 9. Adequate food storage space observed. Perishable and non perishable foods were not observed at this time. 10. Weekly menu not observed. No forms posted. 11. Dining room observed. Table and chairs for adequate seating observed.. 12.Facility has two full restrooms, one for client use, one for staff use, both are operable. Facility is to ensure water temperature is maintained between 105 and 120 degrees 13. Licensee does not currently have a vehicle for facility use. an update will be provided to LPA 14. Licensee to ensure all staff are appropriate fingerprinted and cleared and associated through guardian. The facility is to ensure the following prior to or upon licensure pursuant to the settlement agreement: 1. The facility will remain on a probationary license for 3 years from 12/1/2021 2. Facility shall maintain weekly staff schedules and provide them for review by the department upon request. 3. The Stipulation shall be posted in public view, and be provided to Fresno County Department of Behavioral Health and other involved parties. 4. Facility shall maintain updated client rosters at all times and make available to the department upon request 5. Facilty is to maintain a log of hours of work by Social Work and Mental Health Staff 6. Needs and services plans are to be kept current and developed and maintain in accordance with regulations, which includes involvement and signatures by Social Work Staff, Clients and authorized Representatives. Facility shall maintain a signature page to verify that staff have reviewed the needs and services are to be reported in accordance with regulatory requirmenet. An initial report is to be submitted by the next working day with a full report submitted within 7 days. Reports may be sent by email at CCLFresnoIncidents@dss.ca.gov. 8. Facility is to at all times maintain an appropriate staffing level to provide adequate care and supervision based on client needs and is never to have a staffing level below regulatory ratios. 9.Facility shall maintain current personnel records of each employee pursuant to California Code of Regulations, Title Regulations and Interim Licensing Standards for STRTP facilities. 10. Facility shall maintain all files on site and make available for review during all Department of Social Services inspections. Files include, but are not limited to, personnel, client, training logs which include individual training logs, needs and services plans, and clinical files 11. Facility shall develop a plan for how and with what frequency they will communicate with staflitf the needs, preferences, and behaviors of residents in care. 12. Facility must submit to the Department of Social Services Community Care Licensing Division an updated LIC 500 at minimum of every two months. The form must include Social Worker and Administrator's on-site hours at the facility. The facility must have a named administrator and Social Worker meeting requirements prior to licensure as an STRTP. 13. Facility shall employ a certified administrator at the facility, who has a minimum of one-year experience working as an administrator at another group home or STRTP. The administrator must work sufficient hours to maintain compliance, but no fewer than 40 hours per week at the facility. The administrator must only work as the administrator for this one facility. Respondent shall maintain records of the hours worked by the administrator and make such records available to Licensing staff upon request. The administrator must live no more than fifty (50) miles from the facility. 14. Licensee shall notify the Department of a new administrator prior to a new administrator assuming that role at the facility. 15. Facility shall Create and submit for approval from Community Care Licensing (CCL) a physical plant checklist that the Administrator or their designee completes at least weekly and maintains in a file available for CCL review. 16. Facility shall keep up-to-date menus posted and ensure that all foods listed on menu are on-site and available and make snacks available and accessible to clients at all times. The Plan of Operation and Program statements remain under joint review by CCLD and the Systems of Care (SOC) bureaus. The licensee is to comply with time frames for revision to ensure compliance with regulation. Prior to licensure the facility is to submit: -LIC 500 including a named administrator and a scheduled 40 hours per week on site and a named Social Worker. The facility may note "to be hired" for additional stafff, but sufficient staff are to be hired and trained prior to the acceptance of youth for placement. -Physical plant checklist submitted for facility use as well as a pre-licensing self-certification checklist. - Photos verifying physical plant/grounds are clean and free of debris and hazard. Licensee/Applicant is to submit a plan for the time frame for completion

met_with: Nikkia Moton


summary: Facility Evaluation

raw_content:
Narrative:
On 4/26/23, Licensing Program Analyst (LPA) Lisa Slusher travelled to the facility listed above to conduct a quarterly case management inspection. Facility Inspection conducted. Met at the facility by Executive Director Lawrence Thomas, Assistant Administrator Precious Beard and Facility Manager Leondre McBride. A facility inspection was completed. 1. Facility Grounds inspected and are in need of the following maintenance and repairs prior to STRTP Licensure: Multiple hazards exist (metal pipes, exposed wires, a large amount of debris observed) 2. Outdoor space observed. Multiple hazards observed. 3. Knives and other potentially hazardous items were not stored in locked cabinets. . 4. Locked and centrally stored medications were discussed. Adequate storage space not observed. . 5. First aid kit complete with appropriate manual was present upon inspection. 6. Adequate storage space observed. 7. Individual beds in good repair observed. 8. The house has 3 bedrooms, double occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings. Adequate linens and supplies were not observed. 9. Adequate food storage space observed. Perishable and non perishable foods were not observed at this time. 10. Weekly menu not observed. No forms posted. 11. Dining room observed. Table and chairs for adequate seating observed. 12.Facility has two full restrooms, one for client use, one for staff use, both are operable. Facility is to ensure water temperature is maintained between 105 and 120 degrees 13. Licensee does not currently have a vehicle for facility use. an update will be provided to LPA 14. Licensee to ensure all staff are appropriate fingerprinted and cleared and associated through guardian. The facility is to ensure the following prior to or upon licensure pursuant to the settlement agreement: 1. The facility will remain on a probationary license for 3 years from 12/1/2021. This time frame may be subject to extension given the length of time taken for conversion. 2. Facility shall maintain weekly staff schedules and provide them for review by the department upon request. 3. The Stipulation shall be posted in public view, and be provided to Fresno County Department of Behavioral Health and other involved parties. 4. Facility shall maintain updated client rosters at all times and make available to the department upon request 5. Facilty is to maintain a log of hours of work by Social Work and Mental Health Staff 6. Needs and services plans are to be kept current and developed and maintain in accordance with regulations, which includes involvement and signatures by Social Work Staff, Clients and authorized Representatives. Facility shall maintain a signature page to verify that staff have reviewed the needs and services are to be reported in accordance with regulatory requirmenet. An initial report is to be submitted by the next working day with a full report submitted within 7 days. Reports may be sent by email at CCLFresnoIncidents@dss.ca.gov. 8. Facility is to at all times maintain an appropriate staffing level to provide adequate care and supervision based on client needs and is never to have a staffing level below regulatory ratios. 9.Facility shall maintain current personnel records of each employee pursuant to California Code of Regulations, Title Regulations and Interim Licensing Standards for STRTP facilities. 10. Facility shall maintain all files on site and make available for review during all Department of Social Services inspections. Files include, but are not limited to, personnel, client, training logs which include individual training logs, needs and services plans, and clinical files 11. Facility shall develop a plan for how and with what frequency they will communicate with staflitf the needs, preferences, and behaviors of residents in care. 12. Facility must submit to the Department of Social Services Community Care Licensing Division an updated LIC 500 at minimum of every two months. The form must include Social Worker and Administrator's on-site hours at the facility. The facility must have a named administrator and Social Worker meeting requirements prior to licensure as an STRTP. 13. Facility shall employ a certified administrator at the facility, who has a minimum of one-year experience working as an administrator at another group home or STRTP. The administrator must work sufficient hours to maintain compliance, but no fewer than 40 hours per week at the facility. The administrator must only work as the administrator for this one facility. Respondent shall maintain records of the hours worked by the administrator and make such records available to Licensing staff upon request. The administrator must live no more than fifty (50) miles from the facility. 14. Licensee shall notify the Department of a new administrator prior to a new administrator assuming that role at the facility. 15. Facility shall Create and submit for approval from Community Care Licensing (CCL) a physical plant checklist that the Administrator or their designee completes at least weekly and maintains in a file available for CCL review. 16. Facility shall keep up-to-date menus posted and ensure that all foods listed on menu are on-site and available and make snacks available and accessible to clients at all times. While The Plan of Operation and Program statements remain under joint review by CCLD and the Systems of Care (SOC) bureaus, both agencies have determined the document is sufficiently complete to move forward with STRTP conversion when the facility has met all physical plant and staffing requirements. Prior to licensure the facility is to submit: -LIC 500 including a named administrator and a scheduled 40 hours per week on site and a named Social Worker. The facility may note "to be hired" for additional staff, but sufficient staff are to be hired and trained prior to the acceptance of youth for placement. -Physical plant checklist submitted for facility use as well as a pre-licensing self-certification checklist. - Photos verifying physical plant/grounds are clean and free of debris and hazard. Licensee/Applicant is to submit a plan for the time frame for completion

met_with: Lawrence Thomas, Precious Beard, Leondre McBride


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analyst (LPA) Lisa Slusher travelled to the facility listed above to conduct an annual inspection. Facility has not accepted youth for placement since their licensure on 10/9/2020. The facility has a pending application for conversion to an STRTP. A letter was sent prior to this inspection outlining required program statement updates for conversion. A virtual (Teams) meeting will be scheduled 1. Facility grounds inspected. Facility grounds have been improved to a large degree. Small amounts of debris observed. 2. Adequate indoor activity space and materials observed, and outdoor activity space was observed. 3. Chemicals were not observed to be locked at this time. 4. Procedures for Locked and centrally stored medications discussed. 6. Adequate storage space observed. 7. Individual beds in good repair observed. 8. The house has 3 bedrooms, double occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings. 9. Adequate food storage space observed. Facility will add appropriate supply of foods upon placement of youth in the home. 10. Weekly menu not posted on this date, to be updated and posted when clients are placed. 11. Dining room equipped with large table and chairs accommodating of all clients. 12.Facility has two full restrooms, one for client use, one for staff use, both are operable. Facility is to ensure water measures between 105 and 120 degrees. Facility is still pending updated fire clearance. A follow-up inspection will be required prior to facility accepting clients for placement.

met_with: Lawrence Thomas, Nikkia Moton


summary: Facility Evaluation

raw_content:
Narrative:
On 12/20/22, Licensing Program Analyst (LPAs) Lisa Slusher travelled to the facility listed above to conduct a quarterly case management inspection as well as an annual inspection. This inspection will also serve as a prelicensing inspection for the conversion of the facility to an STRTP.. Facility Inspection conducted. Met at the facility by Executive Director Lawrence Thomas and Administrator Nikkia Moton. A facility inspection was completed. Settlement Terms remain as follows: 1. The facility will remain on a probationary license for 3 years from 12/1/2021 2. Facility shall maintain weekly staff schedules and provide them for review by the department upon request. 3. The Stipulation shall be posted in public view, and be provided to Fresno County Department of Behavioral Health and other involved parties. 4. Facility shall maintain updated client rosters at all times and make available to the department upon request 5. Facilty is to maintain a log of hours of work by Social Work and Mental Health Staff 6. Needs and services plans are to be kept current and developed and maintain in accordance with regulations, which includes involvement and signatures by Social Work Staff, Clients and authorized Representatives. Facility shall maintain a signature page to verify that staff have reviewed the needs and services are to be reported in accordance with regulatory requirmenet. An initial report is to be submitted by the next working day with a full report submitted within 7 days. Reports may be sent by email at CCLFresnoIncidents@dss.ca.gov. 8. Facility is to at all times maintain an appropriate staffing level to provide adequate care and supervision based on client needs and is never to have a staffing level below regulatory ratios. 9.Facility shall maintain current personnel records of each employee pursuant to California Code of Regulations, Title Regulations and Interim Licensing Standards for STRTP facilities. 10. Facility shall maintain all files on site and make available for review during all Department of Social Services inspections. Files include, but are not limited to, personnel, client, training logs which include individual training logs, needs and services plans, and clinical files 11. Facility shall develop a plan for how and with what frequency they will communicate with staflitf the needs, preferences, and behaviors of residents in care. 12. Facility must submit to the Department of Social Services Community Care Licensing Division an updated LIC 500 at minimum of every two months. The form must include Social Worker and Administrator's on-site hours at the facility. The facility must have a named administrator and Social Worker meeting requirements prior to licensure as an STRTP. 13. Facility shall employ a certified administrator at the facility, who has a minimum of one-year experience working as an administrator at another group home or STRTP. The administrator must work sufficient hours to maintain compliance, but no fewer than 40 hours per week at the facility. The administrator must only work as the administrator for this one facility. Respondent shall maintain records of the hours worked by the administrator and make such records available to Licensing staff upon request. The administrator must live no more than fifty (50) miles from the facility. 14. Licensee shall notify the Department of a new administrator prior to a new administrator assuming that role at the facility. 15. Facility shall Create and submit for approval from Community Care Licensing (CCL) a physical plant checklist that the Administrator or their designee completes at least weekly and maintains in a file available for CCL review. 16. Facility shall keep up-to-date menus posted and ensure that all foods listed on menu are on-site and available and make snacks available and accessible to clients at all times. The Plan of Operation and Program statements remain under joint review by CCLD and the Systems of Care (SOC) bureaus. The licensee is to comply with time frames for revision to ensure compliance with regulation. Prior to licensure the facility is to submit: -LIC 500 including a named administrator and a scheduled 40 hours per week on site and a named Social Worker. The facility may note "to be hired" for additional staff, but sufficient staff are to be hired and trained prior to the acceptance of youth for placement. -Physical plant checklist submitted for facility use as well as a pre-licensing self-certification checklist. **Additional checklist to be provided by LPA


facility_name: PEOPLE'S CARE FERNVIEW

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Based on interviews and record reviews the allegations that S1 and S2 did not administer C1's medication and the medication was not logged properly, may have occurred, however is not supported or proven by evidence. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Francisco Benavides.

Investigation Findings:
13On July 01, 2021 at 08:20 am, Licensing Program Analyst (LPA) Darlene Almaraz-Oseguera conducted an unannounced inspection to the facility to deliver the findings of the above allegations. LPA Marisol Lopez conducted a tele-inspection on November 25, 2020 at 11:00 am and no immediate deficiencies were observed. Five staff (S1, S2, S3, S4, S5), zero of four foster children (C1, C2, C3, C4) facility administrator were interviewed. It was reported to Community Care Licensing (CCL) that staff (S1 and S2) did not administer C1's medication and the medication was not logged properly. Confidential staff interviews reported that C1 has been administering C1's medication according to the prescription and the medication logs are being filled out properly. According to the documentation that was provided to the LPA the medication and logs were filled out according to the prescription directives. LPA attempted to interview all four children but was unsuccessful due to them having limited verbal skills and being unresponsive. The interviews that were provided to the LPA were not consistent and did not provide any further specific details regarding C1's medication. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Natasha Dunlap LICENSING EVALUATOR NAME: Darlene Almaraz LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, FACILITY NAME: PEOPLE'S CARE FERNVIEWFACILITY NUMBER: VISIT DATE: 07/01/2021

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

report_type: Complaint Investigation

met_with: Francisco Benavides

complaint_status: unsubstantiated


raw_content:
Narrative:
Confidential interviews denied having heard of S1 using inappropriate forms of discipline however, other statements stated the allegation occurred but did not have further details and no witnesses of the incident. Confidential interviews stated S1 is no longer an employee of the facility however the reason for transferring is unrelated to the allegation. Confidential Interviews were attempted with four of four clients, however clients were not able to be interviewed due the inability to comprehend or answer questions. Based on confidential interviews, the allegation that staff #1(S1) used an inappropriate form of discipline may have occurred, however are not supported or proven by evidence. Therefore, the allegations are unsubstantiated. An exit interview was conducted and a copy of this signed report was emailed to Program Representative Otilli Abuka.

Investigation Findings:
13On June 01, 2022, at 1:50 p.m. Licensing Program Analyst (LPA) Marisol Lopez arrived at the facility unannounced and met with Program Representative Otilli Abuka of People's Care Fernview to discuss the investigative findings for the allegation noted above. On August 25, 2021, at 12:50 p.m., Licensing Program Analyst (LPA) Marisol Lopez and LPA Danielle Garcia met with Program Representative Otilli Abuka to conduct an unannounced initial complaint investigation. LPA's conducted a safety inspection and no deficiencies were observed at that time. During the investigation, LPA Lopez conducted confidential interviews with six staff (S1-S6), one administrator, attempted interviews with four of four clients (C1-C4) and reviewed incident reports. On 08/20/2021, the Department received allegations that staff #1(S1) used an inappropriate form of discipline. It was reported S1 gave C1 a cold shower as a form of punishment. Confidential interviews contradicted the information stating that facility staff as a form of discipline, redirect clients, provide clients with space to return to baseline and provide support to clients to process emotions. (see continuation form LIC9099-C dated 06/1/22) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Marisol Lopez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 08-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, METROPOLITAN DR. # FACILITY NAME: PEOPLE'S CARE FERNVIEWFACILITY NUMBER: VISIT DATE: 06/01/2022

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

met_with: Otilli Abuka.


summary: Facility Evaluation

raw_content:
Narrative:
On Wednesday, June 30, 2021 at 11: AM Licensing Program Analyst (LPA) Linda Haynes conducted an annual inspection of the facility. At the time of Inspection LPA met with Direct Care Staff Devin Wood. The facility was toured inside and out with Direct Care Staff Devin Wood. The home is a one-story residence with four bedrooms and two bathrooms. There were no clients present at time of inspection. Bedrooms are arranged so that no more than one client is in 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 hot water in the kitchen measured to be 105.1 degrees, in bathroom one 112.2 degrees and in bathroom two 110.9 degrees. All hazardous items have been properly made inaccessible to areas where clients will have access. The medications were stored and locked in a cabinet in the kitchen. Sharp knives are inaccessible and stored in a locked safe in the kitchen. The first aid kit is located in the kitchen and contained all required supplies. The facility's smoke detectors and carbon monoxide detectors in each bedroom were checked and were operable. There are no guns or weapons in the facility as stated by House lead Otilli Abuka. LPA observed a minimum 7-day non-perishable and a 2-day perishable supply of food. There was a variety of snacks available for clients as well. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Visitation Policies, and Current menu. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. Four Client and four staff files were reviewed during the inspection and noted to have documents required per regulation in the file. All staff work at the facility have department of Justice, FBI and Child Abuse Index clearances. Based on the facility inspection and file reviews this date, are no deficiencies found at this time. A copy of this report was reviewed and given to Administrator Levy Middlebrooks.

met_with: Levy Middlebrooks


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On July 29, 2022 at 9: AM, Licensing Program Analyst (LPA) Marisol Lopez conducted an unannounced inspection at the facility above. LPA met with Program Representative (P1) Otilli Abuka and Program Administrator Levy Middlebrooks. The purpose of the inspection is to conduct a required annual inspection. The facility is a single-family home, with four client bedrooms, two bathrooms, dining room, living room, kitchen, family room, laundry room, staff office and garage. Bedroom # The room consist of a full-size bed, dresser, night stand, and closet space. It sleeps one client (C1). Bedroom # The room consist of a full-size bed, dresser, night stand, and closet space. It sleeps one client (C2). Bedroom # The room consist of a full-size bed, dresser, night stand, and closet space. It sleeps one client (C3) Bedroom# 4 the room consist of a full-size bed, dresser, night stand, and closet space. It sleeps one client (C4). Bedrooms are arranged so that no more than one child shares a room. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate drawer and closet space for children's belongings. There is sufficient linens, blankets, towels and pillows.The smoke detectors and carbon monoxide detectors were checked and were working properly. The office is maintained locked and staff/client files are kept on site. All hazardous items have been properly stored and made inaccessible. The medications are locked in a kitchen cabinet. There is a lockbox for refrigerated medications available. The garage is maintained locked and consists of an extra refrigerator, washer/dryer, cleansers/chemicals locked in cabinet and extra PPE locked in a cabinet. Sharp knives were inaccessible and stored in the locked in a safe in kitchen cabinet. First Aid kit was accessible and had all required items including the thermometer. There were no guns or weapons as stated by administrator. The hot water temperature was tested and noted to be at 115 degrees and maintained within the regulation range of 105-120 degrees. Trash cans for storage of solid waste had tight fitting lids. (see continuation form LIC 809-C dated 07/29/22) All required postings were visible: Personal Rights, The Facility Sketch, Emergency Disaster Plan and visitation policy were posted. LPA inspected the physical plant, operational requirements, disaster preparedness, emergency intervention plan and reviewed four of four client files (C1-C4) (see confidential name list, LIC811, dated 07/29/2022) and began six of six staff files (S1-S6). Due to time constraints, the annual inspection is being extended for completion of staff file reviews, staff interviews and client interviews. Based on record review, the licensee did not comply as four staff (S3-S6) out of six staff [S1-S6] the facility did not ensure that personnel records are maintained on each employee; four out of four client (C1-C4) files did not have the current court order, or written authorization of the child's parent or guardian, for each psychotropic medication; and four out of four clients (C1-C4) did not have a copy of the child's original needs and services plan signed by the child and his/her authorized representative(s), that they were offered the opportunity to participate in plan development; and verification that the authorized representative(s) have approved the plan which poses a potential health, safety or personal rights risk to persons in care. The facility is being issued a citation in accordance with the Title 22, CCR 80066(a); CCR 84070(b)(12) and CCR84070(c)(1). See LIC809-D dated 07/29/22 for the cited deficiency. An exit interview was conducted, and this report, appeal rights and LIC 811 was reviewed with Program Administrator Levy Middlebrooks and a copy of this report was provided.

Deficiencies:
80066(a): Personnel Records

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information

met_with: Otilli Abuka/ Levy Middlebrooks


summary: Facility Evaluation

raw_content:
Narrative:
On August 05, 2022 at 2: PM, Licensing Program Analyst (LPA) Marisol Lopez conducted an unannounced inspection at the facility above. LPA met with Program Representative (P1) Otilli Abuka and Program Administrator Levy Middlebrooks. The purpose of the inspection is a continuation of the required annual inspection. LPA completed the inspection of six of six staff files (S1-S6) (see confidential name list, LIC811, dated 08/05/2022) three of three staff interviews (S1, S4, S7) and clients (C1-C4) were unable to be interviewed due to clients being non-verbal. During the inspection and file review, no further deficiencies were observed. An exit interview was conducted, and this report was reviewed with Program Administrator Levy Middlebrooks and a copy of this report was provided.


summary: Facility Evaluation

raw_content:
Narrative:
On August 05, 2022 at 1: PM, Licensing Program Analyst (LPA) Marisol Lopez conducted an unannounced inspection at the facility above. LPA met with Program Representative (P1) Otilli Abuka and Program Administrator Levy Middlebrooks. LPA cleared the plan of correction due on 08/05/2022 by conducting a facility inspection of records: LPA reviewed client files (C1-C4) to ensure a copy of the written authorization of the child's parent or guardian, for each psychotropic medication for clients (C1-C4) was maintained in each client file(C1-C4). LPA reviewed clients(C1-C4) needs and service plan and verified signatures documented & attempts to reach social worker for signature were documented. LPA reviewed 4 staff files (S1-S4) and ensured that each personnel records were complete. An exit interview was conducted, and this report was reviewed with Program Administrator Levy Middlebrooks and a copy of this report was provided.


summary: Facility Evaluation

raw_content:
Narrative:
On July 27, 2023, at 9: AM Licensing Program Analysts (LPA's) Lucero Jauregui and Jacob Salem conducted an announced annual facility inspection. LPA's met with Otili Abuka, Facility Manager who provided LPA's with a guided tour of the facility both indoors and outdoors. The facility is a four bedroom and two bathroom (for client use) in a one story home. The facility consists of a staff office, bedrooms, living/dining room, kitchen, and a two car garage that is being used as a laundry room and for storage. All bedrooms serve one client each. All beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. The hygiene closet is located in bathroom 2. Additional linens, bedsheets, and towels were located in the hallway closet. The kitchen was clean and free from observable hazards. Sharps are maintain in a safe behind a locked cabinet, and detergents are locked under the kitchen sink. LPA's observed supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days. Medication is centrally stored in the locked kitchen cabinet. A first-aid kit was observed in the kitchen cabinet with all required items. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment/toys/books/games were observed for children's recreation time. All facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. The hot water temperature was measured in the main bathroom and is currently 111.0 degrees which is in ration. Per facility staff, no firearms or weapons are allowed in the facility. LPA's observed the following items posted Personal Rights, Grievance Procedures, Visitation Policy, Facility sketch, Activity Schedule, Meal Menu, Staff Schedule and Emergency Plan. Continued... Facility vehicle was inspected by LPA's and no deficiencies were observed. Four out of four client files were reviewed (see confidential name list, dated 7/27/23) and four staff files were reviewed. LPA's conducted two staff interviews. LPA's were unable to interview four out of four clients due to them being non-verbal. Based on observations made during the inspection, no deficiencies were observed during today's visit. An exit interview was conducted and a copy of this report was provided to Otili Abuka, Facility Manager.

met_with: Otili Abuka, Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On July 23, 2024, at 11: AM Licensing Program Analyst (LPA) Lucero Jauregui conducted an announced annual facility inspection. LPA Jauregui met with Otili Abuka, Administrator who provided LPA with a guided tour of the facility both indoors and outdoors. The facility is a four bedroom and two bathroom (for client use) in a one story home. The facility consists of a staff office, bedrooms, living/dining room, kitchen, and a two car garage that is being used as a laundry room and for storage. All bedrooms serve one client each. All beds were observed with appropriate clean linens, pillows, comforters, and mattresses in good repair. The hygiene closet is located in bathroom 2. Additional linens, bedsheets, and towels were located in the hallway closet. The kitchen was clean and free from observable hazards. Sharps are maintain in a safe behind a locked cabinet, and detergents are locked under the kitchen sink. LPA observed medication centrally stored in the locked kitchen cabinet. A first-aid kit was observed in the kitchen cabinet with all required items. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris and observable hazards. There is adequate indoor and outdoor activity space. Sports equipment were observed for children's recreation time. All facility smoke detectors and carbon monoxide detectors are in appropriate working order; fire extinguisher is properly charged and serviced. The hot water temperature was measured in the main bathroom and is currently 112.7 degrees which is in ration. Per facility staff, no firearms or weapons are allowed in the facility. LPA observed the following items posted Personal Rights, Grievance Procedures, Visitation Policy, Facility sketch, Activity Schedule, Meal Menu, Staff Schedule and Emergency Plan. Continued... Four out of four client files were reviewed (see confidential name list, dated 7/23/24) and five staff files were reviewed. LPA conducted two staff interviews. LPA was unable to interview four out of four clients due to them being non-verbal. Based on observations made during the inspection, no deficiencies were observed during today's visit. An exit interview was conducted and a copy of this report was provided to Otili Abuka, Administrator.

met_with: Otili Abuka, Administrator


facility_name: PEOPLE'S CARE FREMONT PEAK

summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
The preponderance of evidence standard has been met, and therefore the above allegations are found to be Substantiated. LPA is issuing a citation of California Code of Regulations, Title 22, Section 80076(a)(1) and Section 80076(a)(17). See attached LIC 9099-D. An exit interview was conducted, appeal rights provided, and a copy of the report was left with Interim Administrator Kourtney Hamilton, whose signature on this form confirms receipt.

Investigation Findings:
13On Wednesday 5/11/22, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility to open a complaint investigation of the above allegations. LPA met with Interim Administrator Kourtney Hamilton and Training Administrator Rizza Madlangbayan and informed of the purpose of the visit. Safety percautions were taken, including mask-wearing and pre-visit screening call. During visit, LPA inspected the faciilty kitchen and observed a jar of ThickenUp drink thickener that expired in January 2021 and an old and mushy zucchini in the refrigerator. LPA also observed multiple packages of meat in the freezer with no date of when placed in the freezer, which is significant due to there being a torn package of meat and a bent hamburger patty that may not have been properly stored prior to freezing. There was a leaking package of hot dogs in the refrigerator, and the liquid had leaked significantly into the drawer so that LPA's hand was dripping when picking up an item in the drawer. LPA observed an open container of yogurt in the back of the refrigerator and a plastic piece of trash in a drawer that was disposed of by staff. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Zaid Hakim LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: PEOPLE'S CARE FREMONT PEAKFACILITY NUMBER: VISIT DATE: 05/11/2022

met_with: Interim Administrator Kourtney Hamilton, Training Administrator Rizza Madlangbayan

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Substantiated - 1 allegation

raw_content:
Narrative:
... capable of administering the medication. However, the nursing hours had not yet been cut. Per interviews, due to anticipating the hours would be cut, despite the hours still being in effect, no additional nurse staff was hired or sought. The resident at the sister facility was not being switched to the nasal medication due to the physician determining that this resident would need to remain on the rectal medication, and so their nursing hours were not anticipated to be cut. During record review, LPA nor Interim Administrator were able to locate documentation of the nursing hours currently in effect, and the care plans do not clearly state the specifics of the nursing hours that were in effect. As such, this aspect of the care and treatment services to be provided to both residents cannot be verified, and it cannot be confirmed that the facility is following the care plans as agreed upon by the care teams. Additionally, based on interviews, it was known to the facility that the nursing hours were still in effect for the resident formerly in placement at this facility and that this was still an agreed upon service to be provided to this resident. The preponderance of evidence standard has been met, and therefore the above allegation is found to be Substantiated. LPA is issuing a citation of California Code of Regulations, Title 22, Section 84069.2. See attached LIC 9099-D. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Interim Administrator Rizza Madlangbayan, whose signature on this form confirms receipt.

Investigation Findings:
13On 8/4/22 at 11:29AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility to deliver findings for an investigation of the above allegation. LPA met with Interim Administrator Rizza Madlangbayan and informed of the purpose of the visit. Based on record review and confidential interviews, the facility had a resident in care (Refer to LIC 811, dated 8/4/22) with specialized in-home health care needs who had approved 1:1 nursing hours to administer a rectal medication for seizures. The licensee has a nearby sister facility, at which there is a resident who also has specialized in-home health care needs and who also has approved 1:1 nursing hours to administer a rectal medication for seizures. On at least two occasions, the Interim Administrator of the facility, who no longer works for the agency, asked the former resident's nurse to leave the facility to go to the sister facility to tend to the resident at the sister facility. Based on confidential interviews, the former resident was being switched to a nasal seizure medication for which the care team determined nursing hours would not be required. This resident's file contained documentation signed by the physician verifying that the facility staff were... SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., Suite San Bruno, CA Facility Name: People's Care Fremont Peakfacility Number: Visit Date: 08/04/ Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32... capable of administering the medication. However, the nursing hours had not yet been cut. Per interviews, due to anticipating the hours would be cut, despite the hours still being in effect, no additional nurse staff was hired or sought. The resident at the sister facility was not being switched to the nasal medication due to the physician determining that this resident would need to remain on the rectal medication, and so their nursing hours were not anticipated to be cut. During record review, LPA nor Interim Administrator were able to locate documentation of the nursing hours currently in effect, and the care plans do not clearly state the specifics of the nursing hours that were in effect. As such, this aspect of the care and treatment services to be provided to both residents cannot be verified, and it cannot be confirmed that the facility is following the care plans as agreed upon by the care teams. Additionally, based on interviews, it was known to the facility that the nursing hours were still in effect for the resident formerly in placement at this facility and that this was still an agreed upon service to be provided to this resident. The preponderance of evidence standard has been met, and therefore the above allegation is found to be Substantiated. LPA is issuing a citation of California Code of Regulations, Title 22, Section 84069.2. See attached LIC 9099-D. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Interim Administrator Rizza Madlangbayan, whose signature on this form confirms receipt. SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: LIC9099 (FAS) - (06/04)Page: 2 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: PEOPLE'S CARE FREMONT PEAKFACILITY NUMBER: 075650140

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


raw_content:
Narrative:
... of Monday 10am-2pm, Wednesday 10am-2pm, Thursday 6am-2pm and 2pm-10pm. The preponderance of evidence standard has been met, and therefore the above allegation(s) is/are found to be substantiated. LPA is issuing a citation of Title 22, Section Plan of Operation. See attached LIC 9099-D. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Houselead Tajanae Jacobs, whose signature on this form confirms receipt. ...hours working on site or with the residents directly each week to keep the facility in compliance. The current interim administrator has recently completed the administrator examination and is awaiting the administrator certificate. Lastly, on 8/4/22, during LPA's visit to the facility, LPA obtained copies of the staff screening log, which reflected no screenings were logged on multiple days in June, July, and August, and only one screening was logged on multiple days in these months. Per the LIC 500 obtained, multiple staff work shifts each day, so there should be more than one screening logged each day. However, staff wear masks, staff observed and interviewed did not show symptoms of COVID-19, the facility has limited in-person activities and visits, has signs posted on symptoms and health guidelines, and has maintained the facility in sanitary condition. Staff conducted LPA's entry screening today without prompting. Daily screenings are strongly advised, per Provider Information Notices (PINs) issued during the pandemic, to be completed and LPA advises logging screenings for verification. Although the allegation(s) may have happened or is/are valid, based on LPA's observations and interviews, there is not a preponderance of the evidence to prove the alleged violation(s) did or did not occur. Therefore, the allegation(s) is/are unsubstantiated. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Houselead Tajanae Jacobs, whose signature on this form confirms receipt.

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

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

met_with: Houselead Tajanae Jacobs


summary: Complaint Investigation - Substantiated - 1 deficiency

raw_content:
Narrative:
... including during an incident in which a resident ran toward another resident and hit them. LPA observed the resident who was hit to cower near the other resident. LPA also witnessed the resident with aggressive behavior was irritated and had been told by staff that they would take the resident on a van ride. However, staff did not keep this promise. If staffing was the issue, then this was not an appropriate redirection, as it could not be fulfilled. Further, based on interviews and record review, this resident is physically aggressive with other residents and has hit residents before. The facility has a restraint plan in place but prefers to use verbal de-escalation. Based on interviews, though, there have been multiple occasions where the de-escalation plan could not be followed because there were not enough staff for a restraint. On multiple occasions, the resident who was hit has not been taken to school due to insufficient staffing to prevent the other resident from hitting them, for which a citation was issued on 10/12/22. The preponderance of evidence standard has been met, and therefore the above allegations are found to be substantiated. LPA is issuing a citation of California Code of Regulations, Title 22, Section Personal Rights and Section Responsibility for Providing Care and Supervision. See attached LIC 9099-D. An exit interview was conducted, appeal rights provided, and a copy of this report was left with Compliance & Training Specialist Erinique Jones, whose signature on this form confirms receipt.

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

Deficiencies:
52243: People's Care Fremont Peakfacility Number: 075650140 Visit Date: 12/22/2022 Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32...  including during an incident in which a resident ran toward another resident and hit them.  LPA observed the resident who was hit to cower near the other resident.

LPA also witnessed the resident with aggressive behavior was irritated and had been told by staff that they would take the resident on a van ride.  However, staff did not keep this promise.  If staffing was the issue, then this was not an appropriate redirection, as it could not be fulfilled.  Further, based on interviews and record review, this resident is physically aggressive with other residents and has hit residents before.

title:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 851 TRAEGER AVE., Suite 360 San Bruno, CA 94066 Facility Name


raw_content:
Narrative:
However, this is why calling 911 immediately to seek timely medical attention is important. The facility has a history of admitting residents with seizures, so all staff should be trained on seizures. It was also learned that this resident had a seizure in 2019 which was not reported to the licensing agency or to the authorized representative. During a file review conducted today, LPA observed that there was no incident report for this in the file, despite the file containing reports from 2019. Additionally, based on observation and interview, staff were not aware of the activity calendar and confirmed it had not been implemented, including not doing holiday crafts on a holiday as written on the calendar due to there being no crafts provided and not knowing crafts to be planned. LPA observed in the month of December that the activity plan for October was still posted, and staff were unfamiliar with the November plan. Training on facility activities is required, as the activities being planned is meant to ensure residents are able to engage in enjoyable and skill-building activities, which will also enable staff to monitor resident behaviors and assess whether residents are meeting behavior goals laid out in the needs and services (behavior) plans. Further, during today's visit, LPA observed that the behavior tracker for a resident for whom the behavior plan requires staff to track behaviors had 9 missing full days and an additional 22 missing shifts. Lastly, on 8/4/22, a few days prior to receipt of the complaint, alleging resident records were not maintained at the facility, LPA observed the needs and services plans to not be updated and/or current plans not maintained in the file. A citation was issued. During today's visit, LPA inspected residents records and observed that all four files were missing the current needs and services (behavior report) plans prepared on a quarterly basis by the behaviorist, supplied to LPA by behaviorist and dated October to November 2022. The preponderance of evidence standard has been met, and therefore the above allegations are found to be substantiated. LPA is issuing 6 citations of California Code of Regulations, Title 22, Section Personal Rights, Section Personnel Requirements, Section Reporting Requirements, Section Planned Activities, and Section Client Records. An exit interview was conducted, appeal rights provided, and a copy of this report left with Compliance & Training Specialist Erinique Jones, whose signature on this form confirms receipt.

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

Deficiencies:
84070: (5) Copies of any modifications to the child's needs and services plan...signed by...his/her authorized representative(s)

title:
Children's Records
(c)...the following additional information shall be maintained in the child's record


summary: Complaint Investigation - Substantiated

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

met_with: Interim Administrator Kylie Leblanc


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13On 1/25/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted a follow-up complaint visit. LPA met with Compliance & Training Specialist Erinique Jones and Interim Administrator Kylie Leblanc and informed of the purpose of the visit. During visit, LPA inspected resident mattresses and observed one to have a dip in the middle and one to have multiple tears exposing the foam. Staff informed LPA that new mattresses have been purchased, including one which has already arrived. Staff opened the package and laid out the mattress to expand to be placed in the room with the torn mattress. The preponderance of evidence standard has been met, and therefore the above allegation is found to be substantiated. LPA is issuing a citation of California Code of Regulations, Title 22, Section 84088. An exit interview was conducted, appeal rigths provided, and a copy of this report was provided to Compliance & Training Specialist Erinique Jones, whose signature on this form confirms receipt. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Mendoza LICENSING EVALUATOR NAME: Mariah Hawkins LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 14-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, TRAEGER AVE., SUITE FACILITY NAME: PEOPLE'S CARE FREMONT PEAKFACILITY NUMBER: 075650140


summary: Complaint Investigation - Unsubstantiated - 1 deficiency

raw_content:
Narrative:
Additionally, based on confidential interview, observation, and record review, two residents' hygiene needs were not being met, resulting in hair being uncared for, messy, and/or long and nails being untrimmed, which were partially due to resident behaviors. The preponderance of evidence standard has been met, and therefore the above allegations are found to be substantiated. LPA is issuing citations of California Code of Regulations, Title 22, Section 84065.2 and Section 80078. See attached LIC 9099-D pages. An exit interview was conducted, appeal rights provided, and copy of this report was left with Administrator Jose Guzman, whose signature on this form confirms receipt. ... medication during an escalated incident due to not being able to access the locked medication room. However, based on confidential interview, observation, and record review, it could not be determined that the resident should have been administered medication nor that the resident was prescribed an emergency PRN medication for behavior. Lastly, it was reported that resident beds had improper bedding. Based on confidential interview, observation, and record review, the beds were fitted with clean bedding that met applicable licensing requirements but did not align with internal procedures not specifically outlined in the plan of operation. The facility has since updated all bedding to meet the additional elements of the internal procedures. Although the allegations may have happened or are valid, based on LPA's observations and interviews, there is not a preponderance of the evidence to prove the alleged violations did or did not occur. Therefore, the allegations are unsubstantiated. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Administrator Jose Guzman, whose signature on this form confirms receipt.

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

Deficiencies:
43542: People's Care Fremont Peakfacility Number: 075650140 Visit Date: 05/26/2023 Narrative 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32... medication during an escalated incident due to not being able to access the locked medication room.  However, based on confidential interview, observation, and record review, it could not be determined that the resident should have been administered medication nor that the resident was prescribed an emergency PRN medication for behavior.

Lastly, it was reported that resident beds had improper bedding.  Based on confidential interview, observation, and record review, the beds were fitted with clean bedding that met applicable licensing requirements but did not align with internal procedures not specifically outlined in the plan of operation.

met_with: Administrator Jose Guzman

title:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CENTRAL COAST SC/RES, 851 TRAEGER AVE., Suite 360 San Bruno, CA 94066 Facility Name


facility_name: PEOPLE'S CARE GARTH

raw_content:
Narrative:
Due to lack of evidence and conflicting statements obtained during the investigation, although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove or disprove that a violation occurred; therefore, the above allegations are Unsubstantiated. There were no deficiencies cited at this time. Exit interview was conducted, and a copy of this report was emailed to Azeez Lamina, Administrator to sign and return.

Investigation Findings:
13On May 28, 2020 at 11:45 a.m. Licensing Program Analyst (LPA) Cameo Banks conducted a follow-up complaint visit via telephone to People's Care Garth and spoke with Facility Administrator Azeez Lamina. The purpose of the inspection was to deliver findings for the above complaint allegations. During the course of investigating the allegations, LPA conducted interviews. The interviews did not produce corroborating evidence to support the allegations. Staff denied allegations. Interviews with Staff revealed that there was a conversation amongst staff and Child #1 assumed they were talking about her and became offended even after staff explained that they were not speaking negatively about her. Child #1 continued to make outbursts insisting that Staff were talking about her. Interviews with Staff also revealed that remaining clients in care are nonverbal therefore denying allegation of talking about Child #1 to other clients. There was no evidence that staff harassed or verbally abused Child #1. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Cameo Banks LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: PEOPLE'S CARE GARTHFACILITY NUMBER: VISIT DATE: 05/28/2021

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

met_with: Azeez Lamina Administrator


raw_content:
Investigation Findings:
13On December 31, 2021 at 2: PM, Associate Governmental Program Analyst (AGPA) Tonya L. Barnes-Woodard conducted an unannounced follow-up complaint inspection at People's Care Garth and met with Quanita Abebide. The purpose of this inspection is to deliver findings on the above complaint allegation. During the investigation process, AGPA Woodard conducted confidential interviews with relevant parties and reviewed supportive documentation. The investigation did not reveal corroborating evidence to support the allegation that facility staff are verbally abusive to clients. Confidential interviews were conducted with five staff who each denied the allegation that they yell and curse at clients. Based on confidential interviews with staff, reporting party, alleged victim, and witnees in addition to the review of supporting documentation, the Department has determined that the personal rights allegation cannot be corroborated. Therefore, the finding is unsubstantiated. An unsubstantiated finding means although the allegation may have happened, the preponderance of evidence does not prove it. A copy of this report was left with staff. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Tonya Barnes-Woodard 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 2

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

met_with: Quanita Abebide


raw_content:
Investigation Findings:
13On February 2, 2022 at 2:51pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to People's Care Garth and spoke with Dajahnae Warmack, Direct Care Staff. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation, a total of one (1) client and five (5) staff were interviewed. LPA was unable to conduct confidential interviews with Client #2 (C2) due to C2 is non-verbal. Confidential interviews conducted revealed there was not enough evidence to substantiate facility staff did not provide activities for clients, staff not providing adequate food service to clients, and staff yells at clients. LPA obtained copies of the activity schedule and weekly menu schedule for the clients in care. Based on the interviews conducted, documentary evidence, the information gathered did not produce corroborating evidence to support the above said allegations. LPA Edison was not able to determine if the above said allegations occurred, therefore the allegations are determined to be unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. No deficiencies were observed or cited at the time of this investigation. Exit interview was conducted, and a copy of this report will be emailed to the Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison 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

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

met_with: Dajahnae Warmack-Direct Care Staff


raw_content:
Narrative:
LPA could not obtain the identity of the alleged perpetrator. Confidential interviews with staff and client confirmed that the staff followed directives accordingly to provide the proper care and treated the alleged victim in placement with dignity and respect, and therefore, did not cause any injury to client. Based on the interviews conducted, documentary evidence, the information gathered did not produce corroborating evidence to support the above said allegation. LPA Edison was unable to determine if the above said allegation occurred, therefore the allegation is determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. If any additional information is received, this complaint can be amended, and the finding can be changed. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

Investigation Findings:
13On December 8, 2022 at 11:39am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to People's Care (Garth) and spoke with Vera Adidi, Administrator. The purpose of this visit was to deliver the findings for the above complaint allegation. During the investigation LPA Edison interviewed and accounted for all available relevant parties; and gathered pertinent information regarding the allegation. Based on the interviews and statements obtained during the investigation process, the allegation could not be corroborated. Although, confidential witness statements revealed "Staff caused injuries to a minor while in care", staff denied the allegation and the alleged victim denied the allegation. There is no evidence or witnesses to support that "Staff caused injuries to a minor while in care". Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: PEOPLE'S CARE GARTHFACILITY NUMBER: VISIT DATE: 12/08/2022

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

met_with: Vera Adidi-Administrator


raw_content:
Narrative:
Confidential interviews revealed C1 recanted allegation. LPA observation of Client #1 (C1) during the investigation revealed C1 who stated wanting to go to the hospital. LPA Edison observed C1 to yell and scream that facility staff was trying to choke C1. LPA did not observe any facility staff trying to choke or physically harm C1 in any manner. LPA did not observe any marks, bruises, or injuries on C1. There is no evidence or witnesses to support that "Staff choked minor". LPA obtained additional information from staff who stated that Client #1 (C1) made allegations toward all staff not just Staff #1 (S1). Confidential interviews conducted also reveal staff stated that they could not get in touch with the Administrator when the incident occurred and that they (staff) had just gotten off work earlier that day and did not want to "do a double shift" which is the reason they did not accompany C1 to the hospital. Additional information obtained after the investigation process did not corroborate the allegation. Based on the interviews conducted, documentary evidence, the information gathered did not produce corroborating evidence to support the above said allegation. LPA Edison was unable to determine if the above said allegation occurred, therefore the allegation are determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. If any additional information is received, this complaint can be amended, and the finding can be changed. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

Investigation Findings:
13This an amended report from the original date of 12/8/2022. On December 8, 2022 at 12:55pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to People's Care (Garth) and spoke with Vera Adidi, Administrator. The purpose of this visit was to deliver the findings for the above complaint allegation. During the investigation LPA Edison interviewed and accounted for all available relevant parties; and gathered pertinent information regarding the allegation. Based on the interviews and statements obtained during the investigation process, the allegation could not be corroborated. LPA made several unsuccessful attempts to conduct confidential interviews with witnesses. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: PEOPLE'S CARE GARTHFACILITY NUMBER: VISIT DATE: 12/08/2022

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