summary: Facility Evaluation

raw_content:
Narrative:
On Tuesday 6/22/21 at 9AM, Licensing Program Analysts (LPA's) Isabel Mendoza and Mariah Hawkins met with facility Administrator Augie Arballo for an unannounced annual/required inspection. The STRTP facility consists of four cottages, and only two cottages are being used (Stow and Halleck). This STRTP is licensed for a capacity of 48 and currently has a census of 15 with 7 residents in Halleck and 8 in Stow. At 9:20AM, LPA's Mendoza and Hawkins inspected Stow Cottage. At 10:45AM, LPA's inspected Hallek. LPA's observed the following: Water temperature measured F throughout the cottage. LPA advised the facility to change the temperature. The heater was adjusted, and at 10:38AM the water measured F. At 9:31AM, LPA's observed that the Stow living room / lounge spaces were untidy. There were cards and games pieces spread out on shelves in a disorganized fashion. Halleck was inspected afterwards and was observed to be tidier, but LPA's still observed games pieces on the floor and tossed into drawers without being put away properly, such as back in the puzzle or game box. At 9:54AM, LPA's observed the Stow recreation room to be untidy and unclean. There were toys, game pieces, and other items on the floor and disorganized on the shelves. There was debris on the carpet, which did not appear to have been recently cleaned. Surfaces were unclean. Curtains were missing or in need of repair. At 9:49AM, LPA's observed three rat traps in the downstairs Stow utility room. Administrator stated the site does not have nor recently had a bug or mouse infestation or concern but does have an exterminator come out weekly. Multiple cobwebs and spiders were observed throughout the facility site. At 9:55AM, LPA's observed a trail of ants observed on two walls of the recreation room. An annual continuation will be conducted to complete this annual inspection. LPA's received 15 staff files and 10 client files, which will be reviewed. An exit interview was conducted, appeal rights provided, and a copy of this report left with Administrator Augie Arballo, whose signature on this form confirms receipt. At 9:57AM, LPA's observed the table and couch in the hallway outside the Stow recreation room were dirty. At 9:58AM, LPA's observed behind the hallway table an exposed glue trap with dead bugs and a large dead spider on it. The trap appeared to be old and needed to be replaced. At 10:05AM, LPA's observed rat droppings, an exposed glue trap, and a plate underneath the sofa in the clinician's office in the Stow Cottage basement. At 12:50PM, LPA's inspected the exterminator invoices and observed the following: 6/14/21, 1 mouse removed from admin building, 1 mouse removed from Stow Cottage; 5/24/21, 2 mice removed from Lane Cottage basement and laundry room; 5/10/21, removed 2 mice from admin building, removed 1 mouse from Halleck Cottage kitchen dry food storage; 4/26/21, removed 1 mouse from admin building; 4/12/21, removed 2 mice from Halleck Cottage kitchen area and basement; 1/25/21, removed 1 mouse from admin building; 12/28/20, removed 1 rat from Stow Cottage, removed 2 mice from Williams Building (CSU building), removed 1 mouse from Lane Cottage basement, currently vacant; 11/30/20, removed 1 mouse from Lane Cottage basement; 11/17/20, removed 1 rat from admin building, removed 1 rat from Halleck Cottage; 8/14/20, removed 1 mouse from Stow Cottage under sink, removed 1 mouse from admin building basement, removed 1 mouse from Lane Cottage under stove; 7/21/20, removed 1 rat and 1 mouse. Per the invoice records for June 2020 through June 2021, the exterminator has removed over 20 rodents (mice, rats) from the various cottages and admin building, including from the kitchen, basement, and laundry, as well as rodents from external traps. No report regarding these incidents was made to CCL, and Administrator stated he was not aware of the issue. At 9:33AM, LPA's observed the Stow kitchen to be messy. Cabinets and drawers in each cottage have food crumbs and grime, the refrigerators in each cottage were dirty, pantry shelves in Halleck Cottage were dirty and had dripping containers. The kitchen and dining areas need to be cleaned and sanitized. LPA's observed a nonfunctional dishwasher in the Stow kitchen, a nonfunctional oven (glass door broken this morning) in the Halleck kitchen, and a nonfunctional refrigerator in the Halleck dining room. Staff stated the oven would be replaced and the refrigerator will be checked for functionality by the licensee's facilities department. Additionally, no menu was posted in the Stow kitchen, but staff moved the menu from upstairs to the kitchen. LPA's observed both first aid kits, in Stow and Halleck, to be incomplete with the following items missing or in very low supply: tweezers; alcohol pads; bandages; antiseptic solution. LPA's observed chairs in the upstairs hallways near the bedrooms blocking the passageway. The chairs were for staff providing supervision. LPA's advised that the chairs be moved to avoid obstructing the hallway or that smaller chairs be used, since the hallways are somewhat narrow. LPA's discussed the medication administration procedures with staff. Per staff, medications are transferred from the medication bottle to envelopes and given to evening/night staff to administer to youth who are to take medications at a time after the nursing staff have left for the day. LPA's advised the facility does not transfer medications between containers and instead have staff who have access to the medications administer the medications. Grounds were free of obstruction and hazards. There are no bodies of water on the premises. Administrator reported that there are no firearms or ammunition at the facility site. Medications are stored in medication cabinets in locked staff closets in the upstairs staff offices of each cottage and in the nursing office. Sharps were stored in locked cabinets in the kitchens and were inaccessible to clients. The facility had food to meet the 7-day nonperishable, 2-day perishable mandate. Clients have individual beds. Facility sketches were posted throughout the facility site. Room temperatures were maintained at comfortable temperatures within the permitted range. At visit, Administrator and LPA's discussed the facility policy to have clients be required to wear a mask while at the facility with a 3-step intervention plan for youth who do not wear a mask, which was implemented on 2/02/21. Administrator stated this policy was now under review by their agency in response to the mask mandate being partially lifted in the state. LPA's are issuing 4 citations per California Code of Regulations, Title 22, Sections Buildings and Grounds, Food Services, Health Related Services, and Plan of Operation. LPA's observed multiple spills of food or paint on walls throughout the site, including coffee spill on fan in upstairs Halleck, brown splatter in bedroom in Halleck, and unknown splatters near trash cans in Stow basement hallway. LPA's also observed small graffiti, such as a small drawing of male genitalia in the Halleck lounge; old ink marks, such as the billiards game list of client names from 4/06/06 on a cabinet door in the Stow recreation room; paint splatters, such as in the Halleck basement classroom cabinet areas and Halleck client bedroom; and stickers on the high ceilings of the upstairs Stow Cottage near the bedrooms. Staff were not clear as to how youth got the stickers on the ceiling. Administrator reported the facility is cleaned and disinfected at least three times each day at shift changes. Facility Manager S1 (See LIC Confidential Names) reported that there is a cleaning crew who clean most of the site twice daily but focus more on frequently used spaces rather than pass-through spaces like hallways. At 10:30AM, and throughout the tour, LPA's observed the client bedrooms to be disorganized. Client belongings in the wardrobes and in the under bed storage were messy with items scattered around. Wardrobes were somewhat empty, clothes unfolded and piled inside, and not all clothes appeared to be clean. Staff reported clients are not always comfortable with staff touching their belongings, but clients do not appear to be assisted effectively with organization and related life skills. Administrator stated they will get cloth bins for wardrobe storage. At 10:33AM, LPA's observed more than 5 windows propped open with various items. Multiple bedroom windows were propped open with large books. One window was propped open with a puzzle box, one with a sweatshirt, and another window in one of the upstairs Stow bathrooms was propped open with a wad of paper towels. Some items, such as the books, could be hazardous if they fell from the window sill to the ground below. At 10:22AM, LPA's observed a posting in Stow Cottage of a dress code with policies such as disallowing shoulders from being uncovered. Administrator stated this is in the program plan, and LPA's requested this be checked. At approximately 11:30AM, Administrator reported to LPA's that after checking the program plan, the dress code policy is not included and was not approved by the Licensing agency.

met_with: Administrator Augie Arballo


state: CA

facility_name: EDGEWOOD - THE SAN FRANCISCO PROTESTANT ORPHANAGE

summary: Facility Evaluation - 2 deficiencies

raw_content:
Narrative:
On Wednesday, July 21, 2021, at 10: AM, Licensing Program Analyst (LPA) Isabel Mendoza and Christopher Rollins conducted a Case Management legal/non-compliance inspection. LPA's met with Administrator Augie Arballo, and SF Regional Director, Christina Garcia . The purpose of the inspection was to provide the facility feedback on the 7/1/ NCC submission. The 7/1/21 quarterly submission covers April 2021-June 2021 items. Please note, the April quarterly submission, which covers Jan - March 2021, was provided to the facility via email on 7/13/21. Per the NCC requirements, the facility submitted the below items via thumb drive to LPA Mendoza. 1. All staff is required to take the following training topics quarterly. Also, to provide a list of staff and training on the Excel template that CCL created. · Personal Rights Training · Child Abuse/" What Grooming Looks Likes" · Boundaries 2. At intake, all youth trained on "What grooming looks like" 3. Twice a month, Upper Management conducts unannounced up-night visits. 4. Up night Bed Check Logs- for the following three months (April, May, and June) 5. November and December Up night bed check logs. CCL requested the facility to submit this on 4/1/21 submission during the 2/3/21 inspection. However, the facility did not, so LPA Mendoza asked the facility to submit it with the 7/1/21 submission. [Cont. to LIC 809-C] 6. LIC 500/Staff schedule. The facility did not include the LIC 500 on the original submission, so LPA requested it on 7/8/21. Later that day, LPA obtained a copy of LIC 500. After conducting a comprehensive review on 7/1/21 submission, LPA observed the following items: LPA Mendoza found no issues with client training on grooming. This training is performed with new clients at intake. All staff required training has been complete. Twice a month, upper management random up night visits were completed in April, May, and June. During LPA's review of Excel training spreadsheet, it was learned that the facility includes all employees on the excel sheet. This information was communicated to LPA Mendoza via telephone. However, LIC 500 only listed all staff that provide care and supervision. The facility had a meeting with LPM Juanita Arroyo on 7/20/21 regarding the training excel sheet. The facility will update excel sheet and highlight all staff members who require all three training's. Due to the high volume of entries, LPA made a random selection and reviewed Halleck cottage overnight bed logs for the month of April and May. In April, there were 12 entries where staff performed single bed checks for long periods or several 15 min entries. In May, there was a total of 6-bed logs where staff performed two-person bed checks; all other entries were single bed checks. Based on internal "justification forms," single bed checks were performed by one staff because of either; low staffing, insufficient staffing, or [CONT. to LIC 809-C] , or not enough staff coverage during breaks. LPA Mendoza obtained copies of the April and May justification forms. For the month of June, none were submitted. During LPA's review of May bed logs, the facility updated their overnight bed logs on 5/27/21. The overnight bed logs now request staff members to mark either "yes" or "no" if they performed single bed checks. This information was not communicated to LPA Mendoza per NCC condition. The facility will submit an updated Up night Policy reflecting change to the overnight bed logs. Also, LPA noticed that the overnight shift changed from 10: PM-6: AM to PM to AM. For the month of June, LPA reviewed Stow cottage logs and found a total of 13 entries where staff performed single bed checks. November and December 2020 bed logs: LPA reviewed November (Stow) cottage, and upon review, the facility only submitted 11/1/2020-11/5/2020 overnight bed logs. Administrator confirmed after 11/5/20 the facility did not have any clients in care, due to COVID-19 outbreak. LPA Mendoza reviewed Halleck's November bed logs, and 11/22/20-11/24/20 were missing. Also, there were four entries where staff performed single bed checks, or staff only did one-hour bed checks. LPA reviewed Stow December bed logs from 12/1/2020-12/10/2020, and bed checks were performed by two staff members every 15 minutes. Halleck bed logs from 12/1/20-12/14/20 were reviewed, and LPA observed five entries where staff did single bed checks. During the inspection, LPA Mendoza provided the facility with a copy of LPA's overnight bed log review for all five months, including all specific dates and times of single bed checks. CCL notified the facility that the facilities NCC status is still under review by CCL. Currently, the facility needs to submit the following items for 4/1/21 submission, which was provided via email. LIC 500 for the April NCC submission, justification forms for Stow cottage from Jan-March, and a written plan on what the Administrator and upper management team plan to do to ensure that the overnight has adequate coverage and following all NCC requirements. LPA Mendoza received a thumb drive for most recent bed logs for July, and reviewed several Halleck and found several single bed checks. Justification forms were not included, so LPA Mendoza gave it back to Administrator to include justification forms and submit to LPA. [ Please Refer to Lic 809-c] During todays inspection, Augie and Christina stated that the facilities initial overnight bed check policy stated if a single bed check was performed that the facility would do a justification form. The justification form would cover all single bed checks. During inspection, LPA reviewed all NCC/meeting reports and 812's and could not find anything on this matter. LPA will send policy to LPM for review for future clarification. An exit interview was conducted, and the facility was cited under California Code of Regulations, Title 22, Section 87065. Direct Care Staff/Child Ratios. A copy of the report was left with the Administrator.

Deficiencies:
94066: Edgewood - the San Francisco Protestant Orphanagefacility Number: 380500183 Visit Date: 07/21/2021 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 31 326.	LIC 500/Staff schedule.
87065.5: During the hours of 10 pm to 7 am...When there are two to six children present at the facility, there shall be at least two awake and on duty direct care staff...
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report_type: Facility Evaluation

visit_type: Case Management

met_with: Adminstrator- Augie Arballo

title: Facility Name

title: Direct Care Staff/Child Ratio


facility_name: EGGLESTON- LA VERNE II

summary: Complaint Investigation - Substantiated

raw_content:
Narrative:
Continue from page 1 . . . On 03/08/2024, the Department received a complaint alleging that a staff hit youth. The focused staff (S1) who was identified in the report denied the allegation and stated that the youth became aggressive toward her when the youth was told to hurry up because the facility van was waiting for the youth to be taken to a home pass. S1 stated that the youth spat on her several times and told her that he was going to shoot her and her grand kids. S1 stated that the she confronted the youth about his statement and the youth spat on her and was physically close to her. S1 stated that she put her hand out to make space between herself and the youth. S1 stated that she did not slapped or punch the youth. The focus youth (C1) stated that he went up to his room to pack his stuff because the facility van was going to take the kids on their home passes. C1 stated that S1 kept rushing him and told him to hurry up about five times. C1 stated that he went downstairs with his play station (PS5) and told S1 that he hoped she and her grand son died. C1 stated that S1 pushed him and told him that he did not want any problems but he spat at S1 and S1 slapped him on the left side of his face. C1 stated that he spat on S1 again and S1 slapped him again. C1 stated that he spat on S1 for a third time and S1 punched him on the face and kicked the PS5. C1 stated that there was another staff that got there just before S1 punched him and the other kids were in the van. A second staff worker who was present and witness the incident stated that S1 punched C1 on the face. Another youth that was in the facility heard the arguing between C1 and S1 and came out the room to see S1 kicking C1's PS5 and another youth stated that C1's face was red and was teary eye when C1 got to the facility's van. Based on the staff statements and confidential interviews the allegation is found to be substantiated. A substantiated finding means that the preponderance of evidence standard has been met and the allegation is found to be true. Exit interview completed. The following deficiencies cited and a copy of this report and appeal rights were left with facility representative mention above.

Investigation Findings:
13On May 16, 2024, Licensing Program Analyst (LPA) Heriberto Perez conducted a follow-up complaint inspection to the above facility and met with Jaime Caballero, Administrator. The purpose of the inspection was to deliver the revised finding for the above complaint allegation. During the course of the investigation, LPA interviewed one youth in person in the facility and conducted telephone interviews with one staff (S2) and one youth on 03/22/24, LPA interviewed one staff (S1) via telephone on 03/25/24, LPA interviewed Probation Investigator via telephone on 03/28/24, LPA interviewed probation office (PO1) via telephone on 05/07/24, LPA interviewed Probation Supervisor via telephone on 05/08/24, LPA interviewed probation officer (PO2) via telephone and one youth in person on 05/09/24 (see Confidential Names Form LIC 811 dated May 16, 2023). LPA also reviewed documents including but not limited to Client's Need and Service Plans, Special Incident Reports (SIR) and other documents. It was alleged Staff hit youth. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Heriberto Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: EGGLESTON- LA VERNE IIFACILITY NUMBER: VISIT DATE: 05/16/2024

report_type: Complaint Investigation

met_with: Jaime Caballero, Administrator

complaint_status: SUBSTANTIATED


summary: Facility Evaluation

raw_content:
Narrative:
On December 2, Licensing Program Analysts (LPA) Claudia Portillo conducted an unannounced inspection at the facility at 10: AM. LPA met with Jaime Caballero, Administrator. The purpose of the inspection was to conduct an Annual/Required inspection of the facility. This STRTP is licensed to serve up to six (6) ambulatory males ages 13-17 and also to provide services to non-minor dependents pursuant to W&I Code 16501.1 (C)(1). There are five (5) ambulatory clients currently in placement. This facility is a two story- level house located in a residential neighborhood. This house has 6 bedrooms and 4 bathrooms. There is also a living room, entertainment room, 2 kitchens', and a dining room. There are no bodies of water on the premises. During the inspection, LPA conducted a physical tour (inside and out) and reviewed operational requirements: (physical plant; operations; disaster preparedness; emergency intervention plan, staff files, client files, and core-therapeutic services. The following required posted items were observed accessible to clients: The Emergency Disaster Plan, facility sketch, Personnel Schedule, Clients' Personal Rights, Client's Bill of Rights, and Foster Care Ombudsman, Grievance Procedures, planned activities, facility license, accreditation certificate, visitation policies, current menu and Sexual and Reproductive Health Rights were posted. The kitchen area was observed to be clean and sanitary. There was one-week supply of non-perishable & two days of perishable foods, including nutritious snacks. The carbon monoxide detectors were tested and found to be in good working condition. The facility is equipped with a fire alarm system which is tested monthly by the Administrator and staff. LPA reviewed three staff and two client files. One client and one staff were interviewed. A review of Licensing Information System on December 2, 2021 indicates that all facility staff associated to the FFA have DOJ, FBI, and child abuse index clearances. An exit interview was conducted, and a signed copy of this report was provided to the facility representative along with LIC 809 and LIC 811s (Confidential Names list).

visit_type: Annual

met_with: Jaime Caballero


summary: Facility Evaluation

raw_content:
Narrative:
On July 25, 2024 at 01: PM, Licensing Program Analyst (LPA) Heriberto Perez conducted a case management inspection at the Short Term Residential Therapeutic Program (STRTP) in order to assess an Enhanced Civil Penalty (ECP). LPA Perez discussed the following with the facility representative named above. On 05/16/24, the Department concluded a complaint investigation on the Short Term Residential Therapeutic Program (STRTP) which alleged personal rights violation. A foster minor client was punched by a staff which caused a scratch on the client's face. The allegation was substantiated, and the STRTP was cited for personal rights under Interim Licensing Standards (ILS) 87072(c)(16) Personal Rights. The Department has concluded an analysis and determined that an Enhanced Civil Penalty is warranted for physical abuse. Under Health and Safety (H&S) code section 1548 (C)(i)(2), for a violation that the Department determines constitutes physical abuse, the civil penalty shall be $2,500. Copies of the following reports were provided to the facility representative: LIC 809, LIC Confidential Names Form and LIC 421D Civil Penalty Assessment - Serious Bodily Injury/Physical Abuse. Appeal Rights forms were given and explained.


summary: Facility Evaluation

raw_content:
Narrative:
On November 25, 2025, Licensing Program Analyst (LPAs) Claudia Portillo and Timika Martin conducted an unannounced inspection at the facility. LPAs met with the representatives above. The purpose of the inspection was to conduct a Case Management - unannounced Annual/Required Inspection. LPA obtained and reviewed the following updated documentation: · LIC Personnel, Client roster · LIC C Emergency Disaster Plan/Mass Casualty Plan · Current Board Minutes · Continuous Quality Improvement report · ProAct Certificates The compliance and regulatory enforcement (CARE) tool was used by the LPAs when conducting today's inspection which consisted a review of the following domains: physical plant, operations, disaster preparedness plan, staff files, client files, core therapeutic services and emergency intervention plan. An exit interview was conducted, and a signed copy of this report was provided to the facility representative along with the LIC 809, LIC 809D, and 1 technical advisory were provided.


facility_name: EGGLESTON ONTARIO STRTP

summary: Facility Evaluation

raw_content:
Narrative:
On 1/9/ Licensing Program Analysts (LPAs) Dawn Mahecha and Ashley Ruacho made an unannounced visit to the Eggleston Ontario STRTP for the purpose of a Case management incident report. LPAs met with Administrator and discussed the following incident. Child being detained for driving a stolen vehicle: Administrator stated the following: Two (2) children involved with this incident were dropped off at school by 8: AM on 10/17/2022. Staff went to pick up children from school and children weren't at school. Administrator stated when notifications were being made of children leaving school and being Awoled from facility biological grandmother to one child informed Administrator that child was being held at police department. Administrator went to pick up one child from police department but upon arrival to police department additional child was not at location. Police stated that one child was released on their own recognisance due to age and believed to be only a passenger in vehicle. Child who was in custody was picked up and brought back to facility and other outstanding child was dropped off later that evening by an unknown person. Administrator provided submitted documentation of incident and notifications made to various involved agencies. Based on the information provided facility followed up with children's probation officers and court case dates. At this time child who was arrested Awoled from facility on 12/25/2022 and is now currently under the jurisdiction of probation department. Additional child who was involved with being a potential passenger still resides at location. No further information was provided at this time. Exit interview completed and no deficiencies cited and a copy of this report was emailed to Administrator.

met_with: Billy McDaniel, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On July 11, 2023, at 01: PM, Licensing Program Analyst (LPA) Claudia Portillo conducted an unannounced case management inspection at Eggleston Ontario Short Term Residential Therapeutic Program to follow up on a death incident involving Client #1 (C1). LPA Portillo met with Administrator, Billy McDaniel. LPA took a tour of the home. On July 9, 2023, Eggleston Ontario Short Term Residential Therapeutic Program (STRTP) reported to the Department that on the morning of July 9, 2023, C1 went on an approved home pass (July 7th to July 9th) to visit with his mother. On July 8th, the Therapist contacted the mother to check on the C1's wellbeing and C1 appeared to be doing well. At approximately 9:00 am, on July 9, 2023, staff contacted the mother to arrange pick up for C1, when they were informed that on July 8, 2023, in the night, the youth had snuck out of the house, went to a pizza place with some friends and was shot and killed (date and time is unknown). C1's mother was not able to provide any additional information besides letting staff know that C1 was killed by a gunshot wound. LPA Portillo interviewed the Administrator and Therapist and obtained documentation for the incident. A copy of this report was provided to the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On November 17, 2023, Licensing Program Analysts (LPA) Claudia Portillo, conducted an unannounced Annual Inspection at the facility and met with Quoquese Gray, Acting Administrator. LPA stated the purpose of the inspection to the STRTP representative. LPA obtained and reviewed the following updated documentation: · LIC Personnel and client roster Biannual Reports for the use of Emergency Interventions MHPA Certificate COA Certificate LIC 610C Activity Calendar Food Menu Fire Drills Annual compliance Review consisted of the following (7) domains: physical plant, operations, disaster preparedness plan, emergency intervention, staffing, core-therapeutic services and client files. Only (4) domains were reviewed during today's visit: physical plant, operations, core-therapeutic services and disaster preparedness plan. Further inspection is required on a separate day. The following domains require a continuance of review (staff, client, and emergency intervention). An exit interview was conducted, and a signed copy of this report were provided to the facility administrator.

met_with: Quoquese Gray, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On December 11, 2023, Licensing Program Analyst (LPA) Claudia Portillo conducted an unannounced Annual Inspection and met with Quoquese Gray, Acting Administrator for the purpose of the continuance of the annual. The following topics were inspected using the care tools to complete two categories: client and staff files. Staff interview was conducted. A signed copy of this report, LIC 809D, LIC Confidential Names list dated 12/11/23, and Technical violation and 1 technical advisory was provided to the Administrator for review. No further inspection required

met_with: Quoquese Gray, Acting Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On November 12, 2025, Licensing Program Analyst (LPAs) Claudia Portillo and Humberto Flores conducted an unannounced inspection at the facility. LPAs met with the representatives above. The purpose of the inspection was to conduct a Case Management - unannounced Annual/Required Inspection. LPA obtained and reviewed the following updated documentation: · LIC Personnel, Client roster · LIC C Emergency Disaster Plan · Current Board Minutes · Continuous Quality Improvement report · Mass Casualty Plan · ProAct Certificates The compliance and regulatory enforcement (CARE) tool was used by the LPAs when conducting today's inspection which consisted a review of the following domains: physical plant, operations, disaster preparedness plan, staff files, client files, core therapeutic services and emergency intervention plan. One client was interviewed. An exit interview was conducted, and a signed copy of this report was provided to the facility representative along with the LIC 809, LIC 809D, and 4 technical advisory's were provided.

met_with: Billy McDaniel


facility_name: EGGLESTON TRANSITIONAL GROUP HOME

summary: Facility Evaluation

raw_content:
Narrative:
On 12/15/21 at 10: AM, Licensing Program Analyst (LPA) Claudia Portillo conducted an unannounced inspection at the facility. LPA met with George Bojorquez, Administrator. The purpose of the inspection was to conduct an unannounced Annual/Required Inspection. LPA obtained and reviewed the following updated documentation: · LIC Personnel and client roster · LIC C Emergency Disaster Plan · Council on Accreditation expires on January 20, 2023 · Board of Directors report and program statement The Short-term residential therapeutic program was in full compliance with 7 applicable areas of the Compliance and Regulatory Enforcement (CARE) Tools, for Children's Residential licensees. Annual compliance Review consisted of the following domains: physical plant, operations, disaster preparedness plan, emergency intervention, staffing, client records, and core-therapeutic services. Community care licensing (CCL) focuses its efforts on three priority areas: prevention, compliance, and enforcement. For this review, two (2) placed Probation children were selected for the sample to assess the level of care and services they received. Additionally, LPA reviewed three (3) staff files for compliance with Title Regulations and Interim Licensing Requirements. LPA also conducted interviews with two staff members. No clients were interviewed because they were in school session. An exit interview was conducted and the STRTP Administrator, George Bojorquez who agreed with the review finding and recommendation. LPA provided a signed copy of this report (LIC 809), 1 technical advisory and LIC 811s (Confidential Name/s list) was provided to the facility representative.

met_with: George Bojorquez


summary: Facility Evaluation

raw_content:
Narrative:
On December 20, 2023, Licensing Program Analysts (LPA) Claudia Portillo and Angelina Garibaldo, conducted an unannounced Annual Inspection at the facility and met with George Bojorquez, Administrator. LPAs stated the purpose of the inspection to the STRTP representative. LPA obtained and reviewed the following updated documentation: · LIC Personnel and client roster Biannual Reports for the use of Emergency Interventions MHPA Certificate COA Certificate LIC 610C and mass casualty and disaster plan Activity Calendar Food Menu Fire Drills Resident Council Meeting Notes Annual compliance Review consisted of the following (7) domains: physical plant, operations, disaster preparedness plan, emergency intervention, staffing, core-therapeutic services and client files. Staff and Clients were interviewed. A signed copy of this report, LIC Confidential Names list dated 12/20/23, and Technical advisory was provided to the Administrator for review. No further inspection required


summary: Facility Evaluation

raw_content:
Narrative:
On November 24, 2025, Licensing Program Analysts (LPAs) Claudia Portillo and Angelina Garibaldo 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. LPAs obtained and reviewed the following updated documentation: ꞏ LIC Personnel, Client roster ꞏ LIC 610C Emergency Disaster Plan (Mass Casualty Plan) ꞏ Current Board Minutes ꞏ Continuous Quality Improvement report and Mental Health Program Approval Certificate ꞏ ProAct Certificates The compliance and regulatory enforcement (CARE) tool was used by the LPAs when conducting today's inspection which consisted of a review of the following domains: physical plant, operations, disaster preparedness plan, staff files, client files, core therapeutic services and emergency intervention plan. LPA reviewed 3 staff files and 3 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, LIC 809Ds, and Technical violations were provided.

met_with: George Bojorguez


facility_name: EGGLESTON UPLAND GROUP HOME

summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
Investigation revealed the following: It was alleged that facility staff does not treat youth in a respectful manner. Administrator and staff had similar statements denying the allegation. Administrator and staff stated they do not speak to children inappropriately or rudely or overhear other staff treating children unfairly or rudely. Additionally, they stated that all children are treated the same and that they have not received complaints or information from children that suggest staff disrespect anyone in or out of the home. Interviews conducted with children varied in that one (1) child stated that they felt as though staff were disrespectful and that one (1) staff called them and another person an inappropriate name. However, child could not recall the specific date of when incident occurred or in what context and recounted the incident occurring only once. Interviews conducted with two (2) other children stated that all staff are nice and that they do not recall hearing anyone residing in the home or out being called inappropriate names by staff. Documents reviewed identified no incidents being documented of staff treating children disrespectfully. It was also alleged, facility feeds youths burnt food. Staff and Administrator denied the allegation and again had similar statements that various staff and children cook meals in the home. Staff could not recall an incident when staff or a child burned a meal or tried serving a burnt meal for someone to eat. Staff stated they monitor the children while they are cooking and if staff or children ever burned food, they would throw it out and cook something else. Children had similar statements in that they could not recall a specific incident of being served burnt food. Children stated that children and staff cook meals and that there is ample food to cook in the home. Lastly, it was alleged facility has expired food. During initial inspection LPA Mahecha and Administrator toured the home including the food supply. LPA observed perishable and non-perishable foods as well as the emergency food supply. LPA observed dates of when food was bought and dates of expiration. All food observed was properly marked and expiration dates were marked appropriately. Food was not observed to be moldy or have any past expiration dates. Staff had similar statements and stated that food is checked weekly, groceries are bought weekly and if moldy food is observed it is discarded immediately. Interviews conducted with children varied in that two (2) children stated that they had not observed expired or moldy food but one (1) child stated that they observed two-week-old expired food. LPA observed documented observation of alleged expired food, however, date observed was date of food being bought and not of expiration date. Additionally, documents reviewed identified groceries being bought weekly and ample food being bought for all children in care. LPA was unable to contact county social workers but documents reviewed identified incidents and issues occurring with one child but no documents identified issues with facility or staff within the facility. Based on the information gathered, although the allegation may have happened or is valid, the preponderance of evidence to prove the allegation was not met, therefore the allegation is unsubstantiated. An exit interview was conducted. A copy of this report Confidential Names Form, and Appeal Rights were provided to the facility representative. There were no deficiencies cited during this inspection.

Investigation Findings:
13On 10/7/ Licensing Program Analyst (LPA) Dawn Mahecha made an unannounced visit to the Eggleston Upland Short Term Residential Therapeutic Program (STRTP) for the purpose of concluding the above complaint investigation. LPA met with Administrator and discussed the findings of investigation. Investigation consisted of the following: On October 6, LPA interviewed Administrator, one (1) child and three (3) staff (see confidential names dated 10/6/2022). LPA requested and obtained the following copies: Current staff/ client roster, Criminal record clearances for staff associated to the facility, recent training completed by staff, 4 children's needs and service plan, menu of meals, most documented grocery receipts and any complaints or special incident reports (SIRs) related to child engaging in fights with each other or staff from August 2022 to present date. Additionally, LPA and Administrator toured the facility both inside and out and observed food supply. LPA reviewed provided documents and interviewed additional two (2) clients. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Dawn Mahecha LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: EGGLESTON UPLAND GROUP HOMEFACILITY NUMBER: VISIT DATE: 10/07/2022

complaint_status: unsubstantiated


summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
On 12/8/22 the Department received a complaint alleging S1 made a sexual gesture towards C1. S1 denied the allegation stating S1 never made an inappropriate sexual gesture towards C1. S2 indicated C1 disclosed that S1 made the sexual gesture, however S1 denied making a sexual gesture. S2 stated the other clients denied witnessing S1 make a sexual gesture towards C1. C3 and C4 when interviewed denied witnessing S1 make a sexual gesture towards C1. The CSW indicated having no concerns with the facility. PO1 and PO4 indicated having no concerns with the facility. PO1 indicated C1 disclosed that S1 made a sexual gesture towards C1, however C1 was not able to provide details about the alleged incident. IPO indicated S1 and the other clients interviewed denied witnessing S1 make a sexual gesture towards C1. The others agency's investigative report indicated all clients except C1 denied witnessing S1 make a sexual hand gesture towards C1. Based on the interviews and records reviewed the allegations is/are found unsubstantiated. Although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove the allegations. Appeals rights were provided and discussed with the facility representative mention above. There were no deficiencies cited

Investigation Findings:
13On March 15, 2023 at 9: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegations. LPA Cabral met with the STRTP Administrator Quoquese Gray. During the course of the investigation, LPA Cabral interviewed two facility staff (S1 & S2) and one client (C1) on 12/13/22. LPA interviewed two clients (C3 & C4) and attempted to interview two additional clients (C2 & C5) on 12/15/22 (see Confidential Names Form LIC 811 dated March 15, 2023). LPA Cabral interviewed once county social worker (CSW) on 12/13/22. LPA interviewed one probation officer (PO1) on 12/14/22 and another probation officer (PO4) on 12/20/22. LPA interviewed the other agencies investigating probation officer (IPO) on 1/30/22. LPA reviewed incident reports and letters from clients. LPA reviewed the other agencies investigative report on 3/11/23. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: EGGLESTON UPLAND GROUP HOMEFACILITY NUMBER: VISIT DATE: 03/15/2023

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


raw_content:
Narrative:
Confidential interviews and unannounced inspections by the Department revealed no evidence that the administrator is not meeting the required minimum hours at the facility. A sufficient supply of perishable and non-perishable food was observed on-site, with additional food properly stored in the garage. Sharp items were found secured in a locked safe located in the kitchen. While youth in care occasionally have disagreements, residential treatment as well as mental health staff are consistently present to redirect and/or intervene as needed. No evidence or documentation was found to corroborate the allegations. Based on the information obtained through interviews, observations, and record reviews, there is insufficient evidence to support the allegations. Therefore, the complaint is closed as unsubstantiated. The following reports were provided to the facility representative at the conclusion of today's inspection: LIC9099, LIC9099-C and LIC Confidential Names. Appeal rights forms were also given and explained. There was no deficiency citation issued.

Investigation Findings:
13On October 17, 2025 at 11:25am, Licensing Program Analyst (LPA) Irene Yamamoto conducted a complaint inspection at the facility and met with the facility representative listed above. The purpose of the inspection was to deliver findings regarding the allegations. The complaint alleged multiple instances of neglect, specifically that the administrator is not meeting the required minimum hours at the facility to effectively manage staff and oversee the short-term residential therapeutic program. It was further alleged that, due to the administrator's absence: Staff do not ensure meals are provided to youth in a timely manner; Staff do not prevent physical altercations among youth and Staff do not ensure sharp items are secured and inaccessible to youth. The undersigned LPA investigated the allegations. Confidential interviews were conducted with staff on 5/27/25, 5/28/25, 8/1/25 and 9/30/25. Collateral interviews of other related parties were conducted on 10/9/25. Relevant facility records were requested and reviewed. There was no county placement agency investigation report. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Irene Yamamoto LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION MONTEREY PARK CRP RO, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: EGGLESTON UPLAND GROUP HOMEFACILITY NUMBER: VISIT DATE: 10/17/2025

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


summary: Facility Evaluation

raw_content:
Narrative:
On November 17, 2023, Licensing Program Analysts (LPA) Claudia Portillo, conducted an unannounced Annual Inspection at the facility and met with Quoquese Gray, Administrator. LPA stated the purpose of the inspection to the STRTP representative. LPA obtained and reviewed the following updated documentation: · LIC Personnel and client roster Biannual Reports for the use of Emergency Interventions MHPA Certificate COA Certificate LIC 610C Activity Calendar Food Menu Fire Drills Annual compliance Review consisted of the following (7) domains: physical plant, operations, disaster preparedness plan, emergency intervention, staffing, core-therapeutic services and client files. Only (4) domains were reviewed during today's visit: physical plant, operations, core-therapeutic services and disaster preparedness plan. Further inspection is required on a separate day. The following domains require a continuance of review (staff, client, and emergency intervention). An exit interview was conducted, and a signed copy of this report were provided to the facility administrator.

met_with: Quoquese Gray


summary: Facility Evaluation

raw_content:
Narrative:
On December 6, 2023, Licensing Program Analyst (LPA) Claudia Portillo conducted an unannounced Annual Inspection at Eggleston Youth Center Upland and met with Quoquese Gray, Administrator for the purpose of the continuance of the annual. The following topics were inspected using the care tools to complete two categories: client and staff files. Two staff was interviewed. A signed copy of this report, LIC 809D, LIC Confidential Names list dated 12/6/23, and Technical violation and 1 advisory were provided to the Administrator No further inspection required.


summary: Facility Evaluation

raw_content:
Narrative:
On November 13, 2025, Licensing Program Analyst (LPA) Claudia Portillo conducted an unannounced inspection at the facility. LPA met with the representatives above. The purpose of the inspection was to conduct a Case Management - unannounced Annual/Required Inspection. LPA obtained and reviewed the following updated documentation: ꞏ LIC Personnel, Client roster ꞏ LIC 610C Emergency Disaster Plan (Mass Casualty Plan) ꞏ Current Board Minutes ꞏ Continuous Quality Improvement report ꞏ ProAct Certificates The compliance and regulatory enforcement (CARE) tool was used by the LPA when conducting today's inspection which consisted of a review of the following domains: physical plant, operations, disaster preparedness plan, staff files, client files, core therapeutic services and emergency intervention plan. An exit interview was conducted, and a signed copy of this report was provided to the facility representative along with the LIC 809, LIC 809D, 1 technical advisory, and Technical violations were provided.


facility_name: EGGLESTON WEST COVINA GROUP HOME

summary: Facility Evaluation

raw_content:
Narrative:
On December 6, 2021 at 10: AM, Licensing Program Analyst (LPA) Claudia Portillo conducted an unannounced visit to the above facility for the purpose of conducting an annual random inspection. LPA met with Billy McDaniel. The facility was toured inside and out with the Facility Administrator. There were no clients and staff present at time of inspection. The site is on a temporary, voluntary hold. LPA began facility ground inspection with Administrator at 10: AM. Bedrooms are arranged so that no more than two clients share a room, and there is one client per bed. There is adequate shelf and closet space for client's belongings. The bathrooms were clean and in good repair. All hazardous items have been properly made inaccessible to areas where clients will have access. The First Aid Kit contained all required supplies. The facility's smoke detectors in the bedrooms and hallways were checked and were operable. The following required posted items were observed accessible to clients: Grievance Procedures, Personal Rights, Ombudsman Poster, Visitation policies, and emergency disaster plan. The facility outside grounds was also inspected and it was observed to be clean and well maintained. Emergency exits were free from obstruction. There are no swimming pool/bodies of water located on the premises. Based on the facility inspection there are no deficiencies found at this time. An exit interview was conducted with the Administrator. LPA provided a copy of the following report: LIC 809 to Billy McDaniel.


facility_name: EGGLESTON YOUTH CENTER 1

summary: Facility Evaluation

raw_content:
Narrative:
On 12/20/21 at 10: AM, Licensing Program Analyst (LPA) Claudia Portillo conducted an unannounced inspection at the facility. LPA met with Don Gutierrez, Administrator. The purpose of the inspection was to conduct an unannounced Annual/Required Inspection. LPA obtained and reviewed the following updated documentation: · LIC Personnel and client roster · LIC C Emergency Disaster Plan · Council on Accreditation expires on January 20, 2023 · Board of Directors report, Continuous Quality Improvement data report and program statement The Short-term residential therapeutic program was in full compliance with 6 applicable areas of the Compliance and Regulatory Enforcement (CARE) Tools, for Children's Residential licensees. 1 applicable area will be completed as part of the continuation for this annual (client records). Annual compliance Review consisted of the following domains: physical plant, operations, disaster preparedness plan, emergency intervention, staffing, core-therapeutic services and client files (will be continued during 2nd visit). Community care licensing (CCL) focuses its efforts on three priority areas: prevention, compliance, and enforcement. For this review, LPA reviewed three (3) staff files for compliance with Title Regulations and Interim Licensing Requirements. One client was interviewed for the sample. An exit interview was conducted and the STRTP Administrator, Don Gutierrez who agreed with the review finding and recommendation. LPA provided a signed copy of this report (LIC 809). Further inspection is required on a separate day.

met_with: Don Gutierrez


summary: Facility Evaluation

raw_content:
Narrative:
On December 21, 2021, Licensing Program Analysts (LPA) Claudia Portillo, conducted an unannounced Annual Inspection at Eggleston Youth Center 1 and met with Don Gutierrez, Administrator. LPA stated the purpose of the inspection to the STRTP representative. During the inspection a copy of the client files and voucher binder was requested fro review. The following topics were inspected: CLIENT RECORDS: LPA Portillo reviewed the two (2) client file records. Needs and services plans for all two clients were trauma informed, culturally relevant, and age and developmentally appropriate and identified the child's needs: reason for placement, education, personal care and grooming, ability to manage money, visitation information, mental health services and placement information LPA issued 3 technical advisory's. The facility representative was provided information on where to locate Provider Information Notices (PINs), and shared PIN 21-20-CRP Compliance and Regulatory Enforcement (CARE) Tools, for Children's Residential licensees. A copy of this report (LIC 809), technical advisory's and LIC 811s were provided to the Administrator. Exit interview conducted.


summary: Facility Evaluation

raw_content:
Narrative:
On November 30, 2023, Licensing Program Analysts (LPAs) Claudia Portillo and Claudia Portillo conducted an unannounced Annual Inspection at the facility and met with Don Gutierrez, Administrator. LPAs stated the purpose of the inspection to the STRTP representative. One staff was interviewed. LPA obtained and reviewed the following updated documentation: · LIC Personnel and client roster Biannual Reports for the use of Emergency Interventions MHPA Certificate COA Certificate LIC 610C Activity Calendar Food Menu CQI report and Board minutes Annual compliance Review consisted of the following (7) domains: physical plant, operations, disaster preparedness plan, emergency intervention, staffing, core-therapeutic services and client files. Only (6) domains were reviewed during today's visit: physical plant, staff files operations,emergency intervention, core-therapeutic services and disaster preparedness plan. Further inspection is required on a separate day. The following domains require a continuance of review (client files). An exit interview was conducted, and a signed copy of this report were provided to the facility administrator..


summary: Facility Evaluation

raw_content:
Narrative:
On December 4, 2023, Licensing Program Analysts (LPAs) Claudia Portillo conducted an unannounced Annual Inspection at Eggleston Youth Center 11 and met with Don Gutierrez, Administrator for the purpose of completing the annual. LPA Portillo completed the review of the client files. Interviews with staff were conducted. A signed copy of this report, LIC Confidential Names list dated 12/4/23, and Technical violation and 1 advisory were provided to the Administrator No further inspection required.


summary: Facility Evaluation

raw_content:
Narrative:
On December 4, 2025, Licensing Program Analyst (LPA) Claudia Portillo conducted an unannounced inspection at the facility. LPA met with the representative above. The purpose of the inspection was to conduct a Case Management - unannounced Annual/Required Inspection. LPA obtained and reviewed the following updated documentation: · LIC Personnel, Client roster · LIC C Emergency Disaster Plan/Mass Casualty Plan · Current Board Minutes · Continuous Quality Improvement report · ProAct Certificates The compliance and regulatory enforcement (CARE) tool was used by the LPA when conducting today's inspection which consisted a review of the following domains: physical plant, operations, disaster preparedness plan, staff files, client files, core therapeutic services and emergency intervention plan. An exit interview was conducted, and a signed copy of this report was provided to the facility representative along with the LIC 809, LIC 809D, and technical violations were provided.


facility_name: EGGLESTON YOUTH CENTER II

raw_content:
Narrative:
The facility (GH) staff denied the allegation and stated that clients are given wake up calls during during the school week. The staff stated that several wake up calls are given to the client every 15 minutes or so to get ready to go to school. The staff stated that the clients are encourage to go to school and are reminded of their program. Information revealed that a client refused to go to school several times because the weekend home passes were taken away from the Department but the staff still was working with the client and tried to motivate the client to go to school. The confidential interviews indicated that the staff does wake up call to the clients several times and are told that it time to get ready for school. The interviews revealed that the staff tell the clients that not going to school can affect their privileges and community passes. The confidential interviews indicated that the staff encourages the clients to go to school. Information indicated that a client stop going to school because the passes were taken away from the clients and the client was upset. The confidential interviews revealed that the clients did not have any concerns with the GH and felt that the staff does enough to get them to go to school. The County Social Worker stated that she got reports from the GH saying that attempts were done to get the client to go to school but that maybe the client stopped going to school for other reasons. Based on the interviews and records reviewed, the allegations are found to be unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove the allegations. Copies of LIC9099, LIC9099C, LIC811 and Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On June 10, 2025, Licensing Program Analyst (LPA) Heriberto Perez conducted a follow-up complaint inspection to the above facility and met with Candices Pruitt, CCW3. The purpose of the inspection was to deliver the revised finding for the above complaint allegation. During the course of the investigation, LPA interviewed three staff and two clients in the facility on 03/25/25, LPA conducted telephone interview with County Social Worker (CSW) on 03/25/25 (see Confidential Names Form LIC 811 dated June 10, 2025). LPA also reviewed documents including but not limited to Client's Individualized Education Program (IEP), Child and Family Team (CFT) and Individualized Care Plan (ICP), Special Incident Reports (SIR), and other documents. It was alleged Staff did not ensure that minor was attending school. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Gustavo Garcia LICENSING EVALUATOR NAME: Heriberto Perez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: EGGLESTON YOUTH CENTER IIFACILITY NUMBER: VISIT DATE: 06/10/2025

met_with: Candices Pruitt, CCW3


summary: Facility Evaluation

raw_content:
Narrative:
On 12/20/21 at 02: PM, Licensing Program Analyst (LPA) Claudia Portillo conducted an unannounced inspection at the facility. LPA met with Don Gutierrez, Administrator. The purpose of the inspection was to conduct an unannounced Annual/Required Inspection. LPA obtained and reviewed the following updated documentation: · LIC Personnel and client roster · LIC C Emergency Disaster Plan · Council on Accreditation expires on January 20, 2023 · Board of Directors report, Continuous Quality Improvement data report and program statement The Short-term residential therapeutic program was in full compliance with 6 applicable areas of the Compliance and Regulatory Enforcement (CARE) Tools, for Children's Residential licensees. 1 applicable area will be completed as part of the continuation for this annual (client records). Annual compliance Review consisted of the following domains: physical plant, operations, disaster preparedness plan, emergency intervention, staffing, core-therapeutic services and client files (will be continued during 2nd visit). Community care licensing (CCL) focuses its efforts on three priority areas: prevention, compliance, and enforcement. For this review, LPA reviewed three (3) staff files for compliance with Title Regulations and Interim Licensing Requirements. One client was interviewed for the sample. An exit interview was conducted and the STRTP Administrator, Don Gutierrez who agreed with the review finding and recommendation. LPA provided a signed copy of this report LIC 809. Further inspection is required on a separate day.

met_with: Don Gutierrez, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On December 21, 2021, Licensing Program Analysts (LPA) Claudia Portillo, conducted an unannounced Annual Inspection at Eggleston Youth Center 1 and met with Don Gutierrez, Administrator. LPA stated the purpose of the inspection to the STRTP representative. During the inspection a copy of the client files and voucher binder was requested fro review. The following topics were inspected: CLIENT RECORDS: LPA Portillo reviewed the two (2) client file records. Needs and services plans for all two clients were trauma informed, culturally relevant, and age and developmentally appropriate and identified the child's needs: reason for placement, education, personal care and grooming, ability to manage money, visitation information, mental health services and placement information. LPA issued a Citation and one Technical Advisory. The facility representative was provided information on where to locate Provider Information Notices (PINs), and shared PIN 21-20-CRP Compliance and Regulatory Enforcement (CARE) Tools, for Children's Residential licensees. A copy of this report (LIC 809), LIC 809D, technical advisory's, and LIC 811s were provided to the Administrator. Exit interview conducted.


summary: Facility Evaluation

raw_content:
Narrative:
On June 21, 2022, at 12: PM, Licensing Program Analyst (LPA) Claudia Portillo conducted an unannounced case management inspection at Eggleston Youth Center II Short Term Residential Therapeutic Program to follow up on a death incident involving client #1. LPA met with Don Gutierrez, Administrator. On June 21, 2022, reported to the Department that an 18-year-old male probation resident was found deceased in the facility bathroom. Resident died from a fentanyl overdose. The STRTP reported that the Administrator received a call on June 20, 2022, at approximately 10:30 pm, from the resident's girlfriend stating that she was on the phone with resident when he entered the bathroom to take a shower when suddenly he stopped talking. Administrator advised staff to check on resident's status. Staff then entered the restroom and saw resident lying on the ground. Staff called out his name, checked him and immediately administered 2 sprays of Narcan and began CPR as another staff called 911. Though facility staff responded immediately, Baldwin Park Police and Fire Department arrived within minutes, and the Fire Department immediately took over CPR and placed an oxygen mask on resident. Baldwin Park Fire Department pronounced resident deceased at the scene and contacted Los Angeles County Coroner's office who picked up resident from the STRTP. During the inspection, LPA requested the following documents: POLICE REPORT # A signed copy of this report was provided to the facility representative along with LIC 811 (Confidential names list.)


summary: Facility Evaluation

raw_content:
Narrative:
On 7/27/2022 at 10: AM, Licensing Program Analyst (LPA) Claudia Portillo conducted a case management inspection at the facility and met with the facility representatives named above. The purpose of the inspection was to follow up on an incident that occurred on 6/20/22 involving C1 (clients). On June 21, 2022, the STRTP reported to the Department that an 18-year-old male probation resident was found deceased in the facility bathroom. Resident died from a fentanyl overdose. On 6/21/22, LPA Portillo conducted an initial case management (CM) for this incident and informed the Administrator that a continuance of the CM was going to take place at a later date. During today's inspection, LPA Portillo interviewed the Administrator and two clients. LPA will interview two staff over the phone on 7.29.22. LPA also reviewed client records and obtained copies of pertinent documents. LPA has scheduled phone interviews with staff members to discuss the incident. There is no further follow up required regarding the incident involving C1. This licensing report was reviewed and discussed with the facility representative and a signed copy of this report was provided to the facility representative at the conclusion of the inspection along with Confidential Names list (LIC 811)


summary: Facility Evaluation

raw_content:
Narrative:
On November 16, 2023, Licensing Program Analysts (LPA) Claudia Portillo, conducted an unannounced Annual Inspection at the facility and met with Don Gutierrez, Administrator. LPA stated the purpose of the inspection to the STRTP representative. LPA obtained and reviewed the following updated documentation: · LIC Personnel and client roster Biannual Reports for the use of Emergency Interventions MHPA Certificate COA Certificate LIC 610C Activity Calendar Food Menu Annual compliance Review consisted of the following (7) domains: physical plant, operations, disaster preparedness plan, emergency intervention, staffing, core-therapeutic services and client files. Only (4) domains were reviewed during today's visit: physical plant, operations, core-therapeutic services and disaster preparedness plan. Pending documentation to fully complete the domain for operations: CQI report, car insurance cards for both vehicle (confirmation of renewal was emailed to Administrator but no proof of cards was attached) and Board of Director Minutes. Further inspection is required on a separate day. The following domains require a continuance of review (staff, client, and emergency intervention). An exit interview was conducted, and a signed copy of this report were provided to the facility administrator..


summary: Facility Evaluation

raw_content:
Narrative:
On November 30, 2023, Licensing Program Analysts (LPAs) Claudia Portillo and Timika Martin, conducted an unannounced Annual Inspection at Eggleston Youth Center 1I and met with Don Gutierrez, Administrator for the purpose of the continuance of the annual. The following topics were inspected using the care tools to complete two categories: client (pending review) and staff files. One staff was interviewed. Further inspection is required on a separate day. The following domains require a continuance of review (client files). An exit interview was conducted, and a signed copy of this report were provided to the facility administrator.. Exit interview conducted.


summary: Facility Evaluation

raw_content:
Narrative:
On December 4, 2023, Licensing Program Analysts (LPAs) Claudia Portillo conducted an unannounced Annual Inspection at Eggleston Youth Center 11 and met with Don Gutierrez, Administrator for the purpose of completing the annual. LPA Portillo completed the review of the client files. A signed copy of this report, LIC Confidential Names list dated 12/4/23, LIC809D page, Technical violations/advisory, and appeal rights were provided to the Administrator No further inspection required.


summary: Facility Evaluation

raw_content:
Narrative:
On December 16, 2025, Licensing Program Analyst (LPA) Claudia Portillo conducted an unannounced inspection at the facility. LPA met with the representatives above. The purpose of the inspection was to conduct a Case Management - unannounced Annual/Required Inspection. LPA obtained and reviewed the following updated documentation: · LIC Personnel, Client roster · LIC 610C Emergency Disaster Plan/Mass Casualty Plan · Current Board Minutes · Continuous Quality Improvement report · ProAct Certificates and December Outing Calendar The compliance and regulatory enforcement (CARE) tool was used by the LPA when conducting today's inspection which consisted a review of the following domains: physical plant, operations, disaster preparedness plan, staff files, client files, core therapeutic services and emergency intervention plan. An exit interview was conducted, and a signed copy of this report was provided to the facility representative along with the LIC 809, LIC 811 and LIC 9102 (technical violations) were provided.


facility_name: EGGLESTON YOUTH CENTER V

summary: Facility Evaluation

raw_content:
Narrative:
On November 11, 2021, Licensing Program Analysts (LPA) Claudia Portillo, conducted an unannounced Annual Inspection at Eggleston Youth Center V and met with Jaime Caballero, Administrator. LPA stated the purpose of the inspection to the STRTP representative. During the inspection a copy of the Register of Facility Clients and Personnel Report was provided upon request. The following topics were inspected: PHYSICAL PLANT: A tour of the facility was conducted, along with Jaime Caballero. The License, Children's' foster youth bill of rights, Office of the Ombudsman, Emergency disaster plan, personal rights and Covid-19 information was placed in a prominent place that was accessible to clients in care. Passageways and ramps are unobstructed. The disinfectants and cleaning solutions were stored away from the kitchen areas, food preparation areas to the children. The Menu identifies the meals for each day of the week and ach meal meets at least 1/3 of the recommended in the USDA Basic Food Group Plan-Daily Food Guide. Supplies of staples non-perishable foods for one week and perishable foods for two days are maintained in the facility. However, LPA Portillo observed approximately 6 food cans that were expired and later discarded by staff. Medications are locked and accessible only to employees supervising stored medications. The temperature in the rooms that clients occupy are maintained between 68 and 85 degrees (F) and the hot water temperature was at 107 degrees (F). OPERATIONAL REQUIREMENTS: During the inspection review, LPA observed the facility maintained an updated roster of the clients with pertinent information. The facility administrator and manager are the responsible and capable staff for communicating with emergency personnel in the facility. The facility has developed, maintained, and implemented written complaint procedures. DISASTER PREPAREDNESS PLAN: LPA Portillo reviewed the disaster and mass casualty plan and other provisions by reviewing the program statement. The facility conducts monthly fire and emergency evacuation drills. Drills are documented and kept in the facilty for at least one year. Further inspection is required on a separate day.

met_with: Jaimer Caballero, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On November 18, 2021, at 09: AM, Licensing Program Analysts (LPA) Claudia Portillo conducted an unannounced Annual inspection continuation at Eggleston Youth Center V Short Term Therapeutic Residential Treatment (STRTP) and met with Jaime Caballero. LPA stated the purpose of the inspection to the STRTP representative. During the inspection the following topics were inspected: Emergency Intervention Plan: LPA Portillo reviewed the program statement and PROACT instruction manual and identified that training is provided for all staff. The staff receive on-going training to maintain certification. A monthly log is utilized to document manual restraints to assist with the Bi-Annual Restraint Report. However, the agency has not implemented a competency test for staff and is in the process of developing a test your knowledge form. CORE THERAPEUTIC SERVICES: During the inspection review, LPA reviewed documentation that the facility is providing the Short-Term Therapeutic Program (STRTP) core services and support to the individuals in placement through Eggleston Behavioral Health Services (EBHS) which is a division of Eggleston Youth Center, Inc. The facility has trauma informed, culturally relevant, age, and developmentally appropriate. cont# CLIENT RECORDS: LPA Portillo reviewed the two (2) client file records. Needs and services plans for all two clients were trauma informed, culturally relevant, and age and developmentally appropriate and identified the child's needs: reason for placement, education, personal care and grooming, ability to manage money, visitation information, mental health services and placement information STAFFING RECORDS: During the inspection review, LPA Portillo inspected two (2) staff files and verified that all facility staff was subject to criminal records review, fingerprinted and cleared DOJ, FBI and CACI. Interviews were conducted with 2 staff and 1 client. LPA issued a Citation and Advisory Note-Technical Violation. The facility representative was provided information on where to locate Provider Information Notices (PINs), and shared PIN 21-20-CRP Compliance and Regulatory Enforcement (CARE) Tools, for Children's Residential licensees. A copy of this report and LIC 811 was provided to the facility manager, Jonathan Marquez. Exit interview conducted.


summary: Facility Evaluation

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Narrative:
On December 14, 2023, Licensing Program Analysts (LPA) Claudia Portillo an unannounced Annual Inspection at the facility and met with Jaime Caballero, Administrator. LPA stated the purpose of the inspection to the STRTP representative. One staff was interviewed. At this current moment, the facility is put on voluntary hold. There are no staff or clients at this site. A signed copy of this report was provided to the Administrator No further inspection required.


summary: Facility Evaluation

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Narrative:
An unannounced case management inspection was conducted by Licensing Program Analyst (LPA) Claudia Portillo at the above-named facility on 05/8/24 at 11: AM. LPA met and toured the facility with George Bojorquez, Administrator. There are 3 clients placed in the facility. The purpose of the visit was to conduct a quick review of the operations of the short term residential therapeutic program (STRTP) that was reopened on 4/15/24. During a home inspection the following were observe: · The license, listing of personal rights and additional resources was posted in a prominent, publicly accessible location in the facility. · Disinfectants, cleaning solutions, poisons, and other items that could pose a danger if readily available to clients were stored and inaccessible to clients. · There were non-perishable and perishable foods for clients in care (menus were displayed) · No more than two children shared a bedroom. Individual beds were maintained in good repair; equipped with good springs and a clean mattress; and supplied with pillow(s) which were clean and in good repair. · Toiletries, and grooming and personal hygiene products respect the child's or nonminor dependent's culture, ethnicity, and gender identity and expression. There are no deficiencies to be cited on this date. A copy of this report was provided to the Administrator.


summary: Facility Evaluation

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Narrative:
On November 19, 2025, Licensing Program Analysts (LPA) Claudia Portillo and Humberto Flores 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. LPA obtained and reviewed the following updated documentation: ꞏ LIC Personnel, Client roster ꞏ LIC 610C Emergency Disaster Plan (Mass Casualty Plan) ꞏ Current Board Minutes ꞏ Continuous Quality Improvement report and Mental Health Program Approval Certificate ꞏ ProAct Certificates The compliance and regulatory enforcement (CARE) tool was used by the LPAs when conducting today's inspection which consisted of a review of the following domains: physical plant, operations, disaster preparedness plan, staff files, client files, core therapeutic services and emergency intervention plan. LPA reviewed 2 staff files and 2 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, LIC 809Ds, technical advisory's, and Technical violations were provided.

met_with: Monique Ayala, Facility Manager


facility_name: ELITE FAMILY SYSTEMS, INC- BANYAN HOME

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Investigation Findings:
13Complaint Specialist C.K. Kinney(CS) conducted a telephonic Complaint Inspection due to COVID- Pandemic. CS spoke with Bill Sneed to deliver findings of investigation. CS and LPA Tinoco conducted investigation that included review of documentation, interviews of staff and of clients. Due to a inconsistencies in the information obtained a preponderance of the evidence could not be found the allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed unsubstantiated. No deficiencies observed or cited during this inspection. Copy of this report emailed to Mr. Sneed for signature and return. Copy of Appeal Rights also provided to Mr. Sneed. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Melanie Krage LICENSING EVALUATOR NAME: Charles Kinney 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

met_with: Bill Sneed


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Investigation Findings:
13Complaint Specialist C.K. Kinney(CS) conducted a telephonic Complaint Inspection due to COVID- Pandemic. CS spoke with Bill Sneed to deliver findings of investigation. CS and LPA Tinoco conducted investigation that included review of documentation, interviews of staff and of clients. Due to inconsistencies in the information obtained a preponderance of the evidence could not be found the allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed unsubstantiated. No deficiencies observed or cited during this inspection. Copy of this report emailed to Mr. Sneed for signature and return. Copy of Appeal Rights also provided to Mr. Sneed. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Melanie Krage LICENSING EVALUATOR NAME: Charles Kinney 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


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Investigation Findings:
13Complaint Specialist C.K. Kinney(CS) traveled to Elite Family Systems offices and met with Bill Sneed and Tammy Scoffield to deliver findings of investigation. CS conducted investigation that included review of documentation, interviews of staff and witnesses. Due to insufficient information and inconsistencies in the information obtained a preponderance of the evidence could not be found the allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated. No deficiencies observed or cited. Copy of this report and LIC Appeal rights left with Mr. Sneed at conclusion of inspection. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Charles Kinney 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

met_with: Bill Sneed and Tammy Scoffield


summary: Complaint Investigation - Substantiated - 1 allegation

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Investigation Findings:
13Licensing Program Analyst (LPA) Daiquiri Boyd conducted a follow-up complaint inspection to the Short Term Residential Therapeutic Program (STRTP) and met with Administrator Bill Sneed. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the course of the investigation, Community Care Licensing (CCL) conducted confidential interviews and reviewed clients files. As a result of the information found during the investigation, the above allegations were found to be substantiated. Type A: This poses an immediate health and safety risk to clients in care. Based on the LPA's observations, interviews, and the records review conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be substantiated. A copy of the report and Appeal Rights was provided to the STRTP. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Daiquiri Boyd 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 24-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, E SHAW AVE FACILITY NAME: ELITE FAMILY SYSTEMS, INC- BANYAN HOMEFACILITY NUMBER: 507002176

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


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Investigation Findings:
13Licensing Program Analyst (LPA) Daiquiri Boyd conducted an unannounced visit to the Short Term Residential Therapeutic Program (STRTP) Elite Banyan Home to deliver the findings of the above allegations and met with Administrator, Tyler Ayala. The above allegations were referred to Community Care Licensing for investigation. The investigation included confidential interviews and a review of facility and records of the children in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegations occurred. Therefore, the allegations are UNSUBSTANTIATED at this time. A copy of this report was discussed and provided to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Daiquiri Boyd 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

met_with: Tyler Ayala


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Investigation Findings:
13Licensing Program Analyst (LPA) Daiquiri Boyd conducted an unannounced visit to the Short Term Residential Therapeutic Program (STRTP) Elite Banyan Home to deliver the findings of the above allegation and met with Administrator, Tyler Ayala. The above allegation was referred to Community Care Licensing for investigation. The investigation included confidential interviews and a review of facility and records of the children in care. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegations occurred. Therefore, the allegations are UNSUBSTANTIATED at this time. A copy of this report was discussed and provided to the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Daiquiri Boyd LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


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Narrative:
On the following page, the facility is cited under the General Licensing Requirements and the STRTP Interim Licensing Standards for two type A violations for 887095(c)(2) General Provisions and 87072(c)(11) Personal Rights. A civil penalty is also assessed for a repeat violation. An exit interview was conducted and Appeal Rights and a copy of this report were provided to STRTP.

Investigation Findings:
On the above date, LPA (Licensing Program Analyst (LPA) Daiquiri Boyd conducted a complaint inspection for the purpose of resolving the investigation into the above allegations. An incident with a client resulted with FS12 using restraint techniques that were excessive to the threats posed by the client. The client hit FS12 car with his fist and was making verbal threats of throwing rocks and vandalizing cars with the rocks and was subsequently put in a restraint by FS12 which pinned the clients arm behind his back. FS12 has also been seen by multiple clients and staff occasionally bringing a pocket knife on his person into the facility. Type A: This poses an immediate health and safety risk to clients in care. Based on the LPA's observations, confidential interviews, and the records review conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be SUBSTANTIATED. A copy of the report and Appeal Rights was provided to the STRTP. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Daiquiri Boyd 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 24-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, E SHAW AVE FACILITY NAME: ELITE FAMILY SYSTEMS, INC- BANYAN HOMEFACILITY NUMBER: 507002176

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


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Investigation Findings:
13Licensing Program Analyst (LPA) Daiquiri Boyd conducted a follow-up complaint inspection to the Short Term Residential Therapeutic Program (STRTP) and met with Tyler Ayala. The purpose of the inspection was to deliver the findings for the above complaint allegation regarding the staff not having adequate training. During the course of the investigation, Community Care Licensing (CCL) conducted confidential interviews with clients and staff. The information obtained during the interviews, indicated that there were staff that were not adequately trained while they were caring for a clients medical issues. Type A: This poses an immediate health and safety risk to clients in care. Based on the LPA's observations, interviews, and the records review conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be substantiated. A copy of the report and Appeal Rights was provided to the STRTP. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Daiquiri Boyd 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 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE FACILITY NAME: ELITE FAMILY SYSTEMS, INC- BANYAN HOMEFACILITY NUMBER: 507002176

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


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Investigation Findings:
13Complaint Specialist C.K. Kinney(CS) traveled to Elite Family Systems Leslie Home and met with Jennifer Duarte to deliver findings of investigation for Banyan Home. CS conducted investigation that included review of documentation and confidential interviews. Based on inconsistencies in the information obtained a preponderance of the evidence could not be found that the allegations occurred as reported. Without a preponderance of the evidence the allegations are deemed unsubstantiated. No deficiencies observed or cited during this inspection. Copy of this report, LIC Confidential Names and LIC Appeal Rights left at the facility at conclusion of inspection. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Charles Kinney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Jennifer Duarte


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Investigation Findings:
13Complaint Specialist C.K. Kinney(CS) traveled to Elite Family Systems Leslie Home and met with Jennifer Duarte to deliver findings of investigation for Banyan Home. CS conducted investigation that included review of documentation and confidential interviews. Based on inconsistencies in the information obtained a preponderance of the evidence could not be found that the allegation occurred as reported. Without a preponderance of the evidence the allegation is deemed unsubstantiated. NO deficiencies observed or cited during this inspection. Copy of this report, LIC Confidential Names and LIC Appeal Rights UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Charles Kinney 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


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Investigation Findings:
13On November 05, 2021, Licensing Program Analyst (LPA) Eduardo Barragan conducted a complaint inspection at Elite Family Services - Banyan Home and met with Justen Mackenroth. The purpose of the inspection was to deliver the findings for the above complaint allegation. The Department has investigated the complaint alleging "Client has access to nicotine while in care." LPA Rodriguez spoke with staff, clients and reviewed other predominant documents. Based on documents reviewed, an inspection, and conversations with staff and clients, all the information that was gathered was conflicting. "Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED." An exit interview was conducted with Justen Mackenroth. A copy of this report and appeal rights were provided to Justen Mackenroth. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Eduardo Barragan LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of 3

met_with: Justen Mackenroth


summary: Facility Evaluation

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Narrative:
Complaint Specialist C.K. Kinney(CS) and Licensing Program Analyst Priscilla Zamudio(LPA) traveled to Elite Family Systems offices to conduct an annual inspection of this facility. CS met with Tammy Scoffield and Bill Sneed to conduct the inspection. CS conducted entrance interview, reviewed 6 client and 3 staff files. All required documents are in all of the clients files. CS also traveled to Banyan Home to conduct inspection of the facility. The home is licensed to serve six clients. Currently in placement are six clients. CS toured the facility and observed it to be clean, safe, sanitary and in good repair. CS observed the facility license, the menu, client's personal rights, and other forms posted on the walls throughout the facility. The facility was free of pests. CS interviewed clients and three staff. There are no weapons at the facility. No deficiencies were cited during this inspection. Exit interview conducted and a copy of the report was left at the facility.

met_with: Tammy Scoffield and Bill Sneed


summary: Facility Evaluation

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Narrative:
An unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Eduardo Barragan on 08/05/2021, at 11: AM. During the inspection, LPA Barragan met with Robert Armendariz, Administrator and inspected the facility inside and out. LPA reviewed 3 child's records at 11: AM. LPA will reviewed the staff file at the corporate office at a later date/time. LPA interviewed 1 staff on-site at 2: PM. LPA will interview the client currently taking psychotropic medications at a later date/time. No deficiencies are being cited on this date/time; however, two technical violation is being issued to the facility on this date. LPA conducted an exit interview with Robert Armendariz at 3: PM. LPA will continue the inspection another day. LPA provided the summary report to Robert Armendariz upon completion.

met_with: Robert Armendariz


summary: Facility Evaluation

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Narrative:
On July 13, 2022, Licensing Program analyst (LPA) Rachel Bruce conducted an unannounced visit to Banyon Home STRTP for the purpose of administering a Technical Advisory regarding Reporting Requirements. LPA Bruce met with Robert Armendariz, Facility Manager. Please see LIC 9102 attached.

met_with: Robert Armendariz, Facility Manager


summary: Facility Evaluation - 1 deficiency

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Narrative:
On 9/30/2022, Licensing Program Analyst (LPA), Daiquiri Boyd, visited the Short Term Residential Therapeutic Program (STRTP) Elite Family-Banyan Home for the purpose of conducting an Annual Inspection. LPA was met by Facility Manager staff Melissa Armendariz. LPA conducted a site inspection of the home, assessing the inside and outside of the home. LPA met with Rob Armendariz and discussed facility operations. Deficiencies were cited on this day. LPA will return to conclude this inspection on another day.

Deficiencies:
87095.61(f): Documentation and Reporting Requirements

(f) The licensee must maintain a monthly log of each use of manual restraints. The log must include

met_with: Rob Armendariz


summary: Facility Evaluation

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Narrative:
On 10/03/2022, Licensing Program Analyst (LPA) Daiquiri Boyd, visited the Short Term Residential Therapeutic Program (STRTP) Elite Banyan Home, for the purpose of continuing the inspection that was started on 9/30/2022. LPA Boyd was met by Facility Manager Melissa Armendariz and Administrator Rob Armendariz. A review of client files was conducted on this day. LPA interviewed available staff and clients. Deficiency was issued on this day. LPA to complete the staff file review at a later date.


summary: Facility Evaluation

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Narrative:
On 10/11/22, Licensing Program Analyst (LPA) Daiquiri Boyd, went to the Elite Family Systems Agency office, located at 2935 4th St. Ceres, CA 95307 to review staff files. LPA was met by John Sarhadi and provided the required documents. No deficiencies were cited on this visit.

met_with: John Sarhadi


summary: Facility Evaluation

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Narrative:
On 10/11/ Licensing Program Analyst (LPA) Daiquiri Boyd visited the Short Term Residential Therapeutic Program (STRTP) at Banyan Home to complete the staff and client interviews and to clear the corrections from my previous visit.


summary: Facility Evaluation

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Narrative:
LPA Boyd created this document to provide signatures.


summary: Facility Evaluation

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Narrative:
On November 4, 2022, Licensing Program Analyst (LPA) Daiquiri Boyd visited Banyan Home for the purpose of obtaining signatures on amended documents. LPA met with staff Justen Mackenroth.


summary: Facility Evaluation

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Narrative:
On June 21, 2023, Licensing Program Analyst (LPA) Daiquiri Boyd conducted an unannounced Required Inspection at Elite Family Systems Banyan Home. LPA was met by Administrator Tyler Ayala. LPA toured the facility inside and out. The facility is maintained at a comfortable temperature of 72 degrees Fahrenheit. All trash cans are covered. Smoke alarms were observed and tested and found to be in working order. Carbon monoxide detector was functioning properly. Centrally stored medications are maintained in a locked box within a locked cabinet. Sharps and toxic chemicals are kept locked. Individual beds were observed with appropriate clean linens and are in good repair. Closet space for hanging clothes was adequate and drawers were provided There is at least one week supply of nonperishable and a two day supply of perishable foods. Facility has cameras in common areas of the facility. No firearms or weapons are allowed in the facility. LPA completed 1 client interview. LPA reviewed 2 client files. No citations were issued on this day. LPA will complete this inspection at a later time. A copy of this report was left at the facility.