facility_name: MINDFUL GROWTH FOUNDATION #2

raw_content:
Narrative:
Based on the interviews conducted and documentary evidence, the information gathered did not produce corroborating evidence to support the above said allegations. LPA Edison was not able to determine if the above said allegations occurred, therefore the allegations are determined to be unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

Investigation Findings:
13On March 16, 2022 at 2:30pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Mindful Growth Foundation #2 and spoke with Sherlyn Johnson, Administrator. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation, a total of three (3) clients, three (3) staff and three (3) witnesses were interviewed. Confidential interviews and documentary evidence provided did not substantiate the allegation of Facility staff do not provide adequate supervision for the residents in care. Documentary evidence reveal the staff to client ratio. Confidential interviews and documentary evidence do not substantiate the allegation Facility staff engaged in a physical altercation with resident. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: MINDFUL GROWTH FOUNDATION #2FACILITY NUMBER: VISIT DATE: 03/16/2022

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


state: CA

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
Documentary evidence of SIR #810391 revealed Client #1 (C1) AWOL'd with another peer on 4/29/2022 and incident was cross reported to all agencies including C1's County Social Worker (CSW). Documentary evidence and inconsistent statements also revealed that C1's CSW email may be reported as incorrect in the ITrack system which may be an indicator as to why CSW may not have received the cross reported SIR's. from the facility. Confidential interviews and documentary evidence do not substantiate the allegation that facility does not transport child to school on time. Confidential interviews and documentary evidence provided revealed C1's refusal to attend school on two (2) occasions. LPA obtained two (2) signed copies of client school refusal forms for C1. Confidential interviews and documentary evidence also reveal when C1 does attend school, C1 is transported by staff to school. Documentary evidence also revealed that on one (1) occasion, C1 walked to school. LPA obtained copies of facility shift notes documenting staff transporting C1 to school. Confidential interviews and LPA application revealed that the facility telephone number does have an active voicemail set up. LPA made a telephone call to the facility telephone number and was able to leave a voicemail message. Based on the interviews conducted, documentary evidence, the information gathered did not produce corroborating evidence to support the above said allegations. LPA Edison was not able to determine if the above said allegations occurred, therefore the allegations are determined to be unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

Investigation Findings:
13On June 1, 2022 at 10:12am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Mindful Growth Foundation #2 and spoke with Fannie Linnear, Facility Manager. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation, a total of three (3) staff, three (3) clients, and one (1) witness were interviewed. Confidential interviews and documentary evidence provided did not substantiate the allegation facility does not report child AWOL. LPA obtained copies of Special Incident Report's (SIR) #810391, #810240, #807793, 809577, 808498, and #807735 regarding Client #1's (C1) AWOL incidents. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: MINDFUL GROWTH FOUNDATION #2FACILITY NUMBER: VISIT DATE: 06/01/2022

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

report_type: Complaint Investigation

met_with: Fannie Linnear-Facility Manager

complaint_status: unsubstantiated


raw_content:
Narrative:
Confidential interviews and documentary evidence revealed inconsistent statements and do not substantiate the allegation Facility staff engaged in a physical altercation with resident. Staff interviews revealed no knowledge of any facility staff engaging in a physical altercation with any resident in care. Confidential interviews revealed inconsistency in statements regarding whether residents removed bedroom window screens for the purpose of going in and out of the facility without staff knowledge and for the purpose of residents smoking marijuana out of the bedroom windows. Confidential interviews and inconsistent statements determined that although it was reported that staff would not address residents smoking marijuana outside of the facility, it could not be determined whether or not staff did not address any resident who was caught smoking marijuana at the facility. Based on the interviews conducted and documentary evidence, the information gathered did not produce corroborating evidence to support the above said allegations. LPA Edison was not able to determine if the above said allegations occurred, therefore the allegations are determined to be unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. No deficiencies were observed or cited at the time of this investigation. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

Investigation Findings:
13This an amended report from the original date of 3/16/2022. On March 16, 2022 at 2:30pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Mindful Growth Foundation #2 and spoke with Sherlyn Johnson, Administrator. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation, a total of five (5) clients, five (5) staff and three (3) witnesses were interviewed. Confidential interviews and documentary evidence provided did not substantiate the allegation of Facility staff do not provide adequate supervision for the residents in care. Interviews with staff and clients revealed that clients are adequately supervised, and an incentive program is in place to encourage clients with positive behavior and following the STRTP program rules. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: MINDFUL GROWTH FOUNDATION #2FACILITY NUMBER: VISIT DATE: 07/07/2022

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

met_with: Sherlyn Johnson-Administrator


raw_content:
Narrative:
Documentary evidence also reveal client's acknowledgement and agreement of the house rules as it relates to the policy on marijuana possession and their use on the physical premises of the facility. LPA obtained signed copies by Client #1 (C1), Client #2 (C2), and Client #3 (C3) of the house rules, Code of Ethics, and admissions agreement. LPA also obtained signed copies of Needs and Services Plans for C1, C2, and C3, as well as signed copies of the incentive plan contract as it relates to the drug policy for the facility. Based on the interviews conducted, documentary evidence, the information gathered did not produce corroborating evidence to support the above said allegations. LPA Edison was not able to determine if the above said allegations occurred, therefore the allegations are determined to be unsubstantiated, meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. LPA provided Facility Manager with a current Foster Youth Bill of Rights for the facility. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

Investigation Findings:
13On August 25, 2022 at 12:46pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Mindful Growth Foundation #2 and spoke with Lonette Flowers, Facility Manager. The purpose of this visit was to deliver the findings for the above complaint allegations. During the investigation, a total of three (3) clients, four (4) staff, and five (5) witnesses were interviewed. Confidential interviews and documentary evidence provided did not substantiate the allegation of Staff are not adequately supervising youth. LPA obtained a copy of the LIC 500 which reflects staff supervision for clients in care and overnight shift notes for the period of 7/25/2022 - 8/5/2022. Confidential interviews and documentary evidence did not substantiate the allegations of Staff are providing marijuana to minors and Minors smoking marijuana. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: MINDFUL GROWTH FOUNDATION #2FACILITY NUMBER: VISIT DATE: 08/25/2022

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

met_with: Lonette Flowers-Facility Manager


raw_content:
Narrative:
Documentary evidence revealed client's acknowledgement and agreement of the house rules as it relates to the policy on marijuana possession and their use on the physical premises of the facility. LPA obtained copies of the House Rules and Code of Ethics signed by clients, client Needs and Services Plan, staff shift notes, and client incident reports. LPA also obtained signed copies of the incentive plan contract as it relates to the drug policy for the facility. Based on the interviews conducted, documentary evidence, the information gathered did not produce corroborating evidence to support the above said allegation. LPA Edison was not able to determine if the above said allegation occurred, therefore the allegation is determined to be unsubstantiated, meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that a violation occurred. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.

Investigation Findings:
13On July 27, 2023 at 12:12pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Mindful Growth Foundation #2 and spoke with Thomas Washington, Facility Manager. The purpose of this visit was to deliver the findings for the above complaint allegation. LPA was informed that Sherlyn Johnson, Administrator is not at the facility. During the investigation LPA Edison interviewed and accounted for all available relevant parties and gathered pertinent information regarding the allegation. Based on interviews, documentary evidence, and statements obtained during the investigation process, LPA was unable to corroborate the allegation. Confidential interviews, consistent statements and documentary evidence did not indicate facility staff are allowing minors to smoke marijuana on the premises. Continued on LIC 9099-C UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Daphne Edison LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, N. Continental Blvd. #290B FACILITY NAME: MINDFUL GROWTH FOUNDATION #2FACILITY NUMBER: VISIT DATE: 07/27/2023

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

met_with: Thomas Washington - Facility Manager


raw_content:
Narrative:
Per Interim Licensing Standards (ILS), Article 6, Section 87065.2 (b)(1)-Personnel Duties is being cited. (See LIC9909D). Exit interview was completed and copy of the report and appeal rights were discussed and provided to Facility Administrator, Thomas Washington . Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation did or did not occur, therefore, the allegation is unsubstantiated. No deficiencies cited. Exit interview completed and copy of the report and appeal rights were discussed and provided to Facility Administrator, Thomas Washington.

Investigation Findings:
13On 08/13/25, at 12:13PM, Licensing Program Analyst (LPA) Andrea Aceves and Licensing Program Manager (LPM) Lakescia Smith made an unannounced visit to the above facility to conclude the investigation and to deliver the findings on the above allegation. LPA Andrea and LPM Lakescia met with Facility Administrator, Thomas Washington. During the investigation, LPA Andrea interviewed all available parties and reviewed LIC500-Personnel Report, C1's Needs and Services Plan, pictures of staff sleeping, staff disciplinary reports and signed acknowledgement of policy from S2 and S3. It was reported that "Staff was asleep during his work shift". Interview statements from staff, documentation of disciplinary reports and pictures of staff #2 sleeping were reviewed. In addition, an amended Mindful Growth investigative report that indicates that S2 admitted to being asleep on shift; the preponderance of evidence standard has been met. Per interview with Staff #2, he confirmed that he fell asleep while on shift. Therefore, the allegation of "Staff was asleep during his work shift" is SUBSTANTIATED. See LIC9099C. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Andrea Aceves LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: MINDFUL GROWTH FOUNDATION #2FACILITY NUMBER: VISIT DATE: 08/13/2025

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

met_with: Facility Administrator Thomas Washington


summary: Facility Evaluation

raw_content:
Narrative:
On March 8, 2022 at 9:06am, Licensing Program Analysts (LPA) Daphne Edison made an unannounced visit to Mindful Growth Foundation #2 for the purpose of conducting an Annual Required Inspection. LPA met with Thomas Washington, Facility Manager who granted access into the home and together a tour was conducted both inside and out. The home is licensed to provide care and supervision for six (6) children, ages 12-17 years, ambulatory only. The facility will also provide services to non-minor dependents pursuant to W & I code 16501.1 (C) (1). The census today is six (6). The home is set up as follows: This is a three (3) bedroom, two (2) bathroom home and is located in a residential neighborhood. The home has a living room, dining area, kitchen, a laundry area, a staff office, and a detached garage. Living Room: Equipped with a rectangle wooden storage desk, a sofa, a mounted TV, and has a decorative fireplace mount. Dining Area: Equipped with a wooden table with six (6) chairs, there is also a small desk and chair for client use. Kitchen: Equipped with a stove/oven with five (5) burners, all working at this time. There is a microwave and a refrigerator/freezer combination. The home was observed to have one (1) week of nonperishable and two (2) days of perishable food supplies. Bedroom #1: Occupied. Equipped with two (2) twin sized beds with adequate storage and closet space. Bedroom # 2: Occupied. Equipped with two (2) twin sized beds with adequate storage and closet space. Continued on LIC 809-C Bedroom#3: Occupied. Equipped with two (2) twin sized beds with adequate storage and closet space. (Bathroom #2 is located inside of Bedroom #3). All bedrooms were observed to have adequate lighting, mattresses in good repair and clean linens and bedding. Bathroom #1: Located in the hallway between Bedroom #2 and #3. Equipped with a bathtub/shower combination, a toilet, and a sink. Clean and in operable condition. Bathroom #2: (Located inside of Bedroom #3). Equipped with a standing shower, a toilet, and a sink. Clean and in operable condition. Laundry Area: Located off the kitchen. Equipped with a washer and dryer. Laundry supplies, cleaning solutions are locked in a cabinet with a key accessible by staff. There is a door leading to the back yard. Staff Office: Located off of the dining area. Equipped with a desk, chair, a computer, and it remains locked when not in use by staff. Detached garage: Located in the back of the home and was observed to be used for storage. LPA observed the home to be clean, safe, sanitary and in good repair. Passageways, stairways, inclines, ramps and open porches are unobstructed. Disinfectants, cleaning solutions, and poisons items are made inaccessible to clients. All knives and sharp objects are made inaccessible to the clients in care. Medications are locked in a toolbox stored in the staff office. There are no security bars on the windows. There are no weapons located in the home. All smoke detectors, carbon monoxide detectors tested audible and are working properly. The home is equipped with two (2) regulation fire extinguishers. During this visit, LPA conducted three (3) client interviews and reviewed three (3) client records which contained copies of Needs and Service Plans and Medical Authorizations signed by each child and their authorized representative. Children in care are supervised and protected at all times. Children are accorded dignity in personal relationships with staff and others. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. It was reported that children attend school, extracurricular, cultural and personal enrichment activities. Continued on LIC 809-C LPA will review staff records and conduct staff interviews on a later date. Caregiver(s)/adults working/residing in the home have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. The home is operating within the capacity and limitations of the license. Facility vehicle is in good repair with current and valid vehicle registration and insurance. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit Interview was conducted, and a copy of this report will be emailed to the Administrator.

report_type: Facility Evaluation

visit_type: Annual

met_with: Thomas Washington-Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On March 24, 2022 at 9:08am, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Mindful Growth Foundation #2 for the purpose of conducting a Case Management of an Annual Required Inspection which took place on March 8, 2022. LPA met with Thomas Washington, Facility Manager who granted access into the home and together a tour was conducted both inside and out. The home is licensed to provide care and supervision for six (6) children, ages 12-17 years, ambulatory only. The facility will also provide services to non-minor dependents pursuant to W & I code 16501.1 (C) (1). The census on this day is five (5). The home is set up as follows: This is a three (3) bedroom, two (2) bathroom home and is in a residential neighborhood. The home has a living room, dining area, kitchen, a laundry area, a staff office, and a detached garage. LPA observed the home to be clean, safe, sanitary and in good repair. Passageways, stairways, inclines, ramps, and open porches are unobstructed. Disinfectants, cleaning solutions, and poisons items are made inaccessible to clients. All knives and sharp objects are made inaccessible to the clients in care. Medications are locked in a toolbox stored in the staff office. There are no security bars on the windows. There are no weapons located in the home. All smoke detectors, carbon monoxide detectors tested audible and are working properly. The home is equipped with two (2) regulation fire extinguishers. Children in care are always supervised and protected. Children are accorded dignity in personal relationships with staff and others. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. It was reported that children attend school, extracurricular, cultural, and personal enrichment activities. Continued on LIC 809-C During this visit, LPA reviewed six (6) staff records and conducted three (3) staff interviews. Caregiver(s)/adults working/residing in the home have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. The home is operating within the capacity and limitations of the license. LPA advised Executive Director and Facility Manager about Licensing Fees of $454.00 due by 4/1/2022. Executive Director stated Licensing Fees will be paid by 4/1/2022. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit Interview was conducted, and a copy of this report will be emailed to the Administrator.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On August 25, 2022 at 1:21pm, Licensing Program Analyst (LPA) Daphne Edison made an unannounced visit to Mindful Growth Foundation #2 for the purpose of a Case Management for Special Incident Report #824208. During this visit, confidential interviews were conducted. Additional interviews will be conducted on a later date. On this day, LPA observed a Chrysler Pacifica, License Plate 8RZJ213 in the driveway of the facility at the above address. Facility Manager stated that on 8/19/2022, one (1) staff and one (1) client had been involved in an automobile accident in the Chrysler Pacifica. Facility Manager stated that the Chrysler Pacifica was a rental vehicle. Facility Manager stated that the facility vehicle was in the automotive shop at the time of the accident for maintenance. Facility Manager stated staff and client were uninjured in the automobile accident. Facility Manager stated that neither staff nor client was in need of medical attention as a result of the automobile accident. Facility Manager provided LPA with a copy of Special Incident Report #824208 (SIR). Based on the interviews and information gathered, there was insufficient information provided. This case management needs further investigation. Based on the observations made during today's visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit interview was conducted, and a copy of this report will be emailed to the Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On January 30, 2023 at 8:44am, Licensing Program Analysts (LPA) Daphne Edison made an unannounced visit to Mindful Growth Foundation #2 for the purpose of conducting an Annual Required Inspection. LPA met with Domonique Grigsby, Direct Care Staff and Jasmine Sampson, Executive Director who granted access into the home and together a tour was conducted both inside and out. The home is licensed to provide care and supervision for six (6) children, ages 12-17 years, ambulatory only. The facility will also provide services to non-minor dependents pursuant to W & I code 16501.1(C)(1). The census today is six (6). The home is set up as follows: This is a three (3) bedroom, two (2) bathroom home located in a residential neighborhood. The home has a living room, dining area, kitchen, a laundry area, a staff office, and a detached garage. Living Room: Equipped with a rectangle wooden storage desk, a sofa, a mounted TV, and has a decorative fireplace mount. Dining Area: Equipped with a wooden table with six (6) chairs, there is also a small desk and chair for client use. Kitchen: Equipped with a stove/oven with four (4) burners, all working at this time. There is a microwave and a refrigerator/freezer combination. The home was observed to have one (1) week of nonperishable and perishable food supplies. Bedroom #1: Occupied. Equipped with two (2) twin sized beds with adequate storage and closet space. Bedroom # 2: Occupied. Equipped with two (2) twin sized beds with adequate storage and closet space. Bedroom #3: Occupied. Equipped with two (2) twin sized beds with adequate storage and closet space. (Bathroom #2 is located inside of Bedroom #3). Continued on LIC 809-C All bedrooms were observed to have adequate lighting. All beds were observed to have comfortable mattresses, clean linens, blankets, and pillows, all in good repair. Bathroom #1: Located in the hallway between Bedroom #2 and #3. Equipped with a bathtub/shower combination, a toilet, and a sink. Clean and in operable condition. Bathroom #2: (Located inside of Bedroom #3). Equipped with a standing shower, a toilet, and a sink. Clean and in operable condition. Laundry Area: Located off the kitchen. Equipped with an operable washer and dryer. Laundry supplies, cleaning solutions are locked in a cabinet with a key accessible by staff. There is a door leading to the back yard. Staff Office: Located off the dining area. Equipped with a desk, chair, a computer, and it remains locked when not in use by staff. Detached garage: Located in the back of the home and was observed to be used for storage. LPA observed the home to be clean, safe, sanitary and in good repair. Passageways, stairways, inclines, ramps, and open porches are unobstructed. The front and back yards were inspected and found to be clear of hazards and debris. Disinfectants, cleaning solutions, and poisons items are made inaccessible to clients. All knives and sharp objects are made inaccessible to the clients in care. Medications are locked in a toolbox stored in the staff office. There are no security bars on the windows. There are no weapons located in the home. First aid kit was checked and found to be complete with scissors, tweezers, thermometer, and First Aid Manual. Hot water was tested and is in a safe temperature range All smoke detectors, carbon monoxide detectors tested audible and are working properly. The home is equipped with two (2) fully charged regulation fire extinguishers. During this visit, LPA conducted two (2) client interviews and reviewed five (5) client files which contained copies of Needs and Service Plans and Medical Authorizations signed by each child and their authorized representative. Children in care are supervised and protected. Children are accorded dignity in personal relationships with staff and others. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. It was reported that children attend school, extracurricular, cultural, and personal enrichment activities. Continued on LIC 809-C LPA conducted three (3) staff interviews and reviewed five (5) staff files. Caregiver(s)/adults working/residing in the home have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. The home is operating within the capacity and limitations of the license. All other posting requirements were met. Facility vehicle is in good repair with current and valid vehicle registration and insurance. LPA requested and was provided with a current LIC 500. LPA provided facility with new Foster Youth Bill of Rights poster to display. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit Interview was conducted, and a copy of this report will be emailed to the Administrator.

met_with: Jasmine Sampson-Executive Director


summary: Facility Evaluation

raw_content:
Narrative:
On March 7,2024 at 9:00am Licensing Program Analysts (LPA) Deborah Lee and Licensing Program Manager (LPM) Bernice Karnsrithong made an unannounced visit to Mindful Growth Foundation #2 for the purpose of conducting an Annual Required Inspection. LPA met with Domonique Grisby Facility Manager who granted access into the home and together a tour was conducted both inside and out. The home is licensed to provide care and supervision for six (6) children, ages 12-17 years, ambulatory only. The facility will also provide services to non-minor dependents pursuant to W & I code 16501.1(C)(1). The census today is The home is set up as follows: This is a three (3) bedroom, two (2) bathroom home located in a residential neighborhood. The home has a living room, dining area, kitchen, a laundry area, a staff office, and a detached garage. Living Room: Equipped with a rectangle wooden storage desk, a sofa, a mounted TV, and has a decorative fireplace mount. Dining Area: Equipped with a wooden table with six (6) chairs, there is also a small storage area for games for client use and book for visitor sign-in. Antibacterial wipes are also located on the top of small storage area. Kitchen: Equipped with a stove/oven with four (4) burners, all working at this time. There is a microwave and a refrigerator/freezer combination. The home was observed to have one (1) week of nonperishable and perishable food supplies. Bedroom #1: Occupied. Equipped with two (2) twin sized beds with adequate storage and closet space. Bedroom # 2: Occupied. Equipped with two (2) twin sized beds with adequate storage and closet space. page 1 of Bedroom #3: Occupied. Equipped with two (2) twin sized beds with adequate storage and closet space. (Bathroom #2 is located inside of Bedroom #3). All bedrooms were observed to have adequate lighting. All beds were observed to have comfortable mattresses, clean linens, blankets, and pillows, all in good repair. Bathroom #1: Located in the hallway between Bedroom #2 and #3. Equipped with a bathtub/shower combination, a toilet, and a sink. Clean and in operable condition. Bathroom #2: (Located inside of Bedroom #3). Equipped with a standing shower, a toilet, and a sink. Clean and in operable condition. Laundry Area: Located off the kitchen. Equipped with an operable washer and dryer. Laundry supplies, cleaning solutions are locked in a cabinet with a key accessible by staff. There is a door leading to the back yard. Staff Office: Located off the dining area. Equipped with a desk, chair, a computer, and it remains locked when not in use by staff. Detached garage: Located in the back of the home and was observed to be used for storage along with additional bottled water. LPA observed the home to be clean, safe, sanitary and in good repair. Passageways, stairways, and open porches are unobstructed. The front and back yards were inspected and found to be clear of hazards and debris. Disinfectants, cleaning solutions, and poisons items are made inaccessible to clients. All knives and sharp objects are made inaccessible to the clients in care. Medications are locked in a toolbox stored in the staff office. There are no security bars on the windows. There are no weapons located in the home. First aid kit was checked and found to be complete with scissors, tweezers, thermometer, and First Aid Manual. Hot water was tested and is in a safe temperature range All smoke detectors, carbon monoxide detectors tested audible and are working properly. The home is equipped with two (2) fully charged regulation fire extinguishers. page 2 of During this visit, LPA conducted two (2) client interviews and reviewed 3 client files. Children in care are supervised and protected. Children are accorded dignity in personal relationships with staff and others. Children can contact the licensing agency or Foster Care Ombudsperson in confidence without threats or punishment for making complaints. It was reported that children attend school, extracurricular, cultural, and personal enrichment activities. LPA conducted 3 staff interviews and reviewed 3 staff files. Caregiver(s)/adults working/residing in the home have DOJ/FBI criminal record clearances and Child Abuse Index Checks. Emergency Mass Disaster Casualty Plan was available for review. LPA reiterated the importance of submitting Special Incident Reports and reporting all changes within the facility to Community Care Licensing and any other appropriate agency. The home is operating within the capacity and limitations of the license. All other posting requirements were met. Facility vehicle is in good repair with current and valid vehicle registration and insurance. LPA requested and was provided with a current LIC 500. Based on the observations made during today's inspection, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Exit Interview was conducted, and a copy of this report will be emailed to the Administrator Page 3 of 3.

met_with: Domonique Grisgby, Facility Manager


summary: Complaint Investigation - Unsubstantiated

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Narrative:
During the course of the investigation, LPA received little information regarding the alleged event, especially from eyewitnesses and clients/staff who were actually present at the time. Most staff/clients present at the time denied interviews. LPA did conduct one interview where a client confirmed that a tattoo gun was brought to the facility, but they shared that the facility staff had the appropriate response to remove the tattoo gun and the visitor before any clients received a tattoo. Based on conflicting testimony and lack of evidence, while a tattoo gun was present at the facility, LPA could not determine whether the staff's response was inappropriate in preventing clients from getting tattoos. Therefore, based on the available information LPA gathered from interviews, the preponderance of the evidence standard has not been met; therefore, the allegation of "Staff allowed minors in care to get tattoos at the facility" is found to be unsubstantiated. Exit Interview Conducted

Investigation Findings:
13On 3/12/26, Licensing Program Analyst (LPA) Reagan Cohen arrived at the above facility and met with Darryl Shobey Facility Manager for the purpose of delivering complaint findings regarding the above allegation. During the course of the investigation, LPA interviewed involved staff, clients, and witnesses. No clients currently at the facility were present during the time the allegations were made. All clients also denied any incident of a client getting tattoos on the facility's front porch. Most current staff at the facility were not present during the time the allegations were made. All staff denied any incident involving a client getting tattoos on the facility's front porch. LPA attempted to interview staff and clients from around the time of the allegations. Some clients and staff denied interviews. One client who was present at the time of the allegations shared, "I remember there was a situation once where a visitor did bring over a tattoo gun. The staff was around, and when they saw it, they asked the person to stop and leave. The visitor then left. I believe staff saw it and responded appropriately. The incident was around June. I don't remember what staff or clients were involved." UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lakescia Smith LICENSING EVALUATOR NAME: Reagan Cohen LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 34-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION EL SEGUNDO CRP RO, N. Continental Blvd. #290B FACILITY NAME: MINDFUL GROWTH FOUNDATION #2FACILITY NUMBER: VISIT DATE: 03/12/2026

met_with: Darryl Shobey Facility Manager


raw_content:
Investigation Findings:
13On March 20, at 9:15 am, Licensing Program Analyst (LPA) Kenrick Ellis made an unannounced complaint inspection to the above facility for the purpose of concluding the investigation of the above allegation and deliver the findings. LPA met with Dominque Turner, Direct Support Staff and discussed the investigative findings. It was reported that staff are not properly supervising minors in care resulting in incidents of vandalism. During the investigation (LPA) Kenrick Ellis conducted multiple client,staff, and neighborhood resident interviews. LPA obtained the facilities LIC500, client roster, SIR report related to alleged incident. LPA provided contact information to nieghbors adjacent to the above facility. Interviews conducted could not determine the validity of the allegation. Multiple statements indicated that staff are present and provide supervision to minors in care. Inconsistent statements alleged that youth vandalize neighboring property. No evidence of vandalization was provided to LPA. 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. No deficiencies are being cited at this time. Exit Interview conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: JoAunne Griffin LICENSING EVALUATOR NAME: Kenrick Ellis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

met_with: Dominque Turner, Direct Suport Staff


facility_name: MOLLIE'S HOUSE

raw_content:
Investigation Findings:
13On 07/22/2021, Licensing Program Analysts (LPAs) Lisa Slusher and Tamara Melikian conducted a follow up complaint investigation to inform the facility of the outcome of the investigation. Met at the facility by Executive Director Torella Minor. Interviews were conducted and documents were obtained. Client (#1) had an initial appointment with a mental health clinician, but it is unclear whether a follow up appointment was scheduled and the client (#1) is no longer in placement. Client (#1) was placed at the end of the school year and is no longer in placement, however was advised that client (#1) would be attending school in a home study format. Based on the above, there is not a preponderance of evidence that the clients are not being provided services needed or that the client (#1) was not going to be able to attend school in person for the upcoming school year. A copy of this report is left with the Executive Director. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Lisa Slusher LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, E SHAW AVE This is an official report of an unannounced visit/investigation of a complaint received in our office on 06/30/2021 and conducted by Evaluator Lisa Slusher PUBLICCOMPLAINT CONTROL NUMBER: 24-CR- FACILITY NAME:MOLLIE'S HOUSEFACILITY NUMBER: ADMINISTRATOR:MINOR, TORELLAFACILITY TYPE: ADDRESS: WEST BULLARDTELEPHONE: (559) 425- CITY:FRESNOSTATE: CAZIP CODE: CAPACITY:6CENSUS: 3DATE: 07/22/ UNANNOUNCEDTIME BEGAN: 10: AM MET WITH:Torella MinorTIME COMPLETED:12: PM 9Client not able to have telephone calls. INVESTIGATION FINDINGS: 13On 07/22/2021, Licensing Program Analysts (LPAs) Lisa Slusher and Tamara Melikian conducted a follow up complaint investigation to inform the facility of the outcome of the investigation. Met at the facility by Executive Director Torella Minor. Interviews were conducted and documents were obtained. Based on interviews conducted, client (#1) was unable to have telephone calls with family members that were not on an approved contact list. Based on a review of client records, there was not a valid court order (for family contacts) or limitations approved by the authorized representative (for other contacts). Based on the above, the complaint is Substantiated. Deficiency on the attached page. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Lisa Slusher LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 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: MOLLIE'S HOUSEFACILITY NUMBER: 107202634

met_with: Torella Minor


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Lisa Susher conducted a follow up complaint inspection at the facility and spoke with Facility Manager Renee Lane. The purpose of the inspection was to deliver the findings for the above complaint allegation(s). During the investigation, LPA conducted a record review and conducted interviews with Foster youth, staff and others. LPA conducted review of program statement and incident report dated 7/13/21. Due to the conflicting information revealed in the interview process, the agency has deemed the allegation(s) to be unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to provide the alleged violation did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted, and a copy of this report was provided to the social work supervisor. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Lisa Slusher LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, E SHAW AVE This is an official report of an unannounced visit/investigation of a complaint received in our office on 07/15/2021 and conducted by Evaluator Lisa Slusher PUBLICCOMPLAINT CONTROL NUMBER: 24-CR- FACILITY NAME:MOLLIE'S HOUSEFACILITY NUMBER: ADMINISTRATOR:MINOR, TORELLAFACILITY TYPE: ADDRESS: WEST BULLARDTELEPHONE: (559) 425- CITY:FRESNOSTATE: CAZIP CODE: CAPACITY:6CENSUS: DATE: 11/12/ UNANNOUNCEDTIME BEGAN: 09: AM MET WITH:Renee LaneTIME COMPLETED:12: PM 9Facility did not follow removal procedures with C1. INVESTIGATION FINDINGS: 137/27/21, Licensing Program Analyst (LPA) Lisa Slusher conducted a complaint inspection for Mollie's House STRTP and met with Facility Manager Renee Lane. Interviews were conducted of the administrator, staff and others. LPA reviewed files for submitted incident reports for the youth. LPA reviewed discharge information. Information gathered verifies that tthe facility did not follow appropriate procedures to try to mitigate permanent removal from the facility following temporary removal by law enforcement. Citation issued on this date for section 87068.4(c) Removal And transfer. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Lisa Slusher LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 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: MOLLIE'S HOUSEFACILITY NUMBER: 107202634

met_with: Renee Lane


summary: Complaint Investigation - Substantiated

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Investigation Findings:
13On July 11, 2022, Licensing Program Analyst (LPA) Tamara Melikian conducted an complaint inspection to inform the facility of the outcome of the investigation. Met at the agency by Executive Director Torella Minor. Confidential interviews were conducted and records were reviewed. Based on the above, the complaint is Substantiated. Deficiencies on the attached page. A copy of this report is left with the Executive Director. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Tamara Melikian 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: MOLLIE'S HOUSEFACILITY NUMBER: 107202634

complaint_status: SUBSTANTIATED


summary: Complaint Investigation - Substantiated

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Investigation Findings:
13On the above date, LPA (Licensing Program Analyst) Lisa Slusher conducted a complaint inspection for the purpose of resolving the investigation into the above matter. On 8/21/ S1 had an activity with the youth. During the activity, the staff person allowed a game of "truth or dare" where the dares included licking the floor, drinking a spoonfull of water from the toilet tank, drinking milk with mustard mixed in and wiping their hands underneath the couch and licking their fingers. During the course of the investigation, LPA conducted interviews and reviewed documentation. Based on confidential interviews and documentation the allegation is SUBSTANTIATED. 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 80065(a) Personnel Requirements and 87072(c) Personal Rights. A civil penalty is also assessed for a repeat violation. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Lisa Slusher 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: MOLLIE'S HOUSEFACILITY NUMBER: 107202634


summary: Complaint Investigation - Substantiated

raw_content:
Investigation Findings:
13On the above date, LPA (Licensing Program Analyst) Lisa Slusher conducted a complaint inspection for the purpose of resolving the investigation into the above matter. The previous Therapist for the facility was not meeting mental health requirements for providing services. Additionally, the facility did not maintain needs and services plan explaining the mental health services required for youth. During the course of the investigation, LPA conducted interviews and reviewed documentation. Based on confidential interviews and documentation the allegation is SUBSTANTIATED. The facility is cited on this dat for STRTP Interim Licensing Standards for 87089.1 (d) Mental Health Program Approval SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Lisa Slusher 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: MOLLIE'S HOUSEFACILITY NUMBER: 107202634

met_with: Torella Minor, Renee Lane


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Lisa Slusher conducted an unannounced visit to the Mollie's House STRTP, in order to deliver the findings of the above allegations and met with Administrator, Aaron Holloway. The above allegations were referred to Community Care Licensing for investigation. The investigation included interviews and a review of facility and foster children's records. 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 along with appeal rights. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Lisa Slusher 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


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Investigation Findings:
13On July 17, 2024, Licensing Program Analyst (LPA), Vanessa Galvan traveled to Mollie's House located in Fresno, CA to conduct an unannounced complaint inspection and met with Administrator Renee Lane. The purpose of the inspection was to deliver the findings for the above complaint allegations. The Department has investigated the above complaints. During the course of the investigation, LPA conducted confidential interviews. Based on interviews, it was determined that although the allegations may have happened or is valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted discussing this report and the appeal rights. A copy of this report and appeal rights were provided to Renee Lane at the conclusion of the inspection. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Vanessa Galvan LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORTCALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE This is an official report of an unannounced visit/investigation of a complaint received in our office on 04/25/2024 and conducted by Evaluator Vanessa Galvan PUBLICCOMPLAINT CONTROL NUMBER: 24-CR- FACILITY NAME:MOLLIE'S HOUSEFACILITY NUMBER: ADMINISTRATOR:MINOR, TORELLAFACILITY TYPE: ADDRESS: WEST BULLARDTELEPHONE: (559) 425- CITY:FRESNOSTATE: CAZIP CODE: CAPACITY:6CENSUS: 1DATE: 07/17/ UNANNOUNCEDTIME BEGAN: 01: PM MET WITH:Renee LaneTIME COMPLETED:02: PM 9Staff behavior posed as a risk to the minors while in care. INVESTIGATION FINDINGS: 13On July 17, 2024, Licensing Program Analyst (LPA), Vanessa Galvan traveled to Mollie's House located in Fresno, CA to conduct an unannounced complaint inspection and met with Administrator Renee Lane. The purpose of the inspection was to deliver the findings for the above complaint allegation. The Department has investigated the above complaint allegation. During the course of the investigation, LPA conducted confidential interviews. Based on information obtained and confidential interviews, it was determined that the preponderance of evidence standard has been met; therefore, the above allegation is found to be SUBSTANTIATED. The agency is being cited for Interim Licensing Standards, STRTP Article 06. Continuing Requirements, Personal Rights 87072(c)(16). See Attached LIC 9099D for further information. An exit interview was conducted discussing this report and the appeal rights. A copy of this report and appeal rights were provided to Renee Lane at the conclusion of the inspection. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Vanessa Galvan LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 2 of Control Number 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: MOLLIE'S HOUSEFACILITY NUMBER: 107202634


raw_content:
Investigation Findings:
13On August 28, 2024, Licensing Program Analyst (LPA), Vanessa Galvan traveled to Mollie's House located in Fresno, CA to conduct an unannounced complaint inspection and met with Administrator Renee Lane. The purpose of the inspection was to deliver the findings for the above complaint allegations. The Department has investigated the above complaints. During the course of the investigation, LPA conducted confidential interviews, file review, and obtained copies of documentation. Based on confidential interviews, it was determined that although the allegations may have happened or is valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted discussing this report and the appeal rights. A copy of this report and appeal rights were provided to Renee Lane at the conclusion of the inspection. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Vanessa Galvan 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


raw_content:
Investigation Findings:
13On September 19, 2024, Licensing Program Analyst (LPA), Vanessa Galvan traveled to Mollie's House located in Fresno, CA to conduct an unannounced complaint inspection and met with Administrator Renee Lane. The purpose of the inspection was to deliver the findings for the above complaint allegations. The Department has investigated the above complaints. During the course of the investigation, LPA conducted confidential interviews, file review, and obtained copies of documentation. Based on confidential interviews, it was determined that although the allegations may have happened or is valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted discussing this report and the appeal rights. A copy of this report and appeal rights were provided to Renee Lane at the conclusion of the inspection via email due to printer error. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Vanessa Galvan 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: Renee House


summary: Facility Evaluation

raw_content:
Narrative:
On 06/16/2021, Licensing Program Analyst (LPA) Tamara Melikian and Licensing Program Manager Melanie Krage conducted an unannounced annual inspection at the above facility. Met at the facility by Administrator Torella Minor. Staff files and client files inspected. An inspection of the physical plant was conducted indoors and outdoors. The facility was clean and sanitary and there were no observable hazards. The temperature was a comfortable temperature and met the intent of the regulation. The food was ample and sufficient for both perishable and nonperishable items. There were no bodies of water at the facility. Per the Administrator, there are no firearms at the facility. The facility has one small dog. The medications are double locked and all chemicals and cleaning agents are locked. The personal rights are posted in the facility. The hot water temperature measured at 106 degrees. The current status of the facility's mental health program and accreditation status are discussed with the Administrator. There are no deficiencies to be cited on this date.


summary: Facility Evaluation

raw_content:
Narrative:
On July 7, 2021, Licensing Program Analysts (LPAs) Lisa Slusher and Tamara Melikian conducted a case management inspection at the above facility. Met at the facility by Executive Director Torella Minor. The purpose of the inspection was to discuss the status of the facility's mental health program approval. The 24 month provisional license for the facility expires on July 11, 2021. Ms. Minor was informed by the county that a site inspection would be conducted prior to the July 11, 2021 expiration of the provisional, however, at this time the inspection has not been scheduled. Ms. Minor will contact the county on this date to attempt to schedule an inspection. Community Care Licensing will be immediately informed on whether an inspection will be completed prior to the expiration of the license. Ms. Minor will also submit a closure plan and client roster to Community Care Licensing on this date. There are no deficiencies to be cited on this date.


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, a meeting was held via Microsoft Teams. Present were Licensing Program Analysts Lisa Slusher and Tamara Melikian and Licensing Program Manager Lourey Bartolome. During this call, the upcoming deadline for Accreditation was discussed. It is noted that the agency is already beyond the 24 month regulatory requirement for Accreditation. FFPSA (Family First Prevention Services Act) legislation requires Accreditation by 10/1/21. Currently the agency is scheduled for an accreditation survey by CARF in mid-October, but is trying to schedule the survey for earlier. Administrator Torella Minor will contact the authorized representatives for the 3 youth currently placed in the facility, will contact CARF and inquire about survey/accreditation target dates, and will contact the Foster Care Rates Bureau. An update will be provided to community care licensing.


summary: Facility Evaluation

raw_content:
Narrative:
On this date, LPA (Licensing Program Analyst) Lisa Slusher conducted an unannounced case management inspection. Prior to this inspection a covid risk assessment was completed. During a client file review, it was noted that although the facility conducts pre-Admission screenings and documentation, no crisis management assessment was in file. A technical advisory is issued on this date. No deficiencies cited in areas observed.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 08/24/22, Licensing Program Analyst (LPA) Lisa Slusher conducted an unannounced annual inspection following a pre-visit Covid Assessment. Met at the facility by Facility Manager Renee Lane 1. Facility Grounds were inspected and generally free from Hazard. A technical advisory note is provided on this date. 2. Outdoor space observed. There are items to be removed, and licensee is to provide outdoor activities. . 3. Chemicals were in unlocked areas upon inspection. . 4. Locked and centrally stored medications were observed on this date 5. First aid kit complete with appropriate manual was present upon inspection. 6. Adequate storage space observed. 7. Individual beds in good repair observed. One mattress cover is being replaced due to a tear, but client is not present in the room. 8. The house has 3 bedrooms, double occupancy, all located on one single level. Bedrooms are accommodating of all required furnishings 9. Adequate food storage space observed. 2 days of perishable foods and 7 days of non-perishable foods observed 10. Weekly menu observed 11. Dining room observed. Table and benches provide seating for 6 youth. 12.Facility has two full restrooms, both for client use. One bathroom is in a client bedroom and is for the use of only the youth residing in that room. Water temperature was within the regulatory range. 13. Licensee has a vehicle for use at the facility. insurance and registration are both current. Client files (4) were reviewed. Annual Inspection to be continued at a later date. Facility has Mental Health Program Approval through Fresno County Behavioral Health, a delegate county. The MHPA is current and expires . Facility has accreditation through CARF. Accreditation is current through On this date, the facility is cited for a violation of STRTP interim licensing standards section 87068.3(a) Modifications to needs and services plans. Upon review of files and interview of staff, clients #1,2,3 (See LIC 811 dated 8/24/22 for confidential names) . An Advisory note is also provided to the facility on this date.

Deficiencies:
87068.3(a): 87068.3	Modifications to The Needs and Services Plan

(a) 	The needs and services plan specified in Section 87068.2 shall be updated at least every 30 days to determine the following


summary: Facility Evaluation

raw_content:
Narrative:
On this date, a Case Management inspection is conducted by LPA (Licensing Program Analyst) Lisa Slusher. Met at the facility by Facility Manager Renee Lane. During the completion of an annual inspection, Facility Manager reported an incident occurring on 8/21/22 which came to her attention subsequent to this date. LPA provided information regarding the regulatory requirements for reporting of this incident as well as additional items to keep in staff and client records. Facility will submit an initial report to the CCLD reporting incident reporting email and will follow up with a full report within 7 days. Further investigation into this incident may be required.


summary: Facility Evaluation

raw_content:
Narrative:
On this date, LPA (Licensing Program Analyst) Lisa Slusher conducted a Case Management Inspection for the purpose of continuing and completing the annual inspection which was begun on 8/25/22. Prior to this inspection, LPA reviewed Board Meeting Minutes. During this inspection, personnel files (8) were reviewed. On this date, LPA issued a Technical Advisory note to the facility with regard to the Administrator of the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On this date, LPA (Licensing Program Analyst) Lisa Slusher conducted a Case Management Inspection for the purpose of continuing and completing the annual inspection which was begun on 8/25/22. Prior to this inspection, LPA reviewed Board Meeting Minutes. Personnel Files (9) Reviewed on this date. Additional Follow up for this inspection to be conducted.


summary: Facility Evaluation

raw_content:
Narrative:
On this date, LPAs (Licensing Program Analysts) Lisa Slusher and Briana Placencia conducted a case management inspection for the purpose of completing the annual inspection begun on 8/24/22. Met at the facility by Administrator Torella Minor. During this inspection client interviews (4) were completed. Previous to this date 4 client files and 9 staff files were reviewed. LPA Slusher is also issuing citations and technical advisory/Technical Violations in the following areas: Faciltiy is cited for STRTP interim licensing standards- ILS Emergency Intervention Staff training ILS 87065.1(d)(5) Training Requirements ILS 87070(c)(1) Children's Records ILS 87072(c)(8) Personal Rights ILS 87072 (c)(18) Technical Violations/Advisory notes are issued for- STRTP ILS regulation section 87066(b)(1). Facility lacked job descriptions for each staff member. General Regulations setion 80066(a)(6). Facility lacked documentation of education and experience for each staff member STRTP ILS regulation section 87066(b)(6). Facility is to ensure evaluations of staff in intervals in accordance with their approved program STRTP ILS 87064(b)(1). Facility is to ensure a qualified Administrator is present and documents 20 hours per week on site at the facility. .


summary: Facility Evaluation

raw_content:
Narrative:
On this date, a plan of correction inspection is conducted by LPA (Licensing Program Analyst ) Lisa Slusher. The purpose of this inspection is to follow up on a plan of correction due on 8/30 and 8/31 for sections 87072(c) Personal Rights, specific to phone calls and 87072(c)(18) Personal Rights, specific to allowance. Plan of correction for section 87072(c)(8) Personal Rights was cleared with records received on 9/2/22 resulting in a civil penalty of $200. The deficiency is now considered clear. Section 87072(c)(18) Personal Rights was cleared on 8/31/22. LPA will follow up with additional plans of correction due this week.


summary: Facility Evaluation

raw_content:
Narrative:
On this date, a plan of correction inspection is conducted by LPA (Licensing Program Analyst ) Lisa Slusher. The purpose of this inspection is to follow up on a plan of correction due on 9/6/22 for sections 87095.65(d), Emergency Intervention Staff Training, 87065.1(d)(5)(6) Staff Training and 80075(f) Health Related Services, First Aid training. Sections 87095.65(d) is cleared by receipt of CPI training verification on 9/14/22. A civil penalty of $800 is assessed. Section 87065.1(d)(5)(6) Staff Training is cleared by receipt of training records on 9/14/22. A civil penalty of $800 is assessed. LPA will verify appropriate training hours for staff following this inspection, but the ongoing penalty for maintaining training records will cease as of 9/14. Section 80075(f) Health Related Services, First Aid is cleared on this date 9/15/22 with first aid training records submitted. A Penalty of $900 is assessed on this date.


summary: Facility Evaluation

raw_content:
Narrative:
On this date, Licensing Program Analyst Lisa Slusher conducted a case management inspection. Met with Torella Minor and Renee Lane. During this inspection the following were addressed: LPA obtained a signature for a document dated 11/10/ LPA requested staff training records for all staff persons noted on the LIC 811 dated 8/30/22 (9 staff total) LPA discussed procedures for change of administrator and has sent an email to the executive director and facility manager outlining documentation required within DAYS of a change of Administrator.

met_with: Renee Lane, Torella Minor


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, LPA L Slusher conducted a case management inspection at Mollie's House. Met with facility Manager Renee Lane and discussed the procedure for a change of administrator. LPA will follow up with an email containing the information required to make this change. LPA also discussed current Covid reporting procedures and reminded the facility that a staff person or client who tests positive for Covid must be reported according to routine reporting time frames. **due to computer problem at facility, report sent following inspection**


summary: Facility Evaluation

raw_content:
Narrative:
On this date, a Case Management Inspection is conducted by LPA (Licensing Program Analyst) Lisa Slusher. Met at the facility by Facility Manager Renee Lane. Discussed an issue the facility is having with a youth and a failure to receive a JV 223 from the placing county. Also discussed the problems the facility is having with the LIC 624LE form printing and discussed workarounds to ensure incident reports are submitted in accordance with regulation.


summary: Facility Evaluation

raw_content:
Narrative:
On August 14, 2024, Licensing Program Analyst (LPA), Vanessa Galvan traveled to Mollies House, Short-Term Residential Therapeutic Program located in Fresno, CA, to initiate an inspection and met with Program Director, Renee Lane. The purpose of the inspection was to clear the Plan of Correction. LPA met with Administrator regarding proof of POC. The Administrator provide proof of correction to LPA. The POC has been cleared. No deficiencies observed or cited during today's inspection. A copy of this report was provided to Renee Lane at the conclusion of the inspection.


summary: Facility Evaluation

raw_content:
Narrative:
On 07/22/2021, a case management inspection is completed by LPAs (Licensing Program Analysts) Lisa Slusher and Tamara Melikian. The purpose of this inspection is to follow up on issues discovered during the investigation of a complaint. Deficiencies of the STRTP Interim licensing Standards version 3.1 are noted on the following pages. Deficiencies are noted in the following areas 1. Client #1 (See LIC 811 dated 7/22/21) was not allowed confidential phone calls with family members. No court order was observed ordering supervised family phone calls. 2. Client phone calls (including those to family) are limited to specified days and times in accordance with a level system. 3. The Level system utilized by the facility is not part of the approved Plan of Operation/Program Statement. A copy of this report is left at the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On this date, a case management inspection is conducted by LPAs Lisa Slusher and Tamara Melikian. The purpose of this inspection is to follow up on further issues related to a complaint. The substantiated complaint involves the facility failing to follow appropriate removal procedures. When the incident occurred, Administrator Contacted the department asking about an emergency discharge. Administrator did not follow department recommendations or regulatory requirements. A citation for Administrator Qualifications is issued on this date.


facility_name: MONTEREY COMPASS

summary: Facility Evaluation

raw_content:
Narrative:
On 10/29/2025 at 10: AM, Licensing Program Analysts (LPA) Shikya Belfield, LPA Paul Simeon, and LPA Omar Sawyer met with the above facility for the purpose of conducting components II and III of the Licensing Orientation. Representatives present during the orientation was Administrator Adeya Byrd, Administrator Dawn Henson, and Chief Program Officer Melissa Lawton. The following items were discussed: Component II · Client Assessments / intake policies and procedures / discharge planning / removal and transfers / continued services / community resources and their purposes / · Mental Health Program Approval and Head of Service - It was discussed who is assigned as Head of Service for the program and who they report to. · Organization - It was discussed who each person in the program would report to. From Direct Care Staff to chief program officer. · Administrator Assigned - Adeya Byrd who has their administrator certification. · Any missing forms or clarifications - emergency relocation sites have changes and new LIC610C will be submitted to the department by 11/7/2025. Form LIC 308 will be submitted with any changes will be submitted by 11/7/2025. The Component Three presentation was conducted and STRTP specific information and regulations were reviewed.

met_with: Dawn Henson


summary: Facility Evaluation

raw_content:
Narrative:
On 11/12/25 at 10: AM, Licensing Program Analyst (LPA) Paul Simien conducted an announced visit to the above facility. The purpose of this visit was to conduct the required Prelicensing inspection. LPA met with Dawn Henson, Administrator at the above facility to conduct the required annual inspection. LPA reviewed one staff files and completed the plant, staff, operations, and disaster preparedness sections of the STRTP prelicensing CARE tool. LPA Simien advised the facility to implement the following before accepting clients: Post clients personal rights in a place accessible. install client/representative complaint box in a place accessible. Perishable/non-perishable food supply, trash can with closed top for solid waste, make snacks and kitchen accessible for clients at any time. Desk space for each child. Personal closet space for each child. Supplies, materials, and reading material to implement activities. Non-slip rugs, hot water for bathroom sinks, toilet seat covers. Utility shut off and back-up generator instructions in disaster preparedness plan. Add anti-septic solution to first aid kite. At this time, the inspection is complete. LPA conducted an exit interview with Dawn Henson, Administrator.

visit_type: Prelicensing

met_with: Dawn Henson, Administrator


facility_name: MORGAN HILL STRTP

summary: Facility Evaluation

raw_content:
Narrative:
On 8/4/2022 at 9:00AM, a virtual meeting was conducted with an applicant for the purpose of providing technical assistance prior to the third revision of the application. Present at the meeting: Helga Wong, CCL Licensing Program Manager (LPM) Nelson Martinez, CCL Regional Manager (RM) Selena Hood, CCL Licensing Program Analyst (LPA) Marjana Jackson - System of Care Branch, Manager of Provider Development Unit, Present from Santa Clara County Department of Family and Child Services: Damion Wright - Assistant Director Amber Brandom Brian Hawkinson Gilbert Murillo LPM Wong led introductions. SCC and CCL representatives discussed the questions provided to CCL on 8/1/2022 (see LIC812). Assistant Director Wright informed CCL that the county would need a minimum of 45 days to resubmit the application. The call concluded at 9:50AM.

met_with: Damion Wright


facility_name: MOUNTAIN VALLEY CHILD AND FAMILY-BAR DU

raw_content:
Narrative:
Regarding the allegation that staffs' behavior posed a risk to clients in care, this concerned two areas - staff being on their phones and not paying attention to clients, and one male staff being inappropriate with one client in care. During interviews, all but one interview corroborated that the male staff was not inappropriate towards that client, even when the client was being inappropriate towards him. The staff met with the client and the client's therapist to help in setting boundaries. The staff made all attempts and efforts to stay away from that client. LPA found no basis in the accusation that this staff was inappropriate towards the client. LPA learned that staff used to be on their phones sometimes when they were not supposed to. The facility addressed this at the time by discussing phone rules with them while they are working. Even though staff would be on their phones sometimes during working hours, they also communicated with each other about work, or taking work notes. While the staff may or may not have been on their phones when they weren't supposed to be, there was not a preponderance of the evidence to prove that this did or did not pose a risk to clients in care, therefore LPA has found this allegation to be unsubstantiated. Regarding the allegation that staff withheld food from clients while in care, statements made during interviews were conflicting. All staff denied this allegation occurred. Two clients stated it occurred, however gave different stories about how it occurred. One client denied this ever occurred. Based on the conflicting information, LPA found that while this allegation may have occurred or is valid, there was not a preponderance of the evidence to prove that it did or did not occur, therefore LPA has found it to be unsubstantiated. For the allegation claiming that staff inappropriately restrained a client while in care, LPA also received conflicting information. Two clients stated they have not been in, nor observed an inappropriate restraint from any staff. All staff denied inappropriately restraining any client in care. One staff stated that one staff does grip too tightly during restraints, but does not bend or twist the client in an inappropriate way; the holds are appropriate. Based on the conflicting information, LPA found that while this allegation may have occurred or is valid, there was not a preponderance of the evidence to prove that it did or did not occur, therefore LPA has found it to be unsubstantiated. An exit interview was conducted with FM, and a copy of this report and appeal rights was emailed to FM with a read receipt which will serve as the record of receipt.

Investigation Findings:
13Licensing Program Analyst (LPA) Ayssa Burgess made an unannounced complaint investigation inspection at the facility and met with Faciltiy Manager (FM) Benny Rodriguez, who assisted with the inspection. LPA investigated this complaint by interviewing the facility Therapist, four staff, and three former clients on 1/24/2022, 1/25/2022, 1/26/2022, and 1/27/2022. LPA attemped to contact one more former client, however that client is out-of-state and LPA was unable to make contact. During LPA's interviews, LPA received mixed information. Statements made during this investigation included statements about one staff in particular making non-trauma-informed comments and behaviors towards clients. This was already addressed on 12/23/2020 (involving those same clients and staff), with a citation - 87072(d)(11). The facility cleared that deficiency. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Alyssa M Burgess LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: MOUNTAIN VALLEY CHILD AND FAMILY-BAR DUFACILITY NUMBER: VISIT DATE: 01/28/2022

met_with: Benny Rodriguez


raw_content:
Narrative:
Interviews were conducted and with six facility staff, four youth, three law enforcement officers, a medical professional and guardian from 5/3/2022- 7/19/2022. (See LIC 811, dated on 8/4/2022). Sacramento County Sheriff Report was obtained on 5/2/2022, resulting in an unsubstantiated allegation. Medical records were obtained on 5/24/2022. The allegation is whether Staff 1 (S1) sexually assaulted Youth 1 (Y1) in a bathroom at the facility. Y1 reported being sexually assaulted in a facility bathroom by S1. Y1 was interview by law enforcement then subsequently by Investigator Weaver. The details Y1 reported were not consistent in both statements. Y1 later admitted to lying about the incident due to being "mad". S1 denied the allegation. Additional interviews, three days of video surveillance and medical records did not corroborate or exclude the allegation. Based on the investigation, camera surveillance, records reviewed and interviews conducted, the complaint finding is UNSUBSTANTIATED at this time meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted. A copy of all reports and appeal rights were provided to the facility via email.

Investigation Findings:
13Licensing Program Analyst (LPA) Cindy Johnson arrived at the facility to conduct an unannounced complaint investigation inspection on 8/4/2022 at 1: PM. LPA Johnson spoke with Toby Briglia, Supervisor to discuss the findings of the complaint investigation and allegations stated above. LPA Johnson informed Mr. Briglia this case was investigated by Investigation Branch, Investigator Melissa Weaver. The investigation included: an initial 10-day unannounced complaint investigation inspection was conducted at the facility on 4/11/2022. Facility documents obtained include staff schedule, facility sketch, client rosters, Daily Communication Logs, Night Logs and chore chart. Facility video surveillance and facility's internal investigation were also provided. Facility documents regarding youths include Client Face Sheet, Identification and Emergency Information, Needs & Service Plans, incident report, Mental Health Services Residential Notes. Facility staff documentation obtained include Criminal Records Statement & Out of State Disclosure, Child Abuse Reporting Procedures, Statement Acknowledging Requirement to Report Child Abuse, Interpersonal Relationships and Program Boundaries Acknowledgement, completed training, Memo of Understanding, and exit interview. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Cindy Johnson LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: MOUNTAIN VALLEY CHILD AND FAMILY-BAR DUFACILITY NUMBER: VISIT DATE: 08/04/2022

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

met_with: Toby Briglia, Supervisor


raw_content:
Narrative:
According to the facility's Emergency Intervention Plan and Interim Licensing Standard 87095.22(f)(2)(a), written approval is required from the administrator or designee (not staff involved in the restraint) to continue a restraint past 15 minutes. In addition, C1 should have been checked for any possible injuries which was not assessed. Based on the investigation, records reviewed and interviews conducted, the complaint finding is SUBSTANTIATED at this time meaning that the allegation is valid because the preponderance of the evidence standard has been met. The facility is cited on the attached LIC 9099D for the violations of Interim Licensing Standard, Article 6, 87095.22(f)(2)(a), and 87095.01(a)(14) which is an immediate risk to the health and safety or personal rights of minors in care. An exit interview was conducted. A copy of all reports and appeal rights were provided to the facility via email. However, C1 was not receptive during this incident. The facility's internal investigation and interviews conducted with two staff and C1, were not able to confirm all of the statements made by staff to C1, it is not possible to determine if any statements were inappropriate. The last allegation is whether staff members yelled at C1 during an incident on 7/4/22. C1 admitted to yelling at staff during the incident and restraint on 7/4/22. C1 was able to provide details that C1 was yelling about. C1 made general statements that staff yelled at her, but C1 was not able to provide any details of the comments. Three staff denied yelling at C1. No specific details of statements made by staff to C1 were described or corroborated as "yelling". Therefore, it is not possible to determine if any staff yelled at C1 during the incident and restraint on 7/4/22. Based on the investigation, records reviewed and interviews conducted, the complaint findings are UNSUBSTANTIATED at this time meaning that although the allegations may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview was conducted. A copy of all reports and appeal rights were provided to the facility via email.

Investigation Findings:
13Licensing Program Analyst (LPA) Cindy Johnson arrived at the facility to conduct an unannounced complaint investigation inspection on 10/20/2022 at PM. LPA Johnson spoke with Misty Jackson, Administrator to discuss the findings of the complaint investigation and allegations stated above. LPA Johnson informed Ms. Jackson this case was investigated by LPA Johnson. The investigation included: an initial 10-day unannounced complaint investigation inspection was conducted at the facility on 7/14/2022. Facility documents obtained include staff schedule, client rosters and facility's internal investigation. Facility documents regarding the youth include Client Face Sheet, Needs & Service Plans, incident report, Mental Health Services Residential Notes. Interviews and contacts were conducted and with four facility staff and one youth, from 7/14/2022- 9/21/2022. (See LIC 811, dated on 10/20/2022). The allegation is whether Client 1 (C1) was inappropriately restrained by three staff members on 7/4/22. The facility's internal investigation and interviews conducted with three staff and C1 confirm the restraint lasted for more than 15 minutes, despite not documenting the exact length of the restraint. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jodean Greene LICENSING EVALUATOR NAME: Cindy Johnson LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 23-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, NATOMAS PARK DR., STE FACILITY NAME: MOUNTAIN VALLEY CHILD AND FAMILY-BAR DUFACILITY NUMBER: VISIT DATE: 10/20/2022

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

met_with: Misty Jackson, Administrator