summary: Facility Evaluation

raw_content:
Narrative:
On March 6th, 2026, Licensing Program Analyst (LPA) Maryjane Perez arrived at Alice and Daniel Small Family Home (SFH) for a pre-licensing inspection for an initial license. LPA met with applicants Alice and Daniel Wainaina who led a tour of the entire home inside and outside. The applicants are applying to serve four ambulatory children ages 0 to 17 years old. Currently there are no clients placed in the home. The home is a two-story building with six bedrooms and four and a half bathrooms. The downstairs consisted of an entry way with bathroom #1 that was fully functioning with a toilet and sink. The water temperature was measuring 114.4 degrees Fahrenheit. There was a coat closet and bedroom #1 that was utilized for one client with a full size bed, closet/dresser space, a crib for client use if needed and bathroom #2 that was fully functioning but needed a lock on sink cabinet for cleaning supplies. There was a play area that had toys and a hallway that had fire extinguisher #1 that was operable. The living room had couches, a TV, books and toys. The kitchen had a dining room table with adequate seating. There was a locked cabinet for storing knives and sharp objects, a locked cabinet for storing medications and a first aid kit that was missing a thermometer. There was another locked cabinet for storing client files. The kitchen sink cabinet also had a lock on it as it stored cleaning supplies. The pantry and refrigerator were fully stocked with perishable and non-perishable foods. Bedroom #2 was utilized for one client and had a full size bed with two areas of closet space, a lamp, and bathroom #3. Bathroom #3 had a shower, toilet and sink fully functioning. However, the sink cabinet needed a lock as it stores cleaning supplies. The upstairs consisted of a loft area that had a storage closet with extra linen and a printer. Bedroom #3 was utilized for applicants legal guardian that had a crib and dresser/ closet space. The laundry room was accessible to clients but had several locked cabinets for storing laundry detergents and laundry essentials. Fire extinguisher #2 was located in laundry room and was operable. Bathroom #4 had dual sinks, a bathtub/shower, and a toilet all fully functioning. However, there was a lock needed on one sink cabinet as it stored cleaning supplies. Bedroom #4 was utilized for one client and it had a full size bed, closet/ dresser space, but was missing a lamp or light fixture. Bedroom #5 was utilized for one client and had a full size bed, closet/ dresser space, but was also missing a lamp or light fixture. Bedroom #6 was the master bedroom and had a queen size bed, closet space and bathroom #5 that was fully functioning with a shower, bathtub, and dual sinks. The bedroom is to be locked at all times. The garage was free of hazards and stored extra household items as well as an extra freezer and refrigerator both completely stocked. The garage was locked at all times. The backyard where children will have access to play was completely fenced, had a gate with a latch and was free of hazards. There were no pools or other bodies of water and no weapons/firearms as stated by applicants. Bedrooms were arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items have been properly made inaccessible to areas where children will have access. There was a telephone service, all appliances were in working order, and all trash cans for storage of solid waste had tight fitting lids. Based on this inspection of the home, the facility will need the following corrections: Locks put on 3 bathroom cabinets Thermometer to be placed inside first aid kit Lamps/ light fixtures put in two client bedrooms Create a menu Post emergency disaster plan, visitation log, personal rights, and facility sketch After corrections are completed, the applicants will notify LPA so another inspection can be completed and the request for licensure can be forwarded to Licensing Program Manager for final approval. Component III orientation was also completed this day of March 6, 2026. An exit interview was conducted. A copy of this report was provided to applicants Alice and Daniel Wainaina.

met_with: Applicants- Alice and Daniel Wainaina


state: CA

summary: Facility Evaluation

raw_content:
Narrative:
On April 29, 2025 at 10:00AM, Licensing Program Analyst (LPA) Adaleyci Caballero met with Applicant Alice St. Catherine for a Component II of the application process. Lpa a. Caballero went over revisions needed for the application prior to license and are due no later than May 27, 2025. Lpa a. Caballero provided applicant with a copy of the LIC 184, Notice of Incomplete Application and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant via email. The original signed copy of this report will be placed in the facility file.

report_type: Facility Evaluation

met_with: Alice St. Catherine


summary: Facility Evaluation

raw_content:
Narrative:
On May 28, 2025, at 2:05PM, Licensing Program Analyst (LPA) Adaleyci Caballero completed a pre-licensing inspection of Alice Home Care Small Family Home (SFH). LPA met with Applicant Alice Saint Catherine who led a tour of the home. The facility was toured both inside and out with the applicant. There are no clients in placement. The home is a two-story building with five bedrooms and three full bathrooms which are set up as follows: Bedroom #1(first floor)- It consisted of two single beds. The beds had linen, comforters, and pillows. It will sleep two clients. Bedroom #2(first floor)- It consisted of one bed. The bed had linen, comforters, and pillows. It will sleep one client. Bedroom #3- It consisted of one single bed. The bed had linen, comforters, and pillows. It will sleep adult staff. Bedroom #4- It consisted of one single bed. The bedroom is for applicant's legal guardian. Bedroom #5- (applicant) It consisted of one king bed. It will sleep applicant. A living room, dining room, kitchen, loft, laundry room, three car garage, and a backyard. The garage will be utilized for storage inaccessible to clients. The clients' bedrooms were arranged so that no more than two clients will be in a room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the clients' belongings. There was a smoke detector in every bedroom. The ten smoke detectors were checked and working properly. Carbon Monoxide detector was checked and working properly. The home's central air conditioning module was in the backyard. The water heater was in the garage. The appliances were in working order. There was adequate food storage space and a supply of perishable food and non-perishable food. The home had a trash can for storage of solid waste with a tight fitting lid. The hot water was at a temperature of 116.0 degrees Fahrenheit. There was one fire extinguisher present in the home located in front of the laundry room. It was observed to be properly charged and inspected by the fire department. There are no firearms in the home. There is no pool at the home. The backyard is fully fenced and free of debris. No cameras in the home. No corrections to be made. An exit interview was conducted, and a copy of this report was provided to applicant Alice Saint Catherine via email due to technical difficulties. Application will be forwarded to Licensing Program Manager Abdoulaye Traore for licensure.

visit_type: Prelicensing

met_with: Applicant-Alice Saint Catherine


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On September 24th, 2025 at 10:35AM, Licensing Program Analyst (LPA) Cynthia Ramos met with Licensee Alice St. Catherine who led a tour of the home. Licensee granted LPA access to the home. The purpose of the visit was to conduct a Post Licensing Inspection at Alice Home Care Small Family Home (SFH). The facility was toured inside and out with the Licensee. The home is a two-story home with 5 bedrooms and 3 bathrooms. On the first floor of the home, there was Bedroom #1 which is currently occupied by 15 year old female client. The room had two twin beds and enough closet and drawer space. Client's bathroom was inspected and was in good working conditions. Bedroom #2 contained a queen size bed with enough closet and drawer space, this room was currently vacant for a future client. The kitchen was located downstairs was inspected and organized. Next to the kitchen, there was a living room with television and large couches. The second floor of the home was as follows: Bedroom #3 contained a queen size bed, currently occupied by male adult living in the home. Bedroom #4 contained a queen size bed, currently occupied by adult male living in the home. Bedroom #5 contained queen size bed is occupied by Licensee. All bathrooms in the home were inspected and were in good working conditions. There was an additional living room with a television and couches which clients have access to. All bathrooms in the home were inspected and were working properly. Bedrooms are arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. Continued on the Next Page... All hazardous items have been properly made inaccessible to clients. The medications were locked and stored in a closet downstairs. Cleansers/chemicals were locked and stored in the laundry room and under the kitchen sink which remains locked at all times. Sharp knives were inaccessible and stored in the a kitchen's drawer. The first aid kit was located in the kitchen and contained all required items except the thermometer. There are no guns or weapons as stated by Licensee at this time. The hot water temperature was tested and noted to be 117.3 degrees Fahrenheit. Proper storage of all food was noted. Trash cans for storage of solid waste have tight fitting lids. LPA observed the Emergency Disaster Plan with exit map, Title Personal Rights, and visitation policies were posted. There was one fire extinguisher located in the kitchen. The backyard where children have access to play is completely fenced and free of hazards. The garage was also inspected and is used for extra storage, no hazards were observed. There are no bodies of water or pool in the home. The carbon monoxide/fire detectors alarms were inspected and in good working conditions. A total of 1 client record and 3 staff records were reviewed and were in compliance. Additionally, LPA observed an adult living in the home who was not cleared. Based on observation and interview, the Licensee did not comply by having an uncleared adult in the facility which poses an immediate health and safety risk. A Civil Penalty of $500 is being cited based on California Code of Regulations, 80019(e)(2) please see attached LIC 809D. Based on today's inspection, there is one deficiency being cited at this time. An exit interview, a copy of this report and appeal rights was provided to Alice St. Catherine.

Deficiencies:
80019(e): Criminal Record Clearance

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

met_with: Licensee, Alice St. Catherine


facility_name: ALICE NGANGA SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On June 5, 2025 at 11:am Licensing Program Analyst (LPA) Jennifer Baca met with Licensee Alice Nganga for the purpose of conducting a Component 2 meeting. LPA reviewed the revisions submitted by the Licensee that were requested by the LPA. The sections that were reviewed were the following: 1 .Discharge and Removal- 2 .Emergency Intervention Plan- 3. House Rules-Runaway plan- 4. Discipline policies- 5. Control of real property owners letter- 6. Facility Sketch- LPA verified Licensee photo ID. LPA answered other questions from the Licensee and explained the next steps. LPA has registered the licensee for Component 3 scheduled for June 11, 2025. Orientation certificate for Component 2 was signed. licensee will send updates discussed by June 9, 2025. Facility sketch needed to have the number of youths added, and ambulatory status: drivers license log to verify the current drivers license for transportation: youths bedtimes to be adjusted and be age appropriate. A copy of this report was given to the Licensee.

met_with: Alice Nganga Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 09/15/2025 at 10:08 a.m. Licensing Program Analyst (LPA) Elena Gonzalez-Soto arrived at the facility announced for the purpose of a pre-licensing inspection. LPA was greeted by Alice Ngana, Licensee who assisted with the inspection. Physical Plant: LPA observed the facility is a one-story home with four bedrooms a front yard and a backyard. LPA observed posting of personal rights, working carbon monoxide and smoke detectors, first aid kit, fire extinguisher inspected 04/2025, inaccessible cleaning solutions, food menu, hot water temperature of 112F, Fridge Temperature of 46. F, and freezer temperature of 0.6F. Operations: LPA observed posting of personal rights, observed the area for cash storage, and discussed there shall be at least one medical resource available to call at all times and someone who is capable of communicating with emergency personnel in the facility at all times.\ Staffing: LPA reviewed Licensee's personnel record, and observed criminal record clearance, mandated reporter statement and CPR and First Aid Certification. LPA reviewed Staff 1 (S1) personnel record and observed criminal record clearance and mandated reporter statement. S1 did not have on file a CPR and First Aid Certification. Cont. on LIC812-C Client Records: LPA discussed that client records shall remain available to the licensing agency to inspect, audit, and copy upon request. At this time, there are no clients in care, however pending placement of a client into the facility, the licensee is prepared to provide care and has the following maintained at the facility: a locked and secure location for cash resources to be entrusted to Licensee; a secure location and process for locking and maintaining medication in a centrally stored location; and maintaining separate client records for each client to ensure the confidentiality of the records maintained. Licensee stated S1 has a current CPR and First Aid Certificate. LPA instructed Licensee to print out a copy and place it in S1's personnel file. The facility has no swimming pool or bodies of water on the property, and no use of security recording cameras in private areas. LPA conducted two interviews. LPA completed Component Three of the licensing process with the Licensee. An exit interview was conducted and a copy of this report was issued to Alice Ngana, Licensee.

met_with: Alice Ngana, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On 12/22/2025 at 11: AM Licensing Program Analyst (LPA) Elena Gonzalez-Soto arrived unannounced at the above facility for a case management inspection related to an incident report. LPA met with Alice Ngana who assisted with the inspection. LPA reviewed one client file and obtained the following documents: admission agreement, client history, JV220/223, Health and Education Passport, CFT notes, and IEP. LPA conducted an inspection of the facility. LPA obtained a copy of the LIC 500. No citations were issued during today's inspection. Further follow up is needed. An exit interview was conducted and a copy of this report was issued to Alice Nganga, Licensee.

visit_type: Case Management


summary: Facility Evaluation

raw_content:
Narrative:
On 01/02/2025 at 9: AM Licensing Program Analyst (LPA), Elena Gonzalez-Soto, arrived unannounced at the above facility to continue a case management inspection related to an incident report dated 12/10/2025. LPA met with Alice Ngana, Licensee who assisted with the inspection. LPA conducted an inspection of the facility. LPA conducted two confidential interviews. The facility is being issued a Technical Violation under the California Code of Regulations, Title 22, Division 6, Chapter 1, Article 06 (Continuing Requirements), Section 80068.2 (Needs and Services Plan). The facility is being issued a citation under the California Code of Regulations, Title 22, Division 6, Chapter 1, Article 06 (Continuing Requirements),Section 80078 (Responsibility for Providing Care and Supervision). An exit interview was conducted, a copy of this report and appeal rights were issued to Alice Ngana, Licensee.

met_with: Alice Nganga, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On 05/21/2026 at 1: PM Licensing Program Analyst (LPA) Elena Gonzalez-Soto arrived at the facility unannounced to conduct a post licensing inspection. LPA met with Alice Nganga, Licensee. LPA inspected the following Physical Plant: LPA observed the facility is a one story home with four bedrooms, two bathrooms, a front yard and a backyard. LPA observed posting of personal rights, working carbon monoxide and smoke detectors, first aid kit, fire extinguisher with maintenance completed in April 2025, inaccessible cleaning solutions, food menu. Operations: LPA observed the emergency disaster plan, disaster drill log which indicated a drill completed in January 2026. Staffing Records: LPA reviewed the LIC500 and guardian roster for compliance, LPA observed five out of five staff files which included five out five fingerprint clearances, five out of five personnel records, five out of five signed employee rights forms, five out of five health screenings, five out of five first aid/cpr certificates. Cont. on LIC809-C Further inspection is needed to complete annual inspection. An exit interview was conducted and a copy of this report was issued to Alice Nganga, Licensee.


facility_name: ALICE SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Ashley Ruacho conducted a Component II - Face to Face Meeting at the Monterey Park Regional Office. The following were present: Alice Wambui, Applicant. LPA discussed their application and program statement and advised them of the following corrections. The following information must be completed and submitted to Licensing: Part A LIC Affidavit Regarding Client Cash Resources - amount that will be handled. LIC Personnel Report - Husband and Mother-in-Law need to be listed. LIC Personnel Report - Date of physical. LIC Health Screening Report- New x-ray required. LIC 508D Criminal Record Statement LIC 610C Emergency Disaster Plan - Section IV has an address missing. Brief letter stating they authorize the relocation of the Small Family Home. LIC Fire Inspection - pending Part B Statement of Purpose - placements foster care or regional centers. Page 40- Week one activities - elaborate on learning to build fires. Page 41 - Plan for child and family interaction- Elaborate on this, what is the plan to incorporate foster youth families. Page 45- #5 states - PRN - what is the meaning. Part B Number 6- explain more about how incident will be corrected. Number 7- Elaborate more or include all natural ones used. Number 9 - Cannot use time out for when staff need a break from child's behavior. Page 53- Placing agency typo No restraints used in Small Family Home (SFH). Page 54- People to notify- 911 typo Part B Emergency information. Sign in and sign out procedures. Immunization requirements The following documents were received from the Applicant during the Face To Face Meeting: - SFH Orientation Certificate The Pre-Licensing inspection was scheduled during today's visit. An exit interview was conducted, and a signed copy of this report was provided to the applicant.

met_with: Alice Wambui, Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On April 5th,2024, at 10: AM, Licensing Program Analyst (LPA) Ashley Ruacho conducted an announced pre-licensing inspection at the above address. LPA met with Alice Wambui, applicant. A physical plant inspection was conducted. The following were observed at the time of inspection: This facility is a two- story home located in a residential neighborhood. The facility consists of three bedrooms, three bathrooms, a living and family room, a television room, kitchen, two-car garage with laundry machines, front yard, and backyard space. The front yard is fenced in by a gate. There are two security cameras located in the front yard, two in the backyard and one on each side of the home. There are no cameras inside the home. Overall, the facility is clean, sanitary and in good condition. The facility has no bodies of water. The facility has a centralized heat and air-conditioning unit. Temperatures in all rooms are maintained at 68 degrees (F). The hot water temperature was measured at 120 degrees (F). Carbon monoxide and smoke alarms were tested and observed to be operational. There are two (2) fire extinguishers, one in kitchen and one in the hallway on the second floor. Disinfectants, cleaning solutions, are kept locked in the garage. Knives and sharps will be locked in a kitchen cabinet. The facility has a working telephone. The applicant reports no firearms on the premises. The grounds are free from obstructions and hazards. Clients will be utilizing one bedroom for clients. During inspection, LPA observed that the bedroom has one (1) bed and one (1) crib as well as adequate closet and drawer space to accommodate client's clothing and personal belongings. Bedroom #1 will be occupied by the applicant. Each bed has clean pillows, pillowcases, bed sheets and blankets. LPA also observed extra linens stored in the hallway closet on the second floor. Client records and staff records will be stored and locked in a filing cabinet in the television room. Medications will be centrally stored in the top cabinets locked in the kitchen. A complete first aid kit is readily available in a central location in the facility. Pending Items -Fire inspection to be completed pending appointment (fire department has been contacted). -Applicant reports that Emergency Plan (LIC 601) and facility sketch will be posted at the facility. LPA also conducted Component III - Category Specific Orientation with the applicant. The following items were discussed and provided to the applicant: - Title 22 regulations on Small Family Homes - Continuing Requirements (General Licensing Requirements) - Personnel Records (forms) - Client Records (forms) - Reporting Requirements Applicant will contact LPA by April 12th,2024, regarding when the appointment is for the fire inspection. An exit interview was conducted a signed copy of this report was provided to the applicant.

met_with: ALICE WAMBUI


summary: Facility Evaluation

raw_content:
Narrative:
On November 7, 2024, at 9:30: AM, Licensing Program Analyst (LPA) Gilbert Gutierrez conducted an unannounced post-licensing inspection at the above address and met with Administrator, Alice Wambui. The home is a two-story home located in a residential neighborhood. The home has no placements currently. At around 9: AM, Administrator Wambui gave a tour of the home. The home has three bedrooms and three bathrooms. LPA observed the following: the posted license, facility sketch, and Children's Personal Rights. The sharp objects were stored in the kitchen cabinet with plastic safety lock. The administrator will change the lock depending on the age of the children she will get. There were perishable and nonperishable foods in the home. The cleaning solutions were stored in the garage. Inside the bedroom reserved for children, there is a twin bed and a crib, a closet, and drawers for children's clothing. The extra linens and towels were stored in the hallway closet on the second floor. All confidential records will be stored and locked in metal cabinet. The medications will be stored in metal box with lock. A complete first aid kit is readily available in a central location in the facility. The facility has a working telephone. The facility has a working centralized heating and air conditioning. All the lights and appliances were working. There are security cameras installed outside the facility. No cameras observed installed inside the home. The walkways and hallways were unobstructed. The facility has no bodies of water. The facility is clean, sanitary and in good repair. An exit interview was conducted and a copy of the LIC 809 was provided to the administrator. No deficiency citations issued at the time of the inspection.

met_with: Alice Wambui


summary: Facility Evaluation

raw_content:
Narrative:
On July 9th, 2025, at 1: PM Licensing Program Analyst (LPA) Ashley Ruacho conducted an unannounced Annual Licensing Inspection at the above Small Family Home (SMH) and met with Licensee Alice Wambui. Physical Plant This facility is a two- story home located in a residential neighborhood. The facility consists of three bedrooms, three bathrooms, a living and family room, a television room, kitchen, two-car garage with laundry machines, front yard, and backyard space. The front yard is fenced in by a gate. There are two security cameras located in the front yard, two in the backyard and one on each side of the home. There are no cameras inside the home. LPA Ruacho observed that the facility is clean, safe, sanitary and in good repair. The passageways and entrances inside and outside of the home are unobstructed. Disinfectants and cleaning solutions were stored in a locked container in the garage. Facility has non-perishable foods for at least one week and perishable foods for at least three days. Facility's first aid kit meets the requirements. All kitchen, food preparation, and storage areas are kept clean and free of rodents and other vermin. Carbon monoxide detectors and smoke alarms were tested and observed to be operable. Facility provides basic laundry services. Room temperatures are maintained at a comfortable temperature. The hot water temperature was tested and in working order. Fire extinguisher is fully charged and in working order. All toilets, hand washing and bathing facilities are maintained in safe and sanitary operating condition and meet the requirements. All beds are in good repair and supplied with pillows and linens which are clean and in good repair. Staff and Client Records The Facility currently does not have any clients in care. LPA reviewed one (1) staff file which contained Criminal Record and Child Abuse Index clearance. LPA also reviewed Guardian website for clearances. Staff file had Health screening, TB test and CPR certificate. LPA interviewed one (1) staff. Facility had no clients to interview during this inspection. There were no deficiencies cited at the time of this inspection. An exit interview was conducted. LPA provided the facility administrator a signed copy the LIC 809 and LIC 811 reports

visit_type: Annual

met_with: Alice Wambui - Licensee


facility_name: ALL ABOUT KIDS SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On July 29, 2024 at AM Licensing Program Analyst (LPA) Karen Beal conducted a Microsoft Teams meeting with the applicant(s) and reviewed the application for All About Kids Small Family Home. A LIC 184, Letter of Application Revisions and Facility Evaluation Report (LIC 809) was emailed to applicant for corrections. The applicant signature for this form will be placed in the file.

met_with: Deloris Harris, Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On October 3, 2024, at 1: PM, Licensing Program Analyst (LPA) Karen Beal began a pre-licensing inspection for All About Kids Small Family Home license. LPA met with Delores Harris, applicant, who led a tour of the home. The facility was toured both inside and out with the applicant. Currently there are no clients placed in the home. The applicant is applying to serve three ambulatory, one 0-5 years and two 6-17. The home is a two story building with four bedrooms and three full bathrooms which are set up as follows: · Bedroom #1 (Clients) has two twin bed, will sleep the clients. This bed · Bedroom #2 (Master) has one Cal King size bed and one toddler bed; it will sleep the applicant and one infant client. · Bedroom #3 (Bio Child ) has one full size bed, It will sleep the bio child. · Bedroom #4 (grand parent) had one queen size bed, it will sleep the grandmother. · Living room, kitchen, dining area, three bathrooms, an attached two car garage, a laundry room, storage closet, and the backyard. The Client's bedroom was arranged so that no more than two clients will share the room. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. There was adequate closet space for the client's belongings. ***Continued to LIC 809-C*** ***Continued from LIC 809*** There was a smoke detector/carbon monoxide detector located in the hallway. The smoke detectors and the carbon monoxide detectors were checked, and they were working properly. The home's central air conditioning module was located outside of the home in the side yard. The home's hot water heater was located inside the garage. The fire place is covered. The appliances were in working order. All sharp knives were located in the garage in a locked cabinet. The client's files will be locked inside a locked file cabinet in the garage. There was adequate food storage space. A proper storage of all food was discussed. A trash can for storage of solid waste had a tight fitting lid and was located in the kitchen. The client bathroom also had a trash can with a working lid. Cleaning supplies were located in garage in a locked cabinet. The water temperature of the house was observed to be 109.6 degrees Fahrenheit. The water temperature of the client bathroom 1 was observed to be 110 degrees Fahrenheit and the house temperature was observed to be 78 degrees Fahrenheit. Medications were located in the locked cabinet in the garage. The home's First Aid kit was accessible with all required items included and located in the upstairs hall cabinet. A fire extinguisher was present in the home and located on the wall in the laundry. It was observed to be properly charged. Applicant stated there were no weapons/firearms in the home. LPA observed there were no swimming pool. The backyard where clients will have access to play was completely fenced. The facility sketch, emergency plan, and client rights were hung on the wall by the downstairs bathroom. The applicant is scheduled for Component III on October 10, 2024. Applicant was advised to contact their LPA within 30 days after the placement of the first client. The request for a license will be forwarded to Licensing Program Manager for final approval . An exit interview was conducted. A copy of this report was provided to applicant


summary: Facility Evaluation

raw_content:
Narrative:
On February 26, 2026, at 9: AM, Licensing Program Analyst (LPA) Julian Lucas conducted an unannounced visit at All About Kids Small Family Home (SFH) to conduct an unannounced annual random inspection. LPA met with Administrator Deloris Harris and completed a walkthrough of the facility. LPA began a physical plant inspection at 10: AM assisted by the Administrator, Deloris Harris. During the physical plant inspection, LPA observed the facility to be a two-story facility. A formal entry with a dining room consisting of a sofa and a dinning table with six chairs. There is also a Personal Rights, facility license, and Emergency Disaster Plan postings in the hallway leading to the kitchen and family room. In the kitchen LPA observed postings of the food menu. There is a family room with two sofas and television. The sink reads at 119.2 degrees Fahrenheit. There is a refrigerator with freezer. There is an adequate supply of perishable and non-perishable foods in the refrigerator and cabinets. There is a one-bedroom downstairs for two clients that has two twin size beds, with appropriate linens, pillows, comforters, and a mattress and mattress covers in good repair. There is a closet and two drawers for extra storage space for the client's clothing. There is a restroom at the bottom floor for clients with a sink reading of 119.2 degres Fahrenheit. The garage is used for storage including a locked cabinet with sharps. There is a refrigerator and freezer with additional food. Upstairs there are three bedrooms which includes the master bedroom with bathroom, the restroom sink reads at 119.2 degrees Fahrenheit. Client medication is stored in a locked cabinet in the master bedroom. LPA observed the other two rooms which are occupied by one bio child and one onecare giver. Continued on 809-C LPA inspected the outside physical plant, and it was clean and free of debris. LPA reviewed two client files, and one administrator file, and one caregiver file. LPA conducted one staff interview and one client interview. Based on the annual required inspection on this date, there were no deficiencies found. An exit interview was conducted with the Administrator, Deloris Harris, and a copy of this report was given to the Administrator, Deloris Harris. Exit interview conducted. A copy of this report was provided to the Administrator, Deloris Harris.

met_with: Deloris Harris, Administrator


facility_name: ALL TOGETHER SMALL FAMILY HOME

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Narrative:
It was alleged that a lack of supervision resulted in unexplained injuries to a minor in care. In an interview conducted, the caregiver stated that she was changing another minor in care when one minor who was jumping/playing on the bed fell and hit their face against the edge of the bedframe. The caregiver stated that she took the child to the emergency room and the child was discharged without a CT scan. The caregiver stated that the physician did not have any immediate concerns and instructed her to monitor the child for symptoms of a concussion. No follow-up visits was reportedly necessitated unless a change in condition was observed. Due to the age and cognitive conditions of the children, interviews were unable to be held. A review of records confirmed that a visit with the physician was conducted and that no follow-up visits were necessitated. An interview conducted with the county worker revealed no concerns of a lack of supervision or neglect by the caregiver. Based on interviews conducted and records reviewed, there is not a preponderance of evidence to suggest that the above allegation occurred. Although the allegation may have happened or may be valid, the preponderance of evidence standard has not been met. Therefore, the allegation is deemed UNSUBSTANTIATED. An exit interview was conducted and a copy of this report was provided to the Licensee.

Investigation Findings:
13On April 14, 2023 at approximately 10: AM, Licensing Program Analysts (LPAs) Raymond Wu and Joe Martinez conducted an unannounced complaint inspection visit at the SFH for the purposes of delivering findings for the above allegation. LPA met with the representative above and discussed the purpose of the visit. As part of the investigation, an interview with the caregiver was held on 01/06/23, the county worker was interviewed on 12/28/22, and records were reviewed on 02/06/23 and 04/05/23. (Continued) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Yan Yeung LICENSING EVALUATOR NAME: Raymond Wu LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: ALL TOGETHER SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 04/14/2023

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

report_type: Complaint Investigation

met_with: Raven Campbell

complaint_status: unsubstantiated


raw_content:
Narrative:
On 9/27/23 the Department received a complaint alleging the Small Family Home administrator (AD) has not taken C1 to the dentist; has not enrolled C1 in school; has not followed C1's medication as prescribed; C1 does not have a bed that meets C1's needs and facility's staffing needs are not being met. Based on the information gathered during confidential interviews, relevant parties denied the allegations indicating C1 has been taken to the dentist twice and each time C1 has become aggressive towards the dentist. The dentist has requested C1 be sedated, and AD is waiting for C1's social worker to get court approval for C1 to be put under anesthesia. Investigation revealed C1 has been enrolled in school however since C1 does not have any previous education history, C1 needs an individualized education plan (IEP) to determine if C1 will be enrolled in person school or be home schooled. An IEP is being developed by the school to meet C1's educational needs. LPA reviewed doctor visit notes which indicate C1's prescription for Clonidine is not working and a letter dated October 5, 2023, indicated it was advised C1 stop taking Clonidine patch and Clonidine due to C1 being allergic. Doctor's notes indicated C1 was seen by a doctor on 6/1/23, 6/8/23, 7/25/23 and 10/5/23. LPA reviewed C1's completed medication logs for May, June, July, August, September, and October 2023. AD indicated C1 had a modified bed due to C1's weight and C1's previous social worker had approved the bed. AD stated C1 now has a single bed that accommodates C1's size. LPA observed a single bed when LPA visited the facility. AD sent a picture of C1's bed which shows C1 has a single bed. Confidential interviews indicated C1 always has two staff supervising C1. Staff does not leave C1 unattended and C1 is always supervised. LPA observed two staff present at the facility each time LPA made an unannounced visit to the facility. Based on the interviews and records reviewed the allegations is/are found unsubstantiated. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the allegations. Appeals rights were provided and discussed with the facility representative mentioned above. There were no deficiencies cited.

Investigation Findings:
13On December 19, 2023, at 10: AM Licensing Program Analyst Larry Cabral (LPA) conducted a follow-up inspection for the purpose of providing findings for the above complaint allegations. LPA Cabral met with the Small Family Home Administrator Raven Campbell. During the investigation, LPA Cabral interviewed one facility staff (AD) and attempted to interview one client (C1) on 10/3/23(see Confidential Names Form LIC 811 dated December 19, 2023). LPA Cabral interviewed one county social worker (CSW) on 10/3/23. LPA interviewed one regional center coordinator (RCC2) on 12/13/23 and attempted to interview another regional center coordinator (RCC) on 12/12/23. LPA interviewed a school foster care advocate (FYA) on 12/12/23. LPA reviewed incident reports, health and education passport, medication logs, C1's fact sheet, doctor, and dental visit documents. LPA reviewed an email for the dentist and a letter for a doctor. LPA reviewed the county's delivered service logs. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: Larry Cabral LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: ALL TOGETHER SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 12/19/2023

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

met_with: Raven Campbell, Administrator


summary: Complaint Investigation - Unsubstantiated

raw_content:
Narrative:
DSP had begun a tour of the home with LPA when S1 arrived about ten minutes later with a bag from a chain drug store. S1 excused herself for not being home to greet LPA's arrival, but stated where she had been, and took over the tour of the home. Individual and confidential interviews with S1, DSP, S2 and S3 were consistent in telling of S1's morning errand routine. It was also alleged that S1 is not at the facility the required amount of time. Confidential interviews with S1, DSP, S2, and S3 were consistent in placing S1 as regularly present at the home and providing for regular supervision of C1 by responsible staff in the event S1 was absent while on errands for the home and/or C1. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated. No deficiencies were cited at this time. Exit interview conducted. A signed copy of this report, LIC9099-C, and LIC811 were provided to Raven Campbell, Licensee. Appeal rights provided.

Investigation Findings:
13On March 5, 2024, at 9:00 a.m., Licensing Program Analyst (LPA) John Bonilla arrived unannounced at the All Together Small Family Home (SFH) (See LIC Confidential Names list dated 01/31/24) for the purpose of delivering findings on the above complaint. LPA met with Raven Campbell, Licensee (S1). On January 29, 2024, the Department received a complaint alleging that S1 does not live at the facility. It was also alleged that S1 is not at the facility the required amount of time. During the investigation, LPA reviewed the SFH's file, prior complaint history, arrived unannounced at the SFH, conducted interviews with S1 and staff (DSP, S2, & S3), and took a tour of the SFH. On January 31, 2024, LPA met with S1 at the home during an unannounced visit. While S1 was not present in the home when LPA arrived, LPA was allowed into the home by DSP and made aware that S1 had recently left to local pharmacy to pick up medication for client in care (C1). (Continued next page...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Jean Herring LICENSING EVALUATOR NAME: John Bonilla LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 32-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION LA & TRI-COASTAL CR, CORPORATE CNTR DR. #200A MONTEREY PARK, CA FACILITY NAME: ALL TOGETHER SMALL FAMILY HOMEFACILITY NUMBER: VISIT DATE: 03/05/2024

met_with: Raven Campbell, Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On 2/11/2022 at 10:00AM Licensing Program Analyst (LPA) Dawn Mahecha conducted the following Component II at the Monterey Park Children's Residential Program office with the All together Small Family Home (SFH). Present at the Component II were All togethers' Applicant Raven Campbell and Assistant Dahl Johnson, LPA Mahecha and Yan Yeung, Licensing Program Manager (LPM) via Microsoft Teams. During the meeting the LPA went over the missing and incomplete documents within the application, program statement and supporting documents. LPA provided Title 22 regulations to Administrator of areas identified within the Program Statement that were incomplete including staff training, personnel requirements, house rules, Admission policies, weekly activity plan and reporting requirements. LPA requested following documents and revisions to be submitted to Community Care Licensing (CCL) by March 25, 2022. 1. Criminal Record Clearances for associated staff or adult household members 2. Supportive placement letter 3. Supportive letters identifying relocation 4. Fire Clearance Exit interview conducted and a copy of this report was provided.

met_with: Raven Campbell, Applicant


summary: Facility Evaluation

raw_content:
Narrative:
On 6/13/ Licensing Program Analyst (LPA) Dawn Mahecha made an announced visit to the All together small family home (SFH) for the purpose of a Pre-licensing/ Component III inspection. LPA met with Applicant Raven Campbell and discussed the following information during the inspection. LPA and applicant did a walk thru of the facility both inside and out. This is a two story, single family residence with 4 bedrooms, 3 bathrooms, kitchen, dining, 2 living spaces, backyard, front yard and attached garage. LPA observed the following: Downstairs: Kitchen: LPA observed kitchen to have required perishable and non-perishable food storage for anticipated 4 children in care. All appliances, microwave, oven, stove top at the time of this inspection were working and operable. Fire extinguisher observed full charged which expires 2/ Living spaces: LPA observed living spaces to be clean and free of clutter Dining room: Consisted of table and 5 chairs/ additional dining seating provided in kitchen area Downstairs bathroom: Bathroom has one sink, toilet and shower/ tub combination. Water temperature was tested and water temperature was measured at 118.2 degrees Fahrenheit. Downstairs Bedroom (Guest bedroom): Consists of one (1) queen bed, closet and desk (no clients utilizing bedroom Two downstairs closets were observed. One closet towards the front of the home being used as medication storage, files, knives and cleaning supplies. Second closet being used for coats and additional clothing/ storage items. Upstairs: Bedroom 1: Consisted of two twin beds, two night stands, two side lamps and closet space available. Bedroom had mounted TV. Bedroom 2: Consisted of two twin beds and closet space available. Bedroom had one floor lamp, TV and chair. Master bedroom: Consisted of 1 queen bed, crib/ toddler bed, attached bathroom and walk in closet Bathroom: Consisted of double sinks, toilet, bath/ shower combo. Water temperature was tested and measured at 120.6 degrees Fahrenheit. Laundry room: Consisted of washer/ dryer, sink and was free of clutter or debris All smoke detectors and carbon monoxide machines were tested and tested audible at the time of this inspection. Front/ Backyard: were observed to be clean and free of debris or clutter. LPA observed two tables and 5 chairs in back yard providing ample seating for clients in care. Garage: Split in two sections half being salon set up with chairs and maintained emergency supply kit. Second half utilized as strictly storage. Front entry: Consisted of sanitation area and seating, with log for visitors LPA went over forms with applicant and identified where applicant could retrieve those documents. LPA went over documents received and information provided with Program Statement and Fire clearance. Applicant maintained to fully stocked First Aid kits. Items to repair: 1. Water temperature should be between 105-120 degrees Fahrenheit. Water in upstairs bathroom tested at 120.6 degrees Fahrenheit 8088 (Furniture and Fixtures (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). 2. Light fixture in downstairs bathroom needs cover 3. Screens in upstairs bedroom 1 and 2 need to be replaced or repaired 4. Storage space/ dressers for all clients to have two dressers for storage of personal items in each bedroom. Both bedrooms observed did not have proper dresser storage space available for clients in care. 5. Post food menu, activities list and visitor/ COVID screening log. At the time of this inspections the following observations and corrections were observed. LPA requested applicant to email pictures of proof of corrections being made by June 17th. Exit interview completed, no deficiencies were cited during this inspection and a copy of this report was emailed to applicant for record.


summary: Facility Evaluation

raw_content:
Narrative:
On June 27, Licensing Program Analyst (LPA) Dawn Mahecha made an announced visit to the All Together Small Family Home (SFH) for the purpose of a pre-licensing follow-up. LPA met with applicant Raven Campbell and discussed the following observations observed in previous inspection on June 13, 2022. LPA and applicant did a walk through of home and LPA observed the following corrections made to items requested to be repaired: 1. LPA retested water and both upstairs and downstairs bathrooms water tested at 120 degrees Fahrenheit. 2. Light fixture in downstairs bathroom was working and covered 3. Screens in upstairs bedroom 1 and 2 were observed to be replaced or repaired 4. LPA observed storage space/ dressers for all requested clients. 5. Food menu, activities list and visitor/ COVID screening log were present and observed on kitchen table, front entry and posted wall board. Exit interview completed, no deficiencies cited and a copy of this report was given to applicant.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 12/21/ Licensing Program Analysts (LPAs) Dawn Mahecha and Joe Martinez made an announced visit to the All together Small Family Home (SFH) for the purpose of a post licensing inspection. LPAs met with licensee/ Administrator Raven Campbell and together did a walk through of the facility both inside and out. LPAs observed the following: This is a two story, single family residence with 4 bedrooms, 3 bathrooms, kitchen, dining, 2 living spaces, backyard, front yard and attached garage. LPA observed the following: Downstairs: Kitchen: LPA observed kitchen to have required perishable and non-perishable food storage for anticipated 4 children in care. All appliances, microwave, oven, stove top at the time of this inspection were working and operable. Fire extinguisher observed full charged which expires 2/ Living spaces: LPA observed living spaces to be clean and free of clutter Dining room: Consisted of table and 5 chairs/ additional dining seating provided in kitchen area Downstairs bathroom: Bathroom has one sink, toilet and shower/ tub combination. Water temperature was tested, and water temperature was measured at 106.3 degrees Fahrenheit. Downstairs Bedroom (Guest bedroom): locked and LPAs were unable to obtain access due to licensee had no key Two downstairs closets were observed. One closet towards the front of the home being used as medication storage, files, knives, and cleaning supplies. Second closet being used for coats and additional clothing/ storage items. Upstairs: Bedroom 1: Consisted of two twin beds, two plastic dressers and closet space available. Bedroom had mounted TV. Bedroom 2: Consisted of two twin beds and closet space available,TV and chair. Master bedroom: Consisted of 1 queen bed, crib/ toddler bed, attached bathroom and walk in closet Bathroom: Consisted of double sinks, toilet, bath/ shower combo. Water temperature was tested and measured at 107.8 degrees Fahrenheit. Laundry room: Consisted of washer/ dryer, sink and was free of clutter or debris All smoke detectors and carbon monoxide machines were tested and tested audible at the time of this inspection. Front/ Backyard: were observed to be clean and free of debris or clutter. LPAs observed ample outdoor seating for clients in care. Garage: Split in two sections half being salon set up with chairs and maintained emergency supply kit. Second half utilized as strictly storage. Front entry: Consisted of sanitation area and seating, with log for visitors LPA went over forms with licensee and identified where licensee could retrieve those documents. LPA went over emergency disaster plan and plan of operations. Licensee maintained a fully stocked First Aid kit. LPAs reviewed current LIC500, associations and verified documents were posted and available for review. Currently home has no placement's. Last placement's were removed from home 12/20/2022. LPAs were unable to interview children. Exit interview completed the following deficiencies were cited and a copy of this report was emailed to licensee.,

Deficiencies:
80087: Deficient Practice Statement
1
2
3
4(a)

title: This requirement is not met as evidenced by

description:
Deficient Practice Statement
1
2
3
4(a)


summary: Facility Evaluation

raw_content:
Narrative:
On 7/20/ Licensing Program Analyst (LPA) Dawn Mahecha made an unannounced visit to the All together Small Family Home (SFH) for the purpose of a Annual/ Required inspection. LPA met with Administrator and the following was observed and discussed. LPA reviewed staff and client files and was able to complete two Care tool domains. However, LPA was unable to complete additional domains and will conclude annual inspection at a later date. LPA discussed the following citations observed and to be cited at a later date on reviewed domains: 1. Staff not cleared or associated to facility for two (2) staff identified on LIC500 (staff roster) 2. Staff and client files not having required forms, signatures and training's 3. Plan of operation being incomplete and not having required detail. Exit interview completed, deficiencies observed and to be cited on later date and a copy of this report was provided to Administrator.


facility_name: ALMIGHTY SMALL FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On July 16, 2025, at 9:00 am, Licensing Program Analyst (LPA) Charmaine Linley, and Licensing Program Manager (LPM) Ann Valenzuela met with applicant at the Riverside Children's Residential Program Regional Office for the purpose of conducting a Component II meeting. The applicant was previously emailed the list of revisions, along with LIC 184 and LIC 281 on July 14, 2025. Applicant stated he has experience in Small Family Homes and Group Homes for adults with developmental disabilities. Applicant stated he will not accept clients with specialized health care needs. Applicant stated the goals of the facility are to provide the clients with independent living skills so they can transition into adulthood with skills such as, hygiene, laundry, and making the bed. LPA discussed corrections and revisions needed for the Small Family Home application and supporting documents. The following is a list of the corrections and revisions discussed and requested. These revisions are due by close of business on July 31, 2025:  Sections need to be organized and separated out, use the LIC 281 as a guide. There are duplicate pages after page 52 that are not numbered. Guardian:  Please contact Guardian to find out the status of your clearance. Suggestion is to make sure you have created a user account, you can find information at *** https://www.cdss.ca.gov/inforesources/cdss-programs/community-care-licensing/caregiver-background-check/guardian. Licensee Qualifications:  Applicable experience shall be documented in writing, by a person other than the applicant, and submitted to the licensing agency.  Please describe your experience working with children with special health care needs or the licensed individual that will be present in the home to provide services for children with special health care needs. A9.a Budget Information (LIC 420):  Section C: Other Expenditures needs to be filled out. A10. Personnel Report (LIC 500):  Caregivers names and days/hours on duty needs to be completed. A11. Personnel Record (LIC 501):  This form is missing. A14. Emergency Disaster Plan (LIC 610C):  Section II - Emergency Names to be filled out.  Provide letters of permission from Owners/Manager/Property Owners for both Relocation Sites. A15. Facility Sketch (LIC 999):  Sketch must give dimensions of all rooms.  Bedrooms must include how many clients in each bedroom and if they are ambulatory or non-ambulatory.  Indicate exit routes by number as shown on the LIC Emergency Disaster Plan.  Sketch must also identify utility shut-off locations.  If the facility will have any video cameras inside or outside, the information below must be included and video cameras (including Ring) must be indicated on the facility sketch. *** Video Cameras: Describe the following: (1) Where video cameras are - or will be - located, include on the Facility Sketch. (2) The purpose of the video cameras. (3) How children and authorized representatives will be informed of the location of video cameras and their purpose. (4) How licensees will work with placing agencies to address situations in which a child objects to video cameras. (5) How video cameras will be used in a trauma-informed manner. (6) Whether video cameras will be livestreamed only or recorded. (7) If recorded, who will have access to the recordings and how will the recordings be stored and safeguarded. Section B Documents: B7: Facility Program Description:  Provide a brief statement of the program methods (program philosophy).  Include the days of operation.  The daily schedule of activities should state who plans, conducts and assists clients in participating in these activities.  A one month schedule of planned social, educational and recreational activities, this needs to be specific to the area and not have the same activities day to day. The schedule should have a variety of social, educational, and recreational activities.  Page 9 spelling/grammar error #1.  Page 16, "reporting incidents and complaints," spelling/grammar error.  Page 20, "discharge related to non-emergency status," spelling/grammar error.  Page 23, 24, 43, 47, 49, 50 have spelling/grammar errors.  Description of how the facility is going to handle medical emergencies if a client becomes ill or injured other than calling 911.  A Facility Director and Director of Client Services are referenced; however, these positions are not listed on the LIC 500. *** Medication:  Describe the procedure for handling and assisting children with self-administered medications.  Describe how the Licensee will obtain Parental Consent or JV-220 for children with psychotropic medication.  All psychotropic medications must be logged separately. Please provide a statement that this is being done for each medication. CCL has form that can be used - LIC 622b.  Provide a statement that medication errors will need to be reported and documented to CCL, according to the timeframes for reporting requirements.  Provide a statement that any medication refusal by a client is considered a "Special Incident" and a report will be sent to Community Care Licensing.  Describe how the licensee shall ensure that the personnel records working with children with specialized health care needs will document training and/or have a copy of a valid license or certificate indicating that they are a licensed health care professional (Title 22 83066).  Describe how the motor vehicles used to transport clients shall be maintained in a safe operating condition.  The licensee and their staff are prohibited from smoking a tobacco product, or permitting any person from smoking a tobacco product in a motor vehicle that is regularly used to transport children, regardless of when the children are present. This prohibition applies when the motor vehicle is moving or at rest.  The licensee shall provide transportation for a child in a timely manner to and from the following: (1) School. (2) Extracurricular, enrichment, cultural, and social activities, in accordance with the reasonable and prudent parent standard specified in Section 83067.  Describe how the facility shall ensure that the transportation provided safeguards the health and safety of a child and shall not violate the personal rights of a child as required by Section 83072.  Provide a description of community resources and consultants to be used by the facility, there are only four recreational resources provided, this does not meet standards.  Describe the timeframes including how to submit a grievance/complaint, how the outcome is documented, and where is the procedure documented. *** B8: Rules of Discipline/Personal Rights:  Provide a statement that discipline does not include a violation of personal rights.  Describe the types of discipline that will be used and under what conditions each type will be used. The discipline policies shall also address the following, when appropriate: types of discipline not permitted.  Describe the grounds for removal from placement.  Describe how the child will sign the personal rights form at intake and each time a new right has been added.  Provide a copy of the discipline policy and describe how the child and Authorized Representative will sign the form. B9: Admission Policies:  Page 32-33, incomplete sentences under "criteria for assessing appropriateness change in client status."  Describe the criteria for assessing appropriateness of placement given an individual client's needs (i.e., interviews, procedures for obtaining and developing the necessary paperwork, etc.)  Needs and services plan for children with specialized health care needs to include documentation by the child's county social worker, regional center caseworker or authorized representative that the needs of the child can be met by the facility.  Describe how the Licensee will obtain signatures of the child and Authorized Representative for the initial Needs and Services Plan and anytime there are any updates/modifications.  Describe how the clients/residents will sign that they are informed of their rights and that client's/resident's rights will not be violated. Describe how the facility will obtain emergency information.  Describe how the Licensee will obtain TB testing for the client within their first 30 days and annually thereafter. B10: Sample Menu: The sample menu will include: • Portion sizes. *** B12. Bacteriological Analysis of Private Water Supply (When Water for Human Consumption is from a Private Source):  This section is not complete. B16. First Aid Card:  There is no First Aid Card provided. LPA conducted an exit interview and provided a copy of this report to the applicant, along with the signed Orientation form indicating Component II has been completed. A copy of this report will be placed in the facility file.

met_with: Joshua Creer


summary: Facility Evaluation

raw_content:
Narrative:
On October 20, 2025, Community Care Licensing (CCL) conducted an office conference with Small Family Home (SFH) applicant Joshua Creer regarding their application denial for Almighty Small Family Home (366000020). Present at the meeting were Ann Valenzulea, Licensing Program Manager, Licensing Program Analyst (LPA) Charmaine Linley, and Almighty Small Family Home Applicant, Joshua Creer. The meeting was called to discuss concerns regarding the applicant's discrepancies and inaccurate information found in the application materials and subsequent conversations. LPA explained that CCL is considering denying the applicant's Small Family Home application for Almighty Small Family Home (366000020). The possible denial of the application is based on the submission of multiple misleading and inaccurate statements. This decision is based on the evidence set forth in the reports, statements and other documentary evidence contained in the official files compiled by the department. LPM informed Joshua Creer that CCL is consulting with the Department's attorney on the application denial. If your application is denied, a denial notice will be sent to the applicant explaining all reasons for the application denial and provided in Health and Safety Code Section 1526, an applicant may appeal a denial by submitting a written appeal within 15 days after the licensing agency mails the denial notice. The appeal should include the facility name, facility number, facility address and a copy of the denial letter. The appeal must be post marked or delivered on or before 15 days from the date of the denial letter. LPM explained that if this decision is not appealed on or before the due date the denial will be final. LPM informed applicant that the appeal request is sent to the following address: Jean Chen, Program Administrator, Statewide Children's Residential Program Office, P Street, MS 9-14-880, Sacramento, CA 95814. A copy of this report and appeal rights were provided to Joshua Creer.


facility_name: ALOE SPECIAL CARE HOME

raw_content:
Narrative:
It was also reported that S1 comes to work at the facility smelling like alcohol and cigarettes. It was also reported that S1 is not properly trained to work at the facility. Confidential interviews revealed that there was no suspected physical abuse to C1 and C2. Confidential witness statements revealed that staff are properly trained. Confidential witness statements revealed that a third party had stated that staff are not properly trained. Confidential witness statements also revealed that it is unknown where the information came from regarding whether or not S1 works at the facility while under the influence. Based on confidential interviews and records reviewed, the allegations that C2 sustained a fracture while in care, C1 sustained injury while in care, S1 works while under the influence of a substance, and S1 is not properly trained, are unsubstantiated. Meaning, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated. Exit interview was conducted and a copy of this report, along with appeal rights were explained to LVN Tye Espinoza. Due to printer malfunction, this report will be emailed to LVN Tye Espinoza.

Investigation Findings:
13On September 22, 2022 at 10:44am Licensing Program Analyst (LPA), Adrian Mendez, arrived unannounced to the facility and met with Licensed Vocational Nurse (LVN) Tye Espinoza to deliver the finding for the above stated allegations. The investigation was conducted by Community Care Licensing Investigations Branch (IB) Special Investigator (SI) Rey Lyyjoki and included interviews with six facility staff, and one confidential witness. In addition, facility records, and medical records were reviewed. On April 20, 2022, Community Care Licensing (CCL) received allegations that a resident sustained a fracture while in care, a resident sustained injury while in care, a staff works while under the influence of a substance, and facility staff not properly trained. It was reported that C1 was observed having 10 stitches on C1's forehead. It was also reported that C2 was observed having a cast on C2's leg due to C2 sustaining a tibia fracture at the facility. It was also reported to be believed that C1 and C2 may have sustained the injuries as a result of physical abuse at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Ann Valenzuela LICENSING EVALUATOR NAME: Adrian Mendez 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 22-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, THE CITY DR., SUITE FACILITY NAME: ALOE SPECIAL CARE HOMEFACILITY NUMBER: VISIT DATE: 09/22/2022

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

met_with: Tye Espinoza


summary: Facility Evaluation

raw_content:
Narrative:
On June 23, 2021 at 12:32PM, Licensing Program Analyst (LPA) Adrian Mendez conducted an unannounced required annual inspection of the small family home. LPA met with Administrator Sarah Paul. LPA toured the facility inside and outside with Administrator. The home is a two-story residence with eight bedrooms and five bathrooms. There are currently six clients in care. The small family home is licensed for four non-ambulatory and two ambulatory clients ages three to seventeen years old. There are eight bedrooms, living room, dining room, kitchen, and five bathrooms. The six bedrooms are used for the clients. The clients' 4 bedrooms downstairs have two twin beds and adequate shelf and closet space for client's belongings. The clients' bedrooms are arranged so that there is no more than one client per bed. There are three bathrooms for the clients to share. The bathrooms are clean and in good repair. The hot water in the client bathroom sink was measured to be 117.5 degrees, which is within regulatory requirements. Cleansers/chemicals are inaccessible and locked in the garage. The sharp knives are locked in the laundry room. The First Aid Kit contained all required supplies and is stored in the medicine closet. The clients' medications were observed to be inaccessible and stored in the medicine closet at the end of the hallway. The medication logs are kept updated and the dispensing records had no discrepancies. The smoke/carbon monoxide detectors were checked and were operable. LPA observed a minimum 7-day non-perishable and a 3-day perishable supply of food. There was a variety of snacks available for clients as well. Three clients' and three staff files were reviewed during the inspection. The files appeared to be completed and in order. A review of administrative records indicate that the facility has paid their current licensing fees. The following required posted items were observed accessible to clients: Personal Rights, Facility license, and Emergency Disaster Plan. Based on today's inspection, and file review, there were no deficiencies found at this time. A copy of this report was reviewed and provided to Administrator Sarah Paul.

met_with: Sarah Paul


summary: Facility Evaluation

raw_content:
Narrative:
On November 9, 2022 at 11: AM, Licensing Program Analysts (LPAs) Babatunde Aborchie and Karen Beal conducted an unannounced required annual inspection of the small family home. LPAs met with Supervisor Sarah Paul. LPAs toured the facility inside and outside with supervisor. The home is a two-story residence with eight bedrooms and five bathrooms. There are currently seven clients in care. The small family home is licensed for six non-ambulatory and two ambulatory clients ages three to seventeen years old. There are two living rooms, dining room and a kitchen. The six bedrooms are used for the clients. The clients' 4 bedrooms downstairs have two twin beds and adequate shelf and closet space for client's belongings. The clients' bedrooms are arranged so that there is no more than one client per bed. There are three bathrooms for the clients to share. The bathrooms are clean and in good repair. The hot water in the client bathroom sink was measured to be 111.6 degrees, which is within regulatory requirements. Cleansers/chemicals are inaccessible and locked in the garage. The sharp knives are locked in the garage. The First Aid Kit contained all required supplies and is stored in the medicine closet. The clients' medications were observed to be inaccessible and stored in the medicine closet at the end of the hallway. The medication logs are kept updated and the dispensing records had no discrepancies. The smoke/carbon monoxide detectors were checked and were operable. LPAs observed a minimum 7-day non-perishable and a 3-day perishable supply of food. There were variety of snacks available for clients as well. Three clients' and three staff files were reviewed during the inspection. The files are completed and in order. A review of administrative records indicate that the facility has paid their current licensing fees. The following required posted items were observed accessible to clients: Personal Rights, Facility license, and Emergency Disaster Plan. Based on today's inspection, and file review, there were no deficiencies found at this time. A copy of this report was reviewed and provided to supervisor Sarah Paul.

met_with: Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On December 4, 2023 at 12: PM, Licensing Program Analysts (LPA) Karen Beal conducted an unannounced required annual inspection of the small family home. LPA met with Direct Staff Personnel Kira Sundheim. LPA toured the facility with Chris Barrow inside and outside. The home is a two story residence with eight bedrooms and five bathrooms. There are currently seven clients in care. The small family home is licensed for six non-ambulatory and two ambulatory clients ages three to seventeen years old. There are two living rooms, dining room and a kitchen. The six bedrooms are used for the clients. The clients' 4 bedrooms downstairs have two twin beds and adequate shelf and closet space for client's belongings. The clients' bedrooms are arranged so that there is no more than one client per bed. There are three bathrooms for the clients to share. The bathrooms are clean and in good repair. The hot water in the client bathroom sink was measured to be 116.56 degrees, which is within regulatory requirements. Cleansers/chemicals are inaccessible and locked in the garage. The sharp knives are locked in the garage. The First Aid Kit contained all required supplies and is stored in the medicine closet. The clients' medications were observed to be inaccessible and stored in the medicine closet at the end of the hallway. The medication logs are kept updated and the dispensing records had no discrepancies. The smoke/carbon monoxide detectors were checked and were operable. LPA observed a minimum 7-day non-perishable and a 3-day perishable supply of food. There were variety of snacks available for clients as well. Three clients' and three staff files were reviewed during the inspection. The files are completed and in order. A review of administrative records indicate that the facility has paid their current licensing fees. The following required posted items were observed accessible to clients: Personal Rights, Facility license, and Emergency Disaster Plan. Based on today's inspection, and file review, there were no deficiencies found at this time. A copy of this report was reviewed and provided to Administrator Sarah Paul.

met_with: Sarah Paul, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On August 15, 2024 at 11: AM, Licensing Program Analysts (LPA) Guadalupe Munoz l conducted an unannounced required annual inspection of the small family home. LPA met with Sarah Paul, Facility Administrator and David Chase, Licensee. LPA toured the facility with Jessica Harris, Direct Support Professional, inside and outside. The home is a two story residence with eight bedrooms and five bathrooms. There are currently six clients in care. The small family home is licensed for two non-ambulatory and four ambulatory clients ages to two to seventeen years old. There are two living rooms, dining room and a kitchen. The six bedrooms are used for the clients. There are 3 client bedrooms downstairs for non ambulatory clients. Each bedroom has two twin beds and adequate shelf and closet space for client's belongings and medical devices. The clients' bedrooms are arranged so that there is no more than one client per bed. There are three bathrooms for the clients to share. The bathrooms are clean and in good repair. The hot water in the client bathroom sink was measured to be 112.8 degrees, which is within regulatory requirements. LPA observed a minimum 7-day non-perishable and a 3-day perishable supply of food. There were variety of snacks available for clients as well. The sharp knives are locked in the garage. Cleansers/chemicals are inaccessible and locked in the garage. The clients' medications were observed to be inaccessible and stored in the medicine closet at the end of the hallway. The medication logs are kept updated and the dispensing records had no discrepancies. The smoke/carbon monoxide detectors were checked and were operable. The First Aid Kit contained all required supplies and is stored in the medicine closet. ***This is an amended LIC 809 that was originally signed on 08/15/24*** Three staff files were reviewed during the inspection. The files are completed and in order. A review of administrative records indicate that the facility has paid their current licensing fees. The following required posted items were observed accessible to clients: Personal Rights, Facility license, and Emergency Disaster Plan. Based on today's inspection, and file review, there were two deficiencies found at this time and LPA will return to cite facility at a later date. A copy of this report and LIC 811 dated 8/15/24 was reviewed and provided to Administrator Sarah Paul.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
On 09/13/ LPA Munoz returned to facility and met with Sarah Paul to obtain signature and final print documents that due to computer error were not captured on past visit. On 08/27/24 at 12pm Licensing Program Analyst (LPA) Guadalupe Munoz, LPA Jacqueline Garcia and Licensing Program Manager (LPM) Ann Valenzuela arrived to Aloe Special Care Home, a Small Family Home (SFH) for the purpose of amending LIC 809 that was signed on 08/15/24 and to complete the annual inspection that began on 8/15/24. LPA and LPM met with Licensee, David Chase and Administrator, Sarah Paul. On 8/15/ LPA Munoz began the unannounced required annual inspection, on that date LPA observed that clients C1-6 are over the license age threshold. Upon initial inspection date, LPA also observed four non-ambulatory clients residing in the SFH therefore exceeding their license ambulatory status. Licensee reported that in 2020 they licensed an adult home for C1-C6 to be transferred to, however, the home has not been approved by Regional Center. Licensee reported that they have submitted the program description to Regional Center back in 2020 and has not had any response regarding the approval process and is unsure what is needed to get the home approved. LPA and LPM confirmed Adult Licensed Home, Chase Special Care Home. LPA completed 5 client file review and all required documentation met regulation requirements. LPA reviewed 5 staff files and observed four staff that did not meet staff clearances. The SFH is being cited for Title Continuing Care Requirements (CCR)Section 80010(a) Limitations on Capacity and Ambulatory Status and Health and Safety Code (HSC) Section 1522(c)(1) Administration and CCR Section 80019(e) Criminal Record Clearance. Civil Penalties were assessed for each staff that is not cleared. LPM Valenzuela discussed with Licensee David Chase that CCL is going to place the facility on a plan to follow up weekly on the process of Regional Center Approval and when the clients will be transferred to the adult facility. LPA completed exit interview with David Chase and Sarah Paul. LPA provided a copy of this report, LIC 811 dated 8/27/24 and Appeal Rights were provided to designees.

Deficiencies:
80019(e): Criminal Record Clearance

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


summary: Facility Evaluation

raw_content:
Narrative:
On September 19, 2024, at 1:00 p.m., Children Residential Program (CRP) Licensing Program Manager (LPM) Ann Valenzuela, Adult Senior LPM, Alisa Ortiz, and Licensing Program Analyst (LPA) Jacqueline Garcia met with Aloe Special Care Home Small Family Homes (SFH) Licensee, David Chase, SFH Administrator, Sarah Paul, and Orange County Regional Center Representatives, Jacqueline Puente and Christina Pham at the CRP Orange Local Office for an informal office conference. The purpose of the meeting was to discuss the following issues and concerns with the Licensee for Aloe Special Care Homes regarding Title Continuing Care Requirements Section 80010(a) Limitations on Capacity and Ambulatory Status. On 8/27/ Community Care Licensing (CCL) conducted an unannounced annual inspection and cited the SFH for allowing adult clients to live at the facility. Upon file review CCL determined that all clients in placement were over the age of 22 years. Licensee stated that they have always wanted to continue the care of the client's longer term, as they had them since the age of 3 years. Licensee stated that they had no intention to be out of compliance of Title Regulations as they had submitted an application and were licensed to provide services for adult clients at the Fountain Valley facility, however Regional Center delayed the process which brought them to their current status. Licensee stated they have submitted a new application to the Adult Senior Residential Care application unit on 9/13/24. Licensee changed original plan of having the Fountain Valley Home vendorized by Regional Center to serve the adults clients, as it would be more efficient to change location of the SFH to the Fountain Valley location and turn the current SFH into a licensed Adult Residential Facility for the clients to remain in the same home. LPM Ortiz stated the application was received by the Application Unit on 9/17/24, in addition, there has been communication with the Application Unit and there is an understanding that the application will be expedited. . LPM Valenzuela asked Regional Center Representatives regarding the length of time it will take the Regional Center to approve the vendorization of the Adult Residential Facility. Regional Center Representative Jacqueline Puente stated they could not confirm a timeframe, however David Chase stated he believes it can be approved by 9/23/24. David stated he has been in communication with Regional Center and has made requested revisions to their Program Statement. On 9/19/24 the following plan was identified: · Licensee submitted Adult Residential Facility application on 9/13/24 to the Adult Application Unit. · Application was received on 9/17/24 and will be expedited. · LPA Munoz will communicate weekly with the Licensee. If there are any modifications to the current plan or there are any questions, please contact LPA Guadalupe Munoz at guadalupe.munoz@dss.ca.gov or (949) 701-3475. A copy of this report was reviewed and provided to Licensee David Chase. The signed report will be placed in the facility file.

met_with: Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On July 14, 2025 at 10: AM, Licensing Program Analysts (LPA) Guadalupe Munoz l conducted an unannounced required annual inspection of the Small Family Home. LPA met with Sarah Paul, Facility Administrator and David Chase, Licensee. LPA toured the facility inside and outside. The home is a two story residence with eight bedrooms and five bathrooms. There are currently six clients in care. The small family home is licensed for two non-ambulatory and four ambulatory clients ages two to seventeen years old. There are two common living room areas, dining area and kitchen. There are 3 client bedrooms downstairs for non ambulatory clients. Each bedroom have twin beds and adequate shelf and closet space for client's belongings and medical devices. The clients' bedrooms are arranged so that there is no more than one client per bed. There are three bathrooms for the clients to share. The bathrooms are clean and in good repair. The hot water in the client bathroom sink was measured to be within regulatory requirements. LPA observed a minimum 7-day non-perishable and a 3-day perishable supply of food. There were variety of snacks available for clients as well. The sharp knives are locked in the garage. Cleansers/chemicals are inaccessible and locked in the garage. The clients' medications were observed to be inaccessible and stored in the medicine closet at the end of the hallway. The medication logs are kept updated and the dispensing records had no discrepancies. The smoke/carbon monoxide detectors were checked and were operable. The First Aid Kit contained all required supplies and is stored in the medicine closet. ****** LPA completed six client file reviews and all required documentation met regulation requirements. Five staff files were reviewed during the inspection. The files are complete and meet regulation requirements. A review of administrative records indicate that the facility has paid their current licensing fees. The following required posted items were observed accessible to clients: Personal Rights, Facility license, and Emergency Disaster Plan. Licensee reports that there are no fire arms in the home. The SFH is still in the process of getting licensed for the Adult Residential License(ARF) and reported that on 7/14/25 they completed Component III and pre license visit for the ARF licensing process. Based on today's inspection. LPA observed that clients C1-6 are over the license age threshold. The SFH is being cited for Title Continuing Care Requirements (CCR)Section 80010(a) Limitations on Capacity and Ambulatory Status. An exit interview was conducted with Sarah Paul and a copy of this report and LIC 811 dated 7/14/25 was reviewed and provided to Administrator Sarah Paul.

met_with: David Chase and Sarah Paul


summary: Facility Evaluation

raw_content:
Narrative:
On July 29,2025 at 1: PM, Licensing Program Analysts (LPAs) Guadalupe Munoz and Stefani Mutialu conducted an announced pre-licensing inspection visit for the change of location to the ALOE Special Care Home, Small Family Home. LPAs met with licensee, David Chase and conducted the inspection of the home. The facility is a four bedroom two bathroom single-family, single-story home with an in ground pool and with an attached garage. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris. There is adequate indoor and outdoor activity space. Clients will have access to a telephone in the living room to make and receive confidential telephone calls. Inside the home the fireplace was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where children will have access. The facility smoke detectors and carbon monoxide detectors tested and were observed to be in working order; the fire extinguishers are properly charged and serviced. The facility has a first aid kit with all of the required items and a First Aid manual. The applicants stated there were no weapons in the facility. Disinfectants and cleaning solutions will be stored and locked in the garage. Sharp knives will be stored in a locked kitchen cabinet. Medication will be locked and stored in a cabinet in the hallway of the home.. The following required forms were posted in the facility: Personal Rights form, Foster Care Ombudsmen Poster and LIC Emergency Disaster Plan, and Grievance Policy. The facility is set up as follows The entry hallway leads to an open living room that flows into the dining area and attached kitchen. All shared living spaces have furniture in good condition. At the rear of the home is a sliding glass door that leads to the backyard which has a jacuzzi and pool. The backyard patio is gated with a 5 foot fence that meets the regulation standards. There are three client bedrooms that are designated for two clients per room with twin sized beds dresser and closet space for each client. Each room has adequate clean linens, pillows, blankets, comforters, mattress pads, and mattresses. Bedroom #1 is: designated for two clients, with two twin beds and ample closet spaces. Bedroom #2 is designated for two clients, two twin beds and ample closet spaces. Bedroom #3 is designated for two clients, two twin beds and ample closet space. Bedroom #4 is designated as licensees bedroom. It includes an en suite bathroom. The home is equipped with non ambulatory ramps at front entrance and back exit of home. Client bathroom is in the hallway in front of the bedrooms and it includes a walk in shower to meet the needs of non ambulatory clients. All special incident reports (SIR's) will be sent via e-mail to: cclpaccr@dss.ca.gov. The reporting requirements were reviewed with the Applicant on this date. LPA explained that once the license is approved, all employees shall have an approved criminal record clearance for CCL and be associated to this facility. The request to be licensed for a small family home will be forwarded to Licensing Program Manager for final approval. An exit interview was conducted. A copy of this report was provided to Applicant/Licensee, David Chase.

met_with: David Chase


summary: Facility Evaluation

raw_content:
Narrative:
On December 30, 2025 at 10: AM, Licensing Program Analysts (LPA) Guadalupe Munoz conducted an unannounced post-licensing inspection visit of the ALOE Special Care Home, Small Family Home (SFH). The SFH is licensed to serve six children, two ambulatory and four non ambulatory, ages 0-20 years with Special Health Care needs. There are 0 children currently placed at SFH. LPA met with licensee, David Chase and conducted the inspection of the home. The facility is a four bedroom two bathroom single-family, single-story home with an attached garage and an in ground pool with a 5 foot fence to make pool inaccessible for clients. A physical plant inspection was completed and included the following checks: Facility grounds are clean and free of debris. There is adequate indoor and outdoor activity space. Telephone service and appliances are in working order. Disinfectants and cleaning solutions will be stored and locked in the garage. Sharp knives will be stored in a locked kitchen cabinet. Medication will be locked and stored in a cabinet in the hallway of the home..The facility smoke detectors and carbon monoxide detectors were observed to be in working order; the fire extinguishers are properly charged and serviced. The SFH has a first aid kit with all of the required items and a First Aid manual. The SFH stated there were no weapons in the facility. The SFH ensures that there is one client per bed with appropriate linens, pillows, comforters, and mattresses in good repair. All bedrooms have individual beds and drawer space for each client. ****** The home is equipped with ramps at front entrance and back exit of home for non ambulatory clients. Client bathroom is in the hallway in front of the bedrooms and it includes a walk in shower to meet the needs of non ambulatory clients. All special incident reports (SIR's) will be sent via e-mail to: cclpaccr@dss.ca.gov. The reporting requirements were reviewed with the Applicant on this date. An exit interview was conducted with Licensee and a copy of this report was emailed to License per their request.


facility_name: ALOHA OHANA FAMILY HOME

summary: Facility Evaluation

raw_content:
Narrative:
On September 9, 2025, Licensing Program Analyst (LPA) Maryjane Perez met with applicant Alexander Boateng this date for a Component II. LPA went over revisions needed for the application prior to licensure. LPA gave a copy of the LIC 184, Letter of Application Revision, and additional correspondence to assist with the revisions needed to the application. A copy of this report was provided to applicant Alexander Boateng.

met_with: Applicant- Alexander Boateng


summary: Facility Evaluation

raw_content:
Narrative:
On October 30, 2025, Licensing Program Analyst (LPA) Maryjane Perez arrived at Aloha Ohana Family Home, Small Family Home (SFH) for a pre-licensing inspection for an initial license. LPA met with applicant Alexander Boateng who led a tour of the entire home inside and outside. The applicant is applying to serve four ambulatory clients ages 6-17 years old. The home is a two story building that has four bedrooms and three bathrooms. The downstairs consisted of an entry way with all required postings such as emergency disaster plan, facility sketch, visitation policy, and personal rights. There was bedroom #1 that was a guest bedroom with a queen size bed, closet space, TV, and lighting. Bathroom #1 had hot water temperature measuring 116.6 degrees Fahrenheit and was fully functioning with a shower, toilet, sink, and trash can with a tight fitting lid. The hallway had fire extinguisher #1 that was operable and a first aid kit that was missing a thermometer. The kitchen was clean and sanitary with a locked cabinet for storing knives/ sharp objects and cleaning supplies. There was another locked cabinet above refrigerator for storing medications. The refrigerator and pantry were fully stocked with perishable and nonperishable foods. Their was a dining table and counter space with adequate seating. The living room was fully furnished with couches and TV. The upstairs consisted of bedroom #2 that was the master bedroom for applicant and had a queen size bed, closet and bathroom #2 that was fully functioning. Bathroom #3 had a sink, toilet, and shower/tub and a trash can with a tight fitting lid. There was an office area with a desk, computers and drawers for storing clients files and employee records. However, the drawers were missing a lock to keep files confidential and a lock box for clients cash resources. Bedroom #3 was utilized for two ambulatory clients and had two twin size beds with required bedding, lighting, and closet/ dresser space- currently vacant. Bedroom #4 was utilized for two ambulatory clients and had two beds, one twin size bed and one full size bed with all required bedding, lighting, and closet/ dresser space- currently vacant. The laundry room was accessible to clients with a washer/ dryer and a locked cabinet for storing laundry detergents and cleaning supplies. Bedrooms were arranged so that no more than two children share a room, and there is one child per bed. No room commonly used for other purposes is used as a bedroom, and no bedroom serves as a passageway to another room. The smoke detectors and carbon monoxide detectors were checked and are working properly. All hazardous items have been properly made inaccessible to areas where children will have access. The backyard where children will have access to play was completely fenced, free of hazards, and had a side yard gate with a latch. There was no pool or other bodies or water nor any firearms or weapons as stated by applicant. The garage stored one vehicle and extra household supplies. There was a telephone service, all appliances were in working order, and all trash cans for storage of solid waste had tight fitting lids. Based on this inspection, the facility will need the following corrections: Thermometer lock for client files and employee files lock box for clients cash resources After corrections are completed, the applicant will notify LPA so that another inspection can be completed. Component III orientation was also completed this day of October 30th, 2025. An exit interview was conducted and a copy of this report was provided to applicant Alexander Boateng.

met_with: Aapplicant- Alexander Boateng


summary: Facility Evaluation

raw_content:
Narrative:
On June 3, 2021 at 12: PM Licensing Program Analyst (LPA) Kourtney Williams arrived at the small family home to conduct an unannounced annual inspection. When LPA Williams arrived at the facility wearing a Community Care Licensing (CCL) identification badge, the doorbell was pressed by LPA, and an unknown woman answered the door. The woman stated the Licensee Sharee Williams was not at the home. The woman then called Licensee Sharee Williams on the phone with LPA outside the home. Licensee refused LPA entry into the facility via telephone and stated that the home didn't have any placement since 2016. LPA confirmed with Licensee that the home was still licensed by CCL and regardless of placement status, the annual inspections are required. LPA informed licensee that CCL has the inspection authority of the facility and refusing entry is a violation of the CCL regulations 80044. As a result, the home will be cited and LPA asked Licensee if she was going to proceed with facility closure. Licensee stated that she will close her facility and the facility door was abruptly shut with no further communication with LPA Williams. LPA Williams was unable to complete annual inspection and retrieve signature of the Licensee for this refused inspection. Inspection document emailed to tstc_n@yahoo.com on 06/03/21.

met_with: Sharee Williams