summary: Facility Evaluation

raw_content:
Narrative:
On 11/05/25 at 11:35 am, Licensing Program Analyst (LPA) Simran Nayyar made a visit to the facility regarding the facility closure. LPA met with Emaline Lien, Health Information Specialist and informed them of the purpose of the visit. Emaline Lien is a staff from the Seneca Family of Agencies Foster Family Agency Program (#15390058), she assisted LPA Nayyar with the walk through of the Seneca Aspire Oakland Facility (#15650129), due to there being no other staff present in the Seneca Aspire Oakland Facility at the time. During the walk through, LPA observed there to be no clients in care and the building to be empty due to the facility's closure. Closure letter, closure plan, and forfeited license have been received by the Department. An exit interview was conducted, and a copy of this report was left with Emaline Lien, Health Information Specialist whose signature on this form confirms receipt.


state: CA

facility_name: SENECA ASPIRE OAKLAND 2

summary: Complaint Investigation - Unsubstantiated - 1 allegation

raw_content:
Investigation Findings:
13On 4-10-24 2:30PM, Licensing Program Analyst (LPA) George Karkazis conducted an unannounced inspection at Seneca II, and met with David Jones, Director who helped with the inspection. The purpose of the inspection was to deliver the complaint findings. The complaint alleged that staff are not providing a comfortable and safe environment for the minor, and staff are not providing adequate food service for the minor. LPA Karkazis conducted confidential interviews and conducted document research, in which inconsistent information was provided. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove that the allegations occurred. Therefore, the allegations are UNSUBSTANTIATED. A copy of this report was given to David Jones, Director. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Isabel Diego LICENSING EVALUATOR NAME: George Karkazis LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

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

report_type: Complaint Investigation

met_with: David Jones, Director

complaint_status: unsubstantiated


summary: Facility Evaluation

raw_content:
Narrative:
On March 22 at 8:45AM, Licensing Program Analyst (LPA) Monica Pavia conducted an announced pre-licensing inspection of the facility. LPA met and toured the facility with Lauren Crutsinger, Executive Director, Delaney Messner, Lead Health Information Specialist, Terah Menke, RN, Monique Yoo Gomes, Health Services Manager, and Miles Jordan, Administrator. This is a Short-Term Residential Therapeutic Program for a capacity of two. It is a two story home that consists of two client bedrooms, one client bathroom, living room, lounge, kitchen and staff office. The facility is clean, safe, sanitary, and in good repair. All passageways are unobstructed and all doors open freely. There are no bodies of water on the facility premises. Fire arms are not allowed on the facility premises. Medications will be centrally stored and locked in closet. Disinfectants, sharps, and other toxic materials will be locked. At the time of visit, the following was observed: Fire extinguisher located on both floors. Smoke detectors are throughout the house and operational. Carbon monoxide detector is combined with the smoke detectors. The bedrooms have a bed, clean linens, and adequate drawer/cabinet space. Facility has a fire clearance. First aid kit was observed. Hot water temperature measured at 116 degrees Fahrenheit. This facility is ready for licensure.

report_type: Facility Evaluation

visit_type: Prelicensing

met_with: Lauren Crutsinger


summary: Facility Evaluation

raw_content:
Narrative:
On 8-17-23 9:49AM, Licensing Program Analyst George Karkazis conducted an unannounced Post Licensing Inspection at listed facility. LPA met with Miles Jordan, Administrator, and toured the facility inside and out. Safety precautions were taken including screening call and mask wearing. The Short Term Therapeutic Program is licensed to serve two clients. Present during the inspection were three staff and one client. At 10: AM, LPA Karkazis reviewed client and staff files. All staff and client files were complete and in good order. At 11:45AM, LPA Karkazis toured the facility. LPA Karkazis observed two bedrooms and two bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Karkazis tested the water temperature and found it to be 105.3 degrees which is in range. The thermostat read 69 degrees which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked closet, in a locked safe. LPA witnessed medication temperature log, required by San Francisco County. The facility is in good repair and clean. LPA Karkazis interviewed three staff and one client. At 12: PM, LPA Karkazis toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. At this time there were no deficiencies. An exit interview was conducted, appeal rights discussed and a copy of this report was given to Miles Jordan, Administrator.

met_with: Miles Jordan, Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 3-20-24 10:15AM, Licensing Program Analysts George Karkazis conducted an unannounced Annual/Random inspection at listed facility. LPA met with Delaney Messner, Manager of Operations, and toured the facility inside and out. The Short Term Therapeutic Program is licensed to serve 2 clients. Present during the inspection were 3 staff and 1 client. At 10:25AM LPA Karkazis reviewed client and staff files. All files reviewed were complete and in good order. At 11:47AM, LPA Karkazis toured the facility. LPA Karkazis observed two bedrooms and two bathrooms. LPA observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Karkazis tested the water temperature and found it to be 119 degrees which is in range. The thermostat read 70 which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in a closet in a locked safe. The facility is in good repair and clean. LPA Karkazis interviewed 3 staff and 1 client. At 12:27PM, LPA Karkazis toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. At this time there were no deficiencies. LIC 309, 610C, and 500 were emailed to LPA during inspections. An exit interview was conducted, appeal rights discussed and a copy of this report was given to Delaney Messner, Manager of Operations.

visit_type: Annual

met_with: Delaney Messner, Manager of Operations


summary: Facility Evaluation

raw_content:
Narrative:
On 9-26-24 10:15AM, Licensing Program Analyst (LPA) George Karkazis made an unannounced inspection at Seneca Aspire Oakland 2, and met with Adeya Bird Program Supervisor, Justina Wu Program Supervisor, Maira Polanco Youth Stabilization Specialist, and David Jones Director via phone. The purpose of the inspection was to conduct interviews for incident reports 9-16-24 #0001026-FN, and 9-17-24 #0001025FN. An exit interview was conducted and a copy of this report was given to Adeya Byrd, Program Supervisor.

visit_type: Case Management

met_with: Adeya Bird, Program Supervisor


summary: Facility Evaluation

raw_content:
Narrative:
On 3-11-25 10:16AM, Licensing Program Analysts George Karkazis Will Ea conducted an unannounced Annual/Random inspection at listed facility. LPA met with David Jones, Director and toured the facility inside and out. The Short Term Therapeutic Program is licensed to serve 2 clients. Present during the inspection were 2 staff and 1 clients. At 10:45AM, LPA Karkazis and LPA Ea reviewed client and staff files. All staff and client files were complete and in good order. At 1:12PM, LPA's Ea and Karkazis toured the facility. LPA's Karkazis and Ea observed 2 bedrooms and 2 bathrooms. LPA's observed facility license, personal rights, facility sketch, meal menu, and other forms posted on the walls throughout the facility. LPA Karkazis tested the water temperature and found it to be 119 degrees which is in range. The thermostat read 72 which is within range. Sharps were locked and chemicals were safely stored. There were two days of perishable foods and seven days non-perishable foods present. The medication was also stored and locked in the hallway closet, locked in a safe.. The facility is in good repair and clean. LPA Karkazis interviewed 2 staff and 1 clients. At 1:30PM LPA Karkazis toured the backyard. There were no open bodies of water. The backyard was in good repair and clean. At this time there were no deficiencies An exit interview was conducted, appeal rights discussed and a copy of this report was given to David Jones, Director


summary: Facility Evaluation

raw_content:
Narrative:
On 09/24/25 at 11:25am, Licensing Program Analyst (LPA) Simran Nayyar made an unannounced case management inspection at the above agency. LPA Nayyar met with Adeya Byrd, Assistant Director (AD) and David Jones, Program Director (PD). The purpose of the inspection was to conduct interviews for incident reports #2186-FN and #2193-FN. LPA Nayyar conducted a site inspection at the facility and conducted two (2) confidential interview with Adeya Byrd, Assistant Director (AD) (Please refer to LIC 812s dated 09/24/25). LPA Nayyar requested a safety plan for Client 1 (C1) and Client 2 (C2). Requested documentation will be sent to LPA Nayyar by 10/01/25 via email. Further investigation is needed regarding these incident reports. Exit interview was conducted and a copy of this report was printed and left with David Jones, Program Director (PD) whose signature on this form confirms receipt of these documents.

met_with: Adeya Byrd,Assistant Director & David Jones,Program Director


summary: Facility Evaluation

raw_content:
Narrative:
On 10/29/25 at 10:30am, Licensing Program Analyst (LPA) Simran Nayyar made an unannounced case management inspection at the above agency. LPA Nayyar met with Shaniqua Anderson, Program Supervisor (PS). LPA Nayyar conducted a site inspection at the facility and found the facility to be in good repair. During LPA Nayyar's walk through they observed one (1) staff member to be sitting outside of Client 1 (C1)'s room to ensure extra supervision. The purpose of the inspection was to conduct interviews for incident report #2332-FN. LPA Nayyar conducted a confidential interview with Placement Supervisor, Client 1, and Client 2. (Please refer to LIC 812s dated 10/29/25). LPA Nayyar requested a safety plan for Client 1 (C1) and Client 2 (C2). Requested documentation will be sent to LPA Nayyar by 11/05/25 via email. Further investigation is needed regarding this incident report. Exit interview was conducted and a copy of this report was printed and left with Shaniqua Anderson, Program Supervisor (PS) whose signature on this form confirms receipt of these documents.

met_with: Shaniqua Anderson, Program Supervisor


facility_name: SENECA COMPASS-VENTURA

summary: Facility Evaluation

raw_content:
Narrative:
On 03/02/2023 at 10:00AM Licensing Program Analyst (LPA) Olivia made arrived at the above facility, for the purpose of conducting an Annual Required Inspection on the Seneca Compass-Ventura: Short Term Residential Therapeutic Program (STRTP) facility. LPA Rosas met with Staff#1(S1) who granted access to the Conference Room and an inspection was conducted together. Individuals mention in this report are identify on the Confidential Names List (LIC811) dated 03/02/23. The annual fees are current. The Seneca Compass Ventura program is licensed to provide care and supervision for six (6) clients, ages 12-17, ambulatory only. The program provides intensive, individualized assessment and diagnostic treatment services for youth who do not meet the criteria for a psychiatric hospitalization but require treatment to stabilize their high-risk behaviors. Most youth placed into the Seneca Compass Program come directly from the 23-hour Crisis Stabilization Unit (CSU), where they have received immediate psychiatric assessment and stabilization services following an acute crisis. The residential program is one component of a larger continuum of care for youth in crisis, which include the 23-hour CSU, mobile crisis response services and community-based transition support services. There are currently 2 clients residing at the facility. Seneca Family of Agencies "The Seneca Compass Program", in partnership with Ventura County Behavioral Health Department (VCBHD), provide Short-term Assessment and Residential Treatment to six (6) children for thirty (30) days or less. This is a Commercial Building owned by the by the County of Ventura located in a residential area facing the main street. The National Accreditation through Commission on Accreditation of Rehabilitation Facilities (CARF) valid extended through November 20, 2024. The Mental Health Approval is affected date September 22, 2022 and expires September 22, 2023. There are no bodies on water on the premises. Staff confirmed that there are no firearms or dangerous weapons in the facility. Report continues on LIC809-C, page 1 out of Living Room/Lounge Activity Room: The living room, located in the corner of the hallway adjacent to Bedroom #3, is equipped with living room furniture and a powder room with toilet and sink only. The lounge activity room adjacent to the other side of Bedroom #3 is equipped with adequate living room furniture, desk/chair, books and activity games. Office: This is an office that is being used by the clerical staff. There are two (2) computers, health information and medical billing treatment information is kept in this office. Equipment Room: Only janitorial supplies will be stored in this room. LPA observed a fire extinguisher in this room and in the hallway as well. Staff Office: Is located by the alley main back entry and is equipped with four (4) computers, camera monitors, private bathroom with toilet and sink only. There is also a sitting lounge small area with a sofa and chair. Laundry Room: There is a washer and dryer located in the hallway near the showers. The doors were observed to be locked and made inaccessible to the youth unless supervised by staff. Cleaning solutions are observed to be locked in this room. Common Corridor: There are two sets of double doors, one set of double door lead to the Crisis Stabilization Unit and the other set of double doors lead to the Crisis Stabilization Unit area but both doors are locked always. The lobby area where the receptionist is located is used by Seneca as the main entrance. There is an entrance leading from the lobby area into the Dining Area/Training-Meeting Room that is used by the STRTP. There is no shared hallway area between the Community Treatment Team and the STRTP. Outside Patio Area: The patio is located out the exit doors from the Training/Meeting Room. There is sufficient space. There is no swimming pool or bodies of water on the premises. There are additional doors leading into the dining area. There are also two doors that lead to staff offices of the 23 hours Crisis Stabilization Unit; these doors will always remain locked and not used by the STRTP. The Backyard/Front yard is clean and free of all debris. Report continues on LIC809-C, page 3 out of LPA Rosas reviewed following during the inspection: LPA Rosas requested the following forms for review, Register of Youth (LIC 9020), Current Census, Personnel Report (LIC 500), Emergency Disaster Plan (LIC610C), Emergency Evacuation Plan and Emergency Disaster Plan including log that drills were conducted every six months. In addition, staff weekly schedule, Oxnard Fire Department Annual Licensed Care Inspection letter . Staff Records Review: LPA reviewed five (5) staff records stored in individual personnel file/binders provided by S1. LPA ensured to thoroughly review the records of the primary active staff (i.e Program Administrator, Facility Manager, and three (3) Mental Health Counselors). LPA reviewed the Personnel Report (LIC 500) and confirmed that Direct Care Staff Ratio present for the two (2) clients in placement. LPA confirmed that all staff have required criminal record clearance. DOJ, FBI and Child Abuse Response; which meet qualification. Administrator provided evidence of staff training transcripts that are store on Seneca Institute for Advanced Practice portal. Staff files are kept digitally and hard file are kept in Head Quarters Offices in Northern California. Clients Records Review: LPA reviewed two (2) clients records which meet qualification. Staff Interviews: LPA conducted a confidential interview with one (1) on duty staff. Client Interviews: LPA conducted confidential interviews with two (2) clients present during the inspection. A review of Facility's Personnel Report Summary on 02/27/2022 indicates that all personnel have criminal record clearance has obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. LPA Rosas by email send the following PINS to S1 by email: PIN 22-06-CCLD Guardian Background Check Best Practices, PIN 22-07-CCLD Guardian Webinar For Licensees and Providers, PIN 21-20-CRP Statewide Launch Of New Inspection Tools For Children's Residential Licensees. There were no deficiencies observed or cited at this time. Exit interview was conducted with S1 and a copy of this report was left at the facility. Page 5 out of Alarm/Carbon Monoxide/Fire Extinguishers: There are carbon monoxide alarms available on three different hallways (bedroom hallway, shower hallway and nurse medical hallway) and another alarm was also located in the dining/meeting room area. The facility is equipped with a pull-up alarm system throughout the facility. The system is checked by the County on monthly bases. LPA reviewed the monthly report which indicates that the alarm system is tested on June 30, 2022, and is in working order/PASS. There are four (4) operable Fire Extinguishers available in the facility. One is in the hallway near the bedrooms' area, two in the kitchen area, one in the reception area by the main entrance. Cameras and Delayed Egress Doors: There were a total of 11 cameras located in the entire facility. There were 10 cameras inside the facility (3 cameras by the bedroom hallway, 1 in the patio area, 2 in the dining/meeting room area, 1 in the tele-psych room, 1 in the reception area, 1 in the kitchen hallway, 1 in the hallway passing the kitchen area, 1 inside the back entrance and 1 outside the back entrance). The monitor is installed in the staff office, but staff has no access to view any videos. The Administrator, Program Director and the Head of Service are the only staff in charge who have access to the videos. The cameras are non-audio and LPA observed no monitors in the staff office during the inspection. Per the Administrator, the cameras record about two (2) weeks' worth of footage before rewriting over itself, onto a server, which is only accessible by password, by the Administrator, and the Executive Director. The back-up hard drive server is located in a locked IT room. There is a camera waiver on file. Clients in care are supervised and protected always. Facility is clean, safe, sanitary, and in good repair. Passage ways, stairways, inclines ramps, and open porches are unobstructed. Disinfectants/poisons are inaccessible. Facility posts child's rights if licensed to provide foster care for six or more children. Facility operates within license conditions and limitations including capacity limitations. Facility has a current, written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. Clients can use the telephone unless restricted by court order and are accorded dignity in personal relationships with staff and others. Clients live in a safe, healthy, comfortable facility and are treated with respect. Clients can contact CCL or Foster Care Ombudsperson in confidence without threats or punishment. Report continues on LIC809-C, page 4 out of The facility was equipped as follow and the following was observed during the Inspection: Bedroom #1: Currently is not occupied. There are two (2) full size beds. The room has adequate drawer space, closet and lighting, comfortable mattresses, and clean lines, blankets, and pillows. Bedroom #2: Currently is occupied by client #1 (C1). There are two (2) full size beds. The bedroom has adequate drawer space, closet and lighting, comfortable mattresses, and clean lines, blankets, and pillows. Bedroom #3: Currently is occupied client #2 (C2). There is one (1) full-size bed and one (1) twin size bed; The room has an adequate drawer space, closet and lighting, comfortable mattresses, and clean lines, blankets, and pillows. Bathrooms/Showers: There is one bathroom with a toilet only and two bathrooms with showers only located in hallway outside of bedroom area. All bathrooms are clean, safe and operable. Storage Hallway Closets: There are four closets located in the hallways near the bedroom area and near the shower areas. Two closets were set to store linens, comforters, and pillow, two closets were set to store supplies. There are adequate linen supplies. Dining Area/Group Training-Meeting Room: There is adequate table and chairs for meals. Training-Meeting room is adjourned to the dining area. There is an accessible fireplace with a secured cover on in the dining area. Kitchen/Pantry Food/Storage: There is a commercial kitchen on the premise. There is a stove/oven with operable burners all working properly now. There is a microwave and commercials refrigerator/freezer. The food service in the facility is adequate with perishable/nonperishable food supplies. Sharp knives are kept lock on combination safe. Nurse/Medication Office/Meds Storage Room: There is an area for medication storage and medication will be administered by staff. There are locked cabinets, and a refrigerator for medication. Facility maintains medication logs and first aid kit in this room. The first aid kit is checked and is complete with scissors, tweezers, thermometer, and gauzes, antiseptic and 1st Aid Manual. The door to this room always remains locked. Report continues on LIC809-C, page 2 out of 5

met_with: Staff#1 (S1)


summary: Facility Evaluation

raw_content:
Narrative:
On 02/19/2025, at 9:35 am, Licensing Program Analyst (LPA) Nestor Gomez and Licensing Program Manager (LPM) Kevin Sauk arrived at the above facility, for the purpose of conducting an Annual Required Inspection on the Seneca Compass-Ventura: Short Term Residential Therapeutic Program (STRTP) facility. LPA Gomez met with Susan Guffee who granted access to the facility. The annual fees are current. The Seneca Compass Ventura program is licensed to provide care and supervision for six (6) clients, ages 12-17, ambulatory only. The program provides intensive, individualized assessment and diagnostic treatment services for youth who do not meet the criteria for a psychiatric hospitalization but require treatment to stabilize their high-risk behaviors. Most youth placed into the Seneca Compass Program come directly from the 23-hour Crisis Stabilization Unit (CSU), where they have received immediate psychiatric assessment and stabilization services following an acute crisis. The residential program is one component of a larger continuum of care for youth in crisis, which include the 23-hour CSU, mobile crisis response services and community-based transition support services. There is currently 1 clients residing at the facility. Seneca Family of Agencies "The Seneca Compass Program", in partnership with Ventura County Behavioral Health Department (VCBHD), provide Short-term Assessment and Residential Treatment to six (6) children for thirty (30) days or less. This is a Commercial Building owned by the by the County of Ventura located in a residential area facing the main street. The Mental Health Approval is affected date 9/22/24 and expires 9/22/25. There are facility is currently working on renewing their accreditation with the Joint Commission. No bodies on water on the premises. Staff confirmed that there are no firearms or dangerous weapons in the facility. Continue on 809-C (Page 1) The facility was equipped as follow and the following was observed during the Inspection: Bedroom #1: Currently is not occupied. There are two (2) full size beds. The room has adequate drawer space, closet and lighting, comfortable mattresses, and clean lines, blankets, and pillows. Also contains a restroom with a toilet and sink Bedroom #2: Currently is not occupied. There are two (2) full size beds. The bedroom has adequate drawer space, closet and lighting, comfortable mattresses, and clean lines, blankets, and pillows. Also contains a restroom with a toilet and sink. Bedroom #3: Currently is occupied Client #1 (C1). There is one (1) full-size bed and one (1) twin size bed; The room has an adequate drawer space, closet and lighting, comfortable mattresses, and clean lines, blankets, and pillows. Also contains a restroom with a toilet and sink. Bathrooms/Showers: There is one bathroom with a toilet only and two bathrooms with showers only located in hallway outside of bedroom area. All bathrooms are clean, safe and operable. Storage Hallway Closets: There are four closets located in the hallways near the bedroom area and near the shower areas. Two closets were set to store hygiene and office supplies. Two closets were set to store cleaning supplies, arts and crafts supplies. Dining Area/Group Training-Meeting Room: There is adequate table and chairs for meals. Training-Meeting room is adjourned to the dining area. There is an accessible fireplace with a secured cover on in the dining area. Kitchen/Pantry Food/Storage: There is a commercial kitchen on the premise. There is a stove/oven with operable burners all working properly now. There is a microwave and commercials refrigerator/freezer. The food service in the facility is adequate with perishable/nonperishable food supplies. Sharp knives are kept lock on combination safe. Nurse/Medication Office/Meds Storage Room: There is an area for medication storage and medication will be administered by staff. There are locked cabinets, and a refrigerator for medication. Facility maintains medication logs and first aid kit in this room. The first aid kit is checked and is complete with scissors, tweezers, thermometer, and gauzes, antiseptic and 1st Aid Manual. The door to this room always remains locked. Continue on 809-C (Page 2) Living Room/Lounge Activity Room: The living room, located in the corner of the hallway adjacent to Bedroom #3, is equipped with living room furniture and a powder room with toilet and sink only. The lounge activity room adjacent to the other side of Bedroom #3 is equipped with adequate living room furniture, desk/chair, books and activity games. Office: This is an office that is being used by the clerical staff. There are two (2) computers, health information and medical billing treatment information is kept in this office. Equipment Room: Only janitorial supplies will be stored in this room. LPA observed a fire extinguisher in this room and in the hallway as well. Staff Office: Is located by the alley main back entry and is equipped with four (4) computers, camera monitors, private bathroom with toilet and sink only. There is also a sitting lounge small area with a sofa and chair. Laundry Room: There is a washer and dryer located in the hallway near the showers. The doors were observed to be locked and made inaccessible to the youth unless supervised by staff. Cleaning solutions are observed to be locked in this room. Common Corridor: There are two sets of double doors, one set of double door lead to the Crisis Stabilization Unit and the other set of double doors lead to the Crisis Stabilization Unit area but both doors are locked always. The lobby area where the receptionist is located is used by Seneca as the main entrance. There is an entrance leading from the lobby area into the Dining Area/Training-Meeting Room that is used by the STRTP. There is no shared hallway area between the Community Treatment Team and the STRTP. Outside Patio Area: The patio is located out the exit doors from the Training/Meeting Room. There is sufficient space. There is no swimming pool or bodies of water on the premises. There are additional doors leading into the dining area. There are also two doors that lead to staff offices of the 23 hours Crisis Stabilization Unit; these doors will always remain locked and not used by the STRTP. The Backyard/Front yard is clean and free of all debris. Continue on 809-C (Page 3) Alarm/Carbon Monoxide/Fire Extinguishers: There are carbon monoxide alarms available on three different hallways (bedroom hallway, shower hallway and nurse medical hallway) and another alarm was also located in the dining/meeting room area. The facility is equipped with a pull-up alarm system throughout the facility. The system is checked by the County on monthly bases. LPA reviewed the monthly report which indicates that the alarm system is tested on February 7, 2025, and is in working order/PASS. There are four (4) operable Fire Extinguishers available in the facility. One is in the hallway near the bedrooms' area, two in the kitchen area, one in the reception area by the main entrance. Cameras and Delayed Egress Doors: There were a total of 10 cameras located in the entire facility inside and out. There were 8 cameras inside the facility (3 cameras by the bedroom hallway, 1 in the patio area, 2 in the dining/meeting room area, 1 in the reception area, 1 in the kitchen hallway, 1 in the hallway passing the kitchen area, 1 inside the front entrance and 1 in the lobby. The monitor is installed in the staff office, but staff has no access to view any videos. The Administrator, Program Director and the Head of Service are the only staff in charge who have access to the videos. The cameras are non-audio and LPA observed no monitors in the staff office during the inspection. Per the Administrator, the cameras record about two (2) weeks' worth of footage before rewriting over itself, onto a server, which is only accessible by password, by the Administrator, and the Executive Director. The back-up hard drive server is located in a locked IT room. There is a camera waiver on file. Clients in care are supervised and protected always. Facility is clean, safe, sanitary, and in good repair. Passage ways, stairways, inclines ramps, and open porches are unobstructed. Disinfectants/poisons are inaccessible. Facility posts child's rights if licensed to provide foster care for six or more children. Facility operates within license conditions and limitations including capacity limitations. Facility has a current, written plan of operation. Facility personnel are instructed to report violations of personal rights. Licensee will report changes in the plan of operation affecting service to clients. Licensee will report client injuries requiring medical treatment. Clients can use the telephone unless restricted by court order and are accorded dignity in personal relationships with staff and others. Clients live in a safe, healthy, comfortable facility and are treated with respect. Clients can contact CCL or Foster Care Ombudsperson in confidence without threats or punishment. Continue on 809-C (Page 4) LPA Gomez reviewed following during the inspection: LPA Gomez requested the following forms for review, Current Census, Register of Clients, Personnel Report (LIC 500), and Facility sketch. Staff Interviews: LPA conducted a confidential interview with two (2) on duty staff. A review of the Guardian Report on 02/18/2025 indicates that all personnel have criminal record clearance has obtain the necessary clearances with DOJ, FBI, and Child Abuse Response. Client Interviews: LPA conducted confidential interviews with one (1) client present during the inspection. There were no deficiencies observed or cited at this time. Exit interview was conducted with the Facility Administrator and a copy of this report was emailed to the Facility Administrator. End of Interview (Page 5)

met_with: Susan Guffee - Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 03/04/25, at 9:30 am, Licensing Program Analyst (LPA) Nestor Gomez and Licensing Program Manager (LPM) Kevin Sauk returned to the above mentioned facility to continue the annual inspection that was started on 02/19/2025. LPA Gomez and LPM Sauk met with Sonia Magana who granted access to the facility. The following was observed during the Inspection: Client Interviews: LPA attempted to conduct an interview with Client (C2), but client refused. Staff Records Review: LPA reviewed two (2) staff records for the Facility Administrator(FA) and Mental Health Counselor (S1). Clients Records Review: LPA reviewed client record for client (C1) and client (C2) which meet qualification. There were no deficiencies observed or cited at this time. Exit interview was conducted with the Facility Administrator and a copy of this report was emailed to the Facility Administrator.

met_with: Sonia Magana - Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On 2/10/2026, at 10:55 am, Licensing Program Analyst (LPA) Nestor Gomez made an unannounced inspection to the above-mentioned facility, for the purpose of conducting case management for an SIR (Special Incident Report) that was possibly received late. LPA met with facility administrator, Susan Guffee, who granted access to the facility. The SIR was received on 1/14/2026, but the incident occurred on 12/13/2025. Upon further investigation, it was revealed that C1 was actually enrolled in Ventura Crisis Stabilization Unit (CSU) and not at the above mentioned facility. No further investigation or interviews are required on the above incident and no deficiency will be cited at this time. Exit interview was conducted and a copy of this report will be emailed to the FA.

met_with: SUSAN GUFFEE - Facility Administrator


summary: Facility Evaluation

raw_content:
Narrative:
On 4/15/26, at 10:00 am Licensing Program Analyst (LPA) Nestor Gomez made an unannounced inspection to the above-mentioned facility, for the purpose of following up on a Case Management inspection regarding an incident report that was received on 4/14/26. LPA met with facility administrator (FA), Susan Guffee, who granted access to the facility. No further investigation or interviews are required on the above incident. PER California Code Regulation Health Related Services 87075(c) there is one deficiency to be cited at this time. See 809-D. Exit interview was conducted and a copy of this report will be emailed to the Facility Administrator.

met_with: Facility Administrator - Susan Guffee


facility_name: SENECA COMPASS - PETALUMA

summary: Facility Evaluation

raw_content:
Narrative:
On 8/24/2021, Licensing Program Analyst (LPA) David Hiett conducted an unannounced inspection to the facility for the purpose of conducting an Annual/Required visit. LPA Hiett met with Program Director Aowyn Soane and inspected the facility, inside and out. The facility is clean, safe, sanitary, and in good repair. Front and backyard are safe and free from hazards. All passageways are unobstructed. There are no bodies of water. No room commonly used for other purposes is used as a bedroom. All bedrooms have adequate closet and drawer space. The home is maintained at a comfortable temperature. Sharps are kept locked in the kitchen cabinets and toxins are kept locked in cabinets in the kitchen. Medications are kept double locked in the staff office. There are carbon monoxide and smoke detectors throughout the facility. There were operable fire extinguishers in the facility. There are complete first-aid kits located in the facility. Applicant understands that the hot water temperature must be maintained within the regulation range of 105-120 degrees. There are no firearms on the property. Personal rights, license, Complaint Procedures, and Emergency disaster forms were posted in the facility. Menus and Activities are not currently posted as there are no clients, but facility will post as soon as that occurs. 5 staff files were reviewed. As there have been no clients present in 3 years, no client files were reviewed. The Short-Term Residential Therapeutic Program is licensed to serve three clients ages 12-17. There are currently no placements. Day 1 of Annual Inspection completed 8/24/2021 at 3:27pm. Day 2 of Annual Inspection resumed on 8/26/2021 at 11:50am and was completed at 4:30pm. 2 deficients were cited for Title CCR 87064(b) ADMINISTRATOR QUALIFICATIONS AND DUTIES and CCR 80066(c) PERSONNEL RECORDS (see 809-D). An exit interview was conducted and a copy of the report was left at the facility.

met_with: Aowyn Soane


facility_name: SENECA COMPASS-PETALUMA

summary: Facility Evaluation

raw_content:
Narrative:
On April 18, 2022 at 9:45AM, Licensing Program Analyst (LPA) Monica Pavia, LPA Lisa Schlembach and LPA Lisette Valenzuela conducted an announced pre-licensing inspection of the facility. LPA met and toured the facility with Lauren Crutsinger, Executive Director, Greg Rideout, Chief Program Officer, and Delaney Messner, Lead Health Information Specialist, and Aowyn Soane, Administrator. This is a Short-Term Residential Therapeutic Program for a capacity of one. It is a an apartment on the second floor that consists of one bedroom, one bathroom, living room, lounge and kitchen. Seneca Family if Agencies (agency) will utilize a laundry cleaning service for client's laundry. Agency will utilize a food delivery service for groceries. The facility is clean, safe, sanitary, and in good repair. All passageways are unobstructed and all doors open freely. There are no bodies of water on the facility premises. Fire arms are not allowed on the facility premises. Medications will be centrally stored and locked in lounge closet. Disinfectants, sharps, and other toxic materials will be locked in the lounge closet. At the time of visit, the following was observed: Fire extinguisher located in the kitchen and outside the front door. Smoke detectors are throughout the house and operational. Carbon monoxide detector is combined with the smoke detectors. The bedroom has a bed, clean linens, and adequate drawer/cabinet space. Facility has a fire clearance. First aid kit was observed. Hot water temperature measured at 118 degrees Fahrenheit. This site is ready for licensure, once the fire clearance is received. Agency will supply 2 days of perishable and 7 days of nonperishable food prior to any placement. LPA Pavia will mail a copy of the license to the site location, once licensed.

met_with: Lauren Crustsinger


summary: Facility Evaluation

raw_content:
Narrative:
On 11/2/22, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a post-licensing inspection. LPA met with Manager of Operations Delaney Messner and Assistant Director Miles Jordan and informed of the purpose of the visit. LPA used the CARE Inspection Tool to complete this inspection. LPA interviewed one resident and five staff and toured the facility site. The facility is clean and organized, and the kitchen and bathroom are sanitary. The kitchen is stocked with food in good quality and in a quantity to meet the needs of resident in care. Medication is stored where inaccessible to resident in care, and medication administrator records are correct and up to date. Resident has their own room, with their own bed and personal storage space. The facility has the license, emergency plan, facility sketch, personal rights, and menu posted. A continuation visit will be required to complete this inspection. No deficiencies were found during today's inspection. An exit interview was conducted, and a copy of this report was left with Manager of Operations Delaney Messner, whose signature on this form confirms receipt.

met_with: Manager of Operations Delaney Messner


summary: Facility Evaluation

raw_content:
Narrative:
On 11/9/22 at 10:18AM, Licensing Program Analyst (LPA) Mariah Hawkins made a visit to the facility for a continuation post-licensing inspection. LPA met with Administrator Aowyn Soane and Manager of Operations Delaney Messner and informed of the purpose of the visit. LPA used the CARE Inspection Tool to complete this inspection. At the initial visit, LPA conducted tour and staff and resident interviews. During today's inspection, LPA conducted file reviews. No deficiencies were found. Files are stored electronically, and Administrator and Manager of Operations granted LPA access to files by finding and showing files to LPA. LPA advises that the facility ensure resident medical assessments include documentation of TB test results and that emergency drill documentation include the names of staff who participate in the drill(s). No citations were issued at today's visit. An exit interview was conducted, and a copy of this report was provided to Administrator Aowyn Soane, whose signature on this form confirms receipt.


summary: Facility Evaluation - 1 deficiency

raw_content:
Narrative:
This report was amended on October 18, 2023. On 4/21/23 at 12:30PM, Licensing Program Analyst (LPA) Mariah Hawkins conducted a required annual inspection. LPA met with Administrator Miles Jordan Manager of Operations Delaney Messner and informed of the purpose of the visit. The CARE inspection tool was used to conduct this inspection. LPA conducted a tour of the facility site and reviewed the current LIC 500. A visit will be conducted at a later date to continue this inspection. LPA observed the facility to be clean and living spaces organized. Medications are stored safely and securely. The kitchen contained a variety of food in the quantity and quality to meet the needs of the resident in care. The following requires follow-up. LPA observed the hot water in the bathroom to reach a temperature above the permitted range of F to F. The hot water in the bathroom measured 123. F, and hot water in the kitchen measured 128. F. LPA is issuing a citation of CCR, Title 22, Section 80088. An exit interview was conducted, appeal rights provided, and a copy of this report was provided to Administrator and Manager of Operations Delaney Messner.

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: Administrator Miles Jordan


summary: Facility Evaluation

raw_content:
Narrative:
On 6/7/23, Licensing Program Analyst (LPA) Mariah Hawkins conducted an annual continuation inspection. LPA met with Administrator Miles Jordan and Manager of Operations Delaney Messner and informed of the purpose of the visit. The CARE Inspection tool was used to conduct this inspection. Facility files, including 1 resident file (only 1 resident in care, and only capacity of 1) and 5 personnel files, were reviewed during the inspection and observed to be complete. The facility stores documents in physical files and in electronic files. Administrator and Manager of Operations facilitated the review of electronic files. No deficiencies were cited at today's visit. An exit interview was conducted, appeal rights discussed, and a copy of this report was left with Administrator, whose signature on this form confirms receipt.

met_with: Administrator Miles Jordan; Manager of Operations Delaney Messner


facility_name: SERENITY SPRINGS

summary: Facility Evaluation

raw_content:
Narrative:
On October 27, 2025, Licensing Program Analyst (LPA) Joon Choi conducted a pre-licensing inspection for Serenity Springs Short Term Residential Therapeutic Program's (STRTP) license. LPA met with owner/applicant Sheriah Smith. The facility was toured both inside and out with the applicant. Currently there is no client placed in the facility. The facility is applying to serve six minor clients. The residence was originally a four bedroom, single-story house with two full bathrooms. One of the bedrooms was modified to now serve as a staff office and will also serve as a therapy room. The facility consists of a living room (common area), a kitchen, dining area, staff office/therapy room, the garage, and the backyard. The backyard has a covered patio (aka pergola) and natural grass lawn. There is currently no recreational equipment in the backyard. Within the facility's hallway, there was one storage room; one in the hallway where linen and client hygiene will be kept. The garage has a locked locker for cleaning supplies and the staff office has a locked locker for medications. The facility has 3 bedrooms and one full bathroom designated for clients. There is one bathroom designated for staff only in the staff office. The bedrooms were arranged so that no more than two clients share a room, and there will be one child per bed. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate dresser drawer space and closet space for children's belongings. Towels, linens and extra hygiene were stored in the hallway closet/storage room. The smoke detector / carbon monoxide detector is a two in one unit, and was checked and observed to be working properly. Continued on the Next Page The fireplace was in the living room area, and it was properly screened. Telephone service (land line) and appliances were in a working order. All hazardous items and cleaning materials have been properly made inaccessible to areas where clients would have access by themselves (garage access, with staff only). The medications and sharp objects/knives will be locked and stored in a locked locker in the staff office. Cleansers/chemicals and other hazardous materials were locked and stored in a storage locker in the garage. The first aid kit will be in the staff office. There were no guns or weapons as stated by applicant at this time. The hot water temperature was tested and noted to be holding at 106 degrees fahrenheit.. Facility was advised that upon hearing their provisional license has been issued, then adequate food storage supply of two days of perishable foods and a week of non-perishable food will be required as soon as possible. Proper storage of all food was discussed. Trash cans for storage of solid waste have tight fitting lids. There is also a covered waist basket in the client's bathroom. The Facility Sketch, Emergency Disaster Plan, visitation policy, foster youth bill of rights, client Personal Rights and the contact numbers for the Foster Care Ombudsperson and Community Care Licensing Hot-line were posted. There was no pool or other body of water, and the backyard where clients will have access to play; was completely fenced and free of hazards. Currently, the facility is appropriate for a capacity of six ambulatory clients, ages twelve to seventeen (with the provision for clients who turn eighteen while in care. A technical advisory (TA) was provided at this visit regarding fire extinguisher tags, obtaining a refrigerator for client medications, obtaining additional reading materials, obtaining a first aid kit for the facility vehicle and a recommendation for having a locked hallway storage closet. Licensing Program Manager will complete a final review prior to issuing a provisional license. Exit interview was conducted and a copy of this report and TA was provided owner/applicant Sheriah Smith.

met_with: Sheriah Smith, Owner / Licensee


summary: Facility Evaluation

raw_content:
Narrative:
On April 1, 2026, Licensing Program Analyst (LPA) Joon Choi conducted a post-licensing inspection for Serenity Springs Short Term Residential Therapeutic Program's (STRTP) license. LPA met with Facility Administrator Sheriah Smith (AD) and Direct Care Staff Maria Nunez (S1) The facility was toured both inside and out with AD. Currently there are four clients placed in the facility (but one is in Juvenile Hall). The facility is licensed for a capacity to serve six minor clients. The residence was originally a four-bedroom single story-house with two full bathrooms. One of the bedrooms (the master) was modified and now serves as the staff office and a visit/therapy room. The facility consists of a living room (common area), a kitchen, dining area, staff office/therapy room, the garage, and the backyard. Within the facility there was one storage room in the hallway for linens and hygiene and a storage locker in the garage for client files, cleaning supplies and sharp objects. There is also a locker in the staff office which holds the medications and client cash resources. Adjacent to the dining room there is a staff desk which holds the locked staff files. The facility has 3 bedrooms and one full bathroom designated for clients. There is one bathroom designated for staff only. The bedrooms are arranged so that no more than two clients share a room, and there is one child per bed. Every client bedroom is occupied. No room commonly used for other purposes was used as a bedroom, and no bedroom serves as a passageway to another room. There were adequate drawers and closet space for children's belongings, The smoke detectors and carbon monoxides were checked and were working properly. The fireplace was in the living room area, and it was properly screened. Telephone service and appliances were in a working order. All hazardous items have been properly made inaccessible to areas where clients would have access. There were no guns or weapons as stated by applicant at this time. The hot water temperature was tested and noted to be 109.5 degrees Fahrenheit. There was adequate food storage supply of two days of perishable foods and a week of non-perishable food. The food was all properly stored. Trash cans for storage of solid waste have tight fitting lids. The Facility Sketch, Emergency Disaster Plan, visitation policy and Personal Rights were posted in the front lobby and Foster Care Ombudsperson information. There were no pool or other body of water and the backyard where clients will have access to play was completely fenced and free of hazards. The garage had access to the water heater and the natural gas shut off valve is outside. During the visit, LPAs interviewed one client and two staff. With the assistance of AD and S1, LPA reviewed three client files; there were no deficiencies. With the assistance of AD and S1, LP reviewed three staff files; there were no deficiencies. With the assistance of AD, LPA reviewed the facility's physical plant. operational requirements, disaster preparedness and emergency intervention plan and there were no deficiencies-. Exit interview was conducted and a copy of this report (LIC 809) and a Technical Advisory (TA) was provided to Administrator Sheriah Smith.

met_with: Sheriah Smith, Administrator


facility_name: SIERRA QUEST ACADEMY

summary: Complaint Investigation - Unsubstantiated

raw_content:
Investigation Findings:
13Complaint Specialist C.K. Kinney(CS) traveled to Sierra Quest Academy and met with Carrie Maddox to conduct investigation and deliver findings. CS conducted confidential interviews. CS and Investigator Romelia Munoz conducted investigation that included Review of documentation and confidential interviews. Based on inconsistencies in the information obtained we could not find a preponderance of the evidence that the allegation occurred as reported. Although the allegation may or may not be true, or may or may not be valid without a preponderance of the evidence the allegation is deemed unsubstantiated. No deficiencies observed or cited. Copy of this report, LIC Confidential Names and LIC Appeal Rights left at facility at conclusion of inspection. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Charles Kinney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Carrie Maddox


raw_content:
Investigation Findings:
13Complaint Specialist C.K. Kinney(CS) traveled to Sierra Quest Academy and met with Scott Seymour and Jerry Lura deliver findings of investigation. CS and Investigator Shelley Faulconer conducted investigation that included review of documentation and confidential interviews. Due to inconsistencies in the information obtained a preponderance of the evidence could not be obtained. Although the allegations may or may not be valid, without a preponderance of the evidence the allegations are deemed Unsubstantiated. Copy of this report, LIC Confidential Names and LIC Appeal Rights left at the facility at conclusion of inspection. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Charles Kinney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Scott Seymour and Jerry Lura


summary: Facility Evaluation

raw_content:
Narrative:
On the above date, Licensing Program Analysts (LPA) Lisa Slusher and travelled to the facility listed above to conduct an annual inspection. Met at the facility by Facility Manager Cody Ward and Social Worker Carrie Maddox. The facility listed above is accredited through the joint commission and is in the process of finalizing their current review, and has current Mental Health Program Approval through Mariposa County Mental Health . Arrived at the facility at 9:30 am. At the start of the inspection, LPA discussed procedures for psychotropic medication, current census and other administrative questions. The following were observed upon inspection of the physical plant inspection conducted at 10:30 am : 1. Facility Grounds are clean and free of debris or observable hazard. 2. Adequate indoor and outdoor activity space and materials observed. 3. Chemicals appropriately locked. 4. Locked and centrally stored medications observed. Observed medication logs and discussed procedures for psychotropic medications. 5. First aid kit complete with appropriate manual observed. 6. Adequate storage space observed. 7. Individual beds in good repair observed. 8. The house has 3 bedrooms, one single occupancy, one with a waiver for a maximum occupancy of 3. Bedrooms are accommodating of all required furnishings. 9. Adequate food storage space observed. Supply of two days of perishable foods and a week of nonperishable foods observed upon inspection. 10. Weekly menu posted and accessible to clients. 11.Dining room equipped with large table and chairs accommodating of all clients. 12.Facility has two full restrooms in the house for client use. 13.Appropriate forms posted in view of facility clients. 14.No firearms or weapons are allowed in the facility. The following items were discussed and reviewed by LPA during Inspection 1. LIC Reviewed to ensure appropriate staffing ratios, including Administrator, Social Work personnel, and Direct Care staff. 2. Administrator Jerry Lura is present on-site a minimum of 20 hours per week. 3. Personnel files reviewed (11) at 1:00 pm during today's inspection to ensure staff meet regulatory requirements. All appropriate personnel who require caregiver background checks have received criminal record and child abuse index check clearances or exemptions. All staff are verified to have appropriate emergency intervention training and training hours are within regulatory guidelines. 4. Client files reviewed on this date (4) from 10:45 am-11:45 am. The following are to be updated and submitted to CCL by 12/20/21- LIC 500 (Personnel Report), LIC 9020 (Client Roster), LIC 308, LIC 309, individual staff training records and board meeting minutes for 2021.. No deficiencies noted in areas observed. Client (2) and staff (3) interviews conducted. No deficiencies noted in areas observed.

met_with: Cody Ward, Scott Seymour, Carrie Maddox


summary: Facility Evaluation

raw_content:
Narrative:
Complaint Specialist C.K. Kinney(CS) travelled to the facility listed above to conduct an annual inspection. Met at the facility by Program Director Jerry Lura. The facility listed above is accredited through the Joint Commission, and has current Mental Health Program Approval through Mariposa County Mental Health . Arrived at the facility at 9:30 am. At the start of the inspection, LPA discussed procedures for psychotropic medication, current census and other administrative questions. The following were observed upon inspection of the physical plant inspection conducted at 10:30 am : 1. Facility Grounds are clean and free of debris or observable hazard. 2. Adequate indoor and outdoor activity space and materials observed. 3. Chemicals appropriately locked. 4. Locked and centrally stored medications observed. Observed medication logs and discussed procedures for psychotropic medications. 5. First aid kit complete with appropriate manual observed. 6. Adequate storage space observed. 7. Individual beds in good repair observed. 8. The house has 3 bedrooms, one single occupancy, one with a waiver for a maximum occupancy of 3. Bedrooms are accommodating of all required furnishings. 9. Adequate food storage space observed. Supply of two days of perishable foods and a week of nonperishable foods observed upon inspection. 10. Weekly menu posted and accessible to clients. 11. Dining room equipped with large table and chairs accommodating of all clients. 12.Facility has two full restrooms in the house for client use. 13. Appropriate forms posted in view of facility clients. 14.No firearms or weapons are allowed in the facility. Facility provided updated copies of LIC Register of Clients, LIC 610E Emergency Disaster Plan, LIC Personnel Report and Current Board of Director Meeting Minutes. No deficiencies observed or cited during this inspection.

met_with: Jerry Lura, Scott Seymour and Sara Ciapponi


summary: Facility Evaluation

raw_content:
Narrative:
On 06/17/2025, an unannounced annual inspection is conducted by Licensing Program Analysts (LPAs) Reyna Martinez and Angelica Borja. Met at the STRTP office by Executive Director, Scott Seymour. LPAs inspected the facility, inside and out. LPAs provided the Program Director the entrance checklist and requested the necessary documents. Licensee's Joint Commission Accreditation is valid until August 24, 2027 and the MHPA was is approved until May 22, 2028. There are no firearms or weapons are allowed in the facility. A physical plant was inspected and included the following checks: There is adequate indoor and outdoor activity space observed. The facility is maintained at 74 degrees and the water temperature was at 110 degrees. All facility smoke detectors are in appropriate working order, fire extinguisher is properly charged and serviced on May 16, 2025. Facility maintains an adequate supply of perishable and non-perishable foods. All required forms are posted. Medications are locked and centrally stored. Individual beds were observed with clean linens, and are in good repair. LPAs requested the following documents from the STRTP: LIC 500, Board meeting minutes. Appropriate staff/client ratios were verified during this inspection. The facility employs 1 head of service/executive director, 1 administrator, 5 facility managers, 1 clinician, 1 social worker, and 5 mental health rehabilitation specialists. 5 staff files were reviewed and meet all regulatory requirements. 1 staff was available to be interviewed. 5 records of clients were reviewed. 3 clients were available for interview, 3 clients declined to be interview. No Deficiencies were cited on today's visit. A copy of this report was left at the facility.

met_with: Scott Seymour


summary: Facility Evaluation

raw_content:
Narrative:
On 12/18/2025, Licensing Program Analyst (LPA) Reyna Martinez conducted an unannounced case management for the above facility. Met by Jerry Lura, Administrator. The purpose of the inspection was to discuss an incident that involved client, C1 (see LIC811 dated 12/18/2025) for an incident that occurred on November 22, 2025. LPA gathered additional details to verify outcome of re-training for direct care staff, S1 (see LIC811 dated 12/18/2025) for missed medication dose. LPA discussed medication requirements and Administrator reported re-training has been completed for the staff and there has been no further incidents with the medication. No additional follow up needed. There are no deficiencies to be cited on this date. A copy of this report is left with Jerry Lura, Administrator.

met_with: Jerry Lura


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Reyna Martinez on February 11, 2026 at 10: AM. This case management inspection is conducted pursuant to Health and Safety Code 1538.9(a)(2). During the inspection, LPA met with Jerry Lura, Administrator and inspected the facility inside and out. LPA reviewed 0 child's records and 2 staff personnel files on site at the facility. There were no minors in placement who qualify for inspection at this time. LPA reviewed 0 child's psychotropic medications and medication records. LPA interviewed 2 staff on site to discuss the facilities policies and procedures of operation. LPA interviewed no children currently on psychotropic medication as there are no minors in placement who qualify for inspection at this time LPA provided a copy of the licensing report to Administrator, Jerry Lura No deficiencies are being cited at this time. LPA conducted exit interview with Jerry Lura, Administrator.


summary: Facility Evaluation

raw_content:
Narrative:
On 02/11/2026, Licensing Program Analyst (LPA) Reyna Martinez met with Jerry Lura, Administrator to conduct an unannounced case management inspection in response to an incident that occurred on November 11, 2025. Based on confidential interviews, an incident occurred at the STRTP on November 11, 2025 involving C1 and C2 that was not reported to the department within the required reporting requirements. The Department determined this to be a risk to the health and safety of the children in care at this time, therefore California Code of Regulations Section 80061(b) Reporting Requirements are being cited on the attached LIC-809D page. A copy of this report and Appeal Rights was provided to the facility.


summary: Facility Evaluation

raw_content:
Narrative:
On 04/27/2026, Licensing Program Analyst (LPA) Reyna Martinez met with Eduardo Bautista, Facility Manager to conduct an unannounced case management inspection in response to an incident report received by the Department on March 18, 2026. Incident Report involving Client #1 (C1 - See LIC Confidential Names List) for an incident that occurred on February 26, 2026 was not reported to the department within the required reporting requirements. The Department determined this to be a risk to the health and safety of the children in care at this time, therefore California Code of Regulations Section 80061(b) Reporting Requirements are being cited on the attached LIC-809D page. A copy of this report and Appeal Rights was provided to the facility.

met_with: Eduardo Bautista


raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Reyna Martinez conducted a complaint inspection and met with Eduardo Bautista, Facility Manager. The purpose of the inspection was to deliver the findings for the above complaint allegations. The Department has investigated the complaint alleging Staff allowed the minors to fight while in care; Staff do not provide adequate supervision to the minors; Staff did not prevent the minors from causing harm to other minors; and Staff yells at the minors. LPA conducted interviews and obtained documentation.There were inconsistencies in the confidential interviews. Although the allegations may have happened or is valid, there is not a preponderance of evidence to provide the alleged violations did or did not occur, therefore the allegations are unsubstantiated. An exit interview was conducted, and a copy of this report was left at the facility. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Vanessa Galvan LICENSING EVALUATOR NAME: Reyna Martinez LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


facility_name: SIERRA QUEST GIRLS ACADEMY

raw_content:
Investigation Findings:
13On December 3, Liicensing Program Analyst (LPA) Lisa Slusher conducted a follow-up complaint inspection at Sierra Quest Girls Academy on behalf of LPA Tamara Melikian. The purpose of the inspection was to deliver the findings for the above complaint allegations. LPA Melikian interviewed staff, clients and reviewed pertinent documents. Based on interviews conducted and information gathered, there were some discrepancies found. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. A copy of this report and appeal rights were emailed to facility Administrator. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Lisa Slusher LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

met_with: Carrie Maddox, Scott Seymour


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced annual inspection was conducted by LPA (Licensing Program Analyst) Lidia Tinoco and Les Inouye on at Sierra Quest Girls Academy. LPA met with Jerry Laura and Scott Seymour and inspected the facility. All facility smoke detectors were tested and appear to be in appropriate working order, fire extinguisher is properly charged. The facility currently had perishable and non-Perishable items in the facility and also keeps additional food supply at another building on-site at the facility. Individual beds were observed with appropriate clean linens and are in good repair. The facility is maintained at 72 degrees. A swimming pool was observed with a certified net . No firearms or weapons are allowed in the facility. Licensee has obtained Mental Health Certification Including the following: Mental Health Program Approval valid through 12/07/2021, Medi-Cal site certification issued on January 7, 2020. Licensee has obtained National Accreditation through Joint Commission. The Accreditation is valid until Joint Commission conduct their accreditation requirement. Facility staff and client records were reviewed. There were no deficiencies to be cited on this date. A copy of this report was left with


facility_name: SIERRA VISTA-HUNTER HOUSE

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Daiquiri Boyd conducted a follow-up complaint inspection with the Short Term Residential Theraputic Program (STRTP) and met with Natasha Landon. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Boyd conducted interviews with clients and staff and collected the police report. The interviews revealed that when the fight occured between clients on this day, staff were present and did intervene and attemt to stop the fighting. Client stated that they wanted to fight and no one knew of the plan to fight prior to it starting. Although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove the above allegation; therefore, the allegation is unsubstantiated. LPA provided a copy of the report to the STRTP. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Daiquiri Boyd LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2

met_with: Natasha Landon


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Daiquiri Boyd conducted a follow-up complaint inspection with the Short Term Residential Theraputic Program (STRTP) and met with Natasha Landon. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Boyd conducted interviews with clients and staff. The interviews revealed that there was no one at the home that coorberated that this occured or have seen anything consistent with what was initially alleged. Client was unable to give LPA any details about the incident, when questioned. Although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove the above allegation; therefore, the allegation is unsubstantiated. LPA provided a copy of the report to the STRTP. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Daiquiri Boyd LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 2


raw_content:
Investigation Findings:
13Complaint Specialist C.K. Kinney(CS) traveled to Sierra Vista-Hunter House and met with Jen Stevens to deliver findings of investigation. Investigator Ruben Munoz and CS conducted investigation that included review of documentation, and confidential interviews and due to inconsistencies in the information received could not reach a preponderance of the evidence the allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed unsubstantiated. No deficiencies observed or cited during this inspection. Copy of this report and Appeal Rights left at Sierra Vista Hunter House at conclusion of inspection. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Charles Kinney LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

met_with: Jen Stevens


raw_content:
Investigation Findings:
13On February 5, 2024, Licensing Program Analyst (LPA) Lidia Tinoco conducted an unannounced visit to the Sierra Vista Hunter House STRTP in order to deliver the findings of the above allegations and met with Direct Care Staff Timeka Boyd who was authorized to sign by House Manager, Jerome Johnson over the phone. On December 29, 2024, the above allegation was referred to Community Care Licensing for investigation. The investigation included an inspection of the Facility, confidential interviews, and a review of facility records. The complaint alleged that a Facility staff had inappropriate interactions with a youth while in care. The information reviewed and the parties interviewed provided conflicting information regarding this issue. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the allegation occurred therefore the allegation is UNSUBSTANTIATED at this time. A copy of this report was discussed and provided along with appeal rights. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Lourey Bartolome LICENSING EVALUATOR NAME: Lidia Tinoco LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1

met_with: Timeka Boyd, Direct Care Staff


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

met_with: Shadi Ahmad


summary: Complaint Investigation - Substantiated - 1 deficiency - 1 allegation

raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Daiquiri Boyd conducted a follow-up complaint inspection to the Short Term Residential Therapeutic Program (STRTP) and met with Shadi Ahmad. The purpose of the inspection was to deliver the findings for the above complaint allegation regarding the staff not providing adequate supervision to the clients in care. During the course of the investigation, Community Care Licensing (CCL) conducted interviews with clients and staff. The information obtained during the interviews, indicated that the supervision of the nightstaff was not consistent resulting in the foster children not receiving appropriate and adequate supervision. Type A: This poses an immediate health and safety risk to clients in care. Based on the LPA's observations, interviews, and the records review conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be substantiated. A copy of the report and Appeal Rights was provided to the STRTP. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Daiquiri Boyd LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE FACILITY NAME: SIERRA VISTA-HUNTER HOUSEFACILITY NUMBER: 500306051

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

Deficiencies:
87065.2: (1)	Supervision, protection, and care of children at all times, individually and in groups.

complaint_status: SUBSTANTIATED

title: Personnel Duties- (b)Direct care staff shall perform the following duties


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Daiquiri Boyd conducted a follow-up complaint inspection with the Short Term Residential Theraputic Program (STRTP) and met with Chad (Shadi) Ahmad. The purpose of the inspection was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Boyd conducted confidential interviews and reviewed client files. The interviews revealed that there is no consistent consensus as to whether the allegations listed above happened or didn't happen. Although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove the above allegation; therefore, the allegation is unsubstantiated. LPA provided a copy of the report to the STRTP. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Daiquiri Boyd LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 1


summary: Complaint Investigation - Substantiated - 1 deficiency

raw_content:
Investigation Findings:
13On the above date, Licensing Program Analyst (LPA) Brinae Pointer conducted a complaint inspection and met with Adminstrator & Facility Manager, Jerome Johnson. The purpose of the inspection was to deliver the findings for the above complaint allegation. Based on interviews it was determined that staff violated the Personal Rights of the youth by remanding the youth to their bedrooms for an extended period of time. Based on the LPA's observations, confidential interviews and records review which were conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be substantiated. A deficiency is being cited for the Interim Licensing Standards (ILS)Interim Licensing Standards, STRTP, Article 06. Continuing Requirements, Personal Rights, 87072(c)(16) Personal Rights. A copy of the report and Appeal Rights was provided to the STRTP. SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Tamara Melikian LICENSING EVALUATOR NAME: Brinae Pointer LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION FRESNO RO, E SHAW AVE FACILITY NAME: SIERRA VISTA-HUNTER HOUSEFACILITY NUMBER: 500306051

Deficiencies:
87072(c): The licensee shall ensure that each child... is accorded the personal rights... To be free of physical, sexual, emotional, or other abuse, and from corporal or unusual punishment, exploitation, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature including, but not limited to, interference with the daily living functions of eating, sleeping, or toileting, or withholding of shelter, clothing, or aids to physical functioning

met_with: Jerome Johnson, Administrator-Facility Manager


summary: Facility Evaluation

raw_content:
Narrative:
On the above mentioned date, Licensing Program Analyst, (LPA) Brinae Pointer traveled to Sierra Vista Hunter House, Short Term Residential Placement to conduct an unannounced visit. The purpose of the inspection is to follow up on a previous complaint on the backyard fence. While this LPA was assessing the grounds, LPA was asked an administrative question by staff about the steps of becoming an administrator for the facility. This LPA reviewed the requirements of becoming an administrator as discussed with LPM Galvan and addressed the matter via case management. No deficiencies were cited on this date and Technical Assistance was provided by LPA Pointer.

met_with: Timeka Boyd, Interim Supervisor


facility_name: SIERRA VISTA-WOODBRIDGE HOUSE

raw_content:
Narrative:
any report of the contact and conversation that school staff had with facility staff. Type A: This poses an immediate health and safety risk to clients in care. Based on the LPA's observations, interviews, and the records review conducted, the preponderance of evidence standard has been met, therefore, the above allegation is found to be substantiated. A copy of the report and Appeal Rights was provided to the STRTP.

Investigation Findings:
13Licensing Program Analyst (LPA) Daiquiri Boyd conducted a follow-up complaint inspection to the Short Term Residential Therapeutic Program (STRTP) and met with Sophia Haro. The purpose of the inspection was to deliver the findings for the above complaint allegation regarding staff not documenting incidents as required. Staff Haro advised LPA Boyd that the facility was now under a new Program Coordinator(PC). LPA Boyd called and spoke with PC Chad Ahmad regarding the allegations and a plan of correction. During the course of the investigation, Community Care Licensing (CCL) conducted interviews with clients, facility staff, and school staff. The information obtained during the interviews, indicated that school staff reported to facility staff, an incident that happened between the two clients at the school. Facility staff was unable to provide LPA ...see continuation page SubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Daiquiri Boyd LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 24-CR- STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY COMPLAINT INVESTIGATION REPORT (Cont)CALIFORNIA DEPARTMENT OF SOCIAL SERVICES COMMUNITY CARE LICENSING DIVISION CCLD Regional Office, E SHAW AVE FACILITY NAME: SIERRA VISTA-WOODBRIDGE HOUSEFACILITY NUMBER: VISIT DATE: 01/19/2022

met_with: Sophia Haro


raw_content:
Investigation Findings:
13Licensing Program Analyst (LPA) Daiquiri Boyd conducted a follow-up complaint inspection with the Short Term Residential Theraputic Program (STRTP) and met with Administrator, Clarissa Ochoa . The purpose of the inspection was to deliver the findings for the above complaint allegations. During the course of the investigation, LPA Boyd conducted confidential interviews and reviewed client and facility files. Although the allegation may have happened or may be valid, there is not a preponderance of the evidence to prove the above allegation; therefore, the allegation is unsubstantiated. LPA provided a copy of the report to the STRTP. UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Juanita Arroyo LICENSING EVALUATOR NAME: Daiquiri Boyd LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of 3

met_with: Clarissa Ochoa


summary: Facility Evaluation

raw_content:
Narrative:
On 1/19/2022, Licensing Program Analyst (LPA) Daiquiri Boyd made an unannounced visit to Woodbridge House. During the visit, LPA Boyd discussed COVID reporting procedures with staff Sophia Haro and asked if there was any need for PPE. Staff said that they did not need PPE, but asked if CCL was going to be providing any home test kits for COVID. LPA Boyd advised staff that there was no word on any test kits and whether any would be provided to any facilities. Staff discussed the clients well being and said that they were well prepared with food and supplies and there was no shortages at this time. Visit was ended with staff.


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced SB Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Tamara Melikian on 03/07/2022 at 10:00AM. During the inspection, LPA Melikian met with Kristine Estes, Administrator and Chad Ahmad, Program Director, and inspected the facility inside and out. LPA reviewed four children's records on site at the facility at 10:00AM LPA reviewed two staff personnel records on site at the facility at 11:30AM. LPA reviewed four children's psychotropic medications and medication records at 11:50AM. LPA interviewed two staff at 12:15PM. Children were in school on this date and will be interviewed at a later time. LPA conducted exit interview with Kristine Estes, Administrator at 12:45PM. LPA provided the summary report to Kristine Estes, Administrator upon completion. There were no deficiencies to be cited on this date.

met_with: Chad Ahmad, Kristine Estes


summary: Facility Evaluation

raw_content:
Narrative:
Licensing Program Analyst (LPA) Daiquiri Boyd visited Short Term Residential Therapeutic Program (STRTP) Sierra Vista Woodbridge House, for the purpose of discussing concerns with the safety of clients Mariah Nunez-Lara (DOB 3/30/11) and Heaven Charleston (DOB 8/12/10). Staff was able to confirm with LPA that clients are kept on opposite ends of the home for sleep, clients are supervised at all times while in the home. Night staff is doing bed checks for clients, to ensure they are safe an in their beds. Facility staff stated that the school is also aware of the concerns and has enacted a plan for safety as well. Staff Blanca stated that the CFT for Heaven was held recently and there is a plan for her to move up to a resource home and she has already made a few visits to get to know the family. Client Mariah has also had a CFT, but the plan going forward for her is not known at this time. Staff said that Kristine Rae at the main office, will be able to give further details on how the plan for Mariah is going. Staff Clarissa Ochoa stated that when there is an incident between the clients, it had come up between the clients at a team meeting with all the clients at the home. Staff Clarissa said that the girls are receptive and understanding when everyone talks together. Staff Clarissa stated that the girls have asked to be able to hang out once again, but staff told them that for now they need to continue to work the plan in place and see how things go. Staff assured LPA that they are continuing their efforts for the safety of these clients and the others in this home.

met_with: Blanca Ortega


summary: Facility Evaluation

raw_content:
Narrative:
An unannounced Psychotropic Medication Inspection was conducted by Licensing Program Analyst (LPA) Jessica Rodriguez on April 19, 2023, at 10:05A.M. This case management inspection is conducted pursuant to Health and Safety Code Section 1538.9 (a)(2). During the inspection, LPA Rodriguez met with Shadi "Chad" Ahmad, Administrator and inspected the facility inside and out. LPA reviewed 3 of 4 child's records and 2 of 2 staff personnel files on site at the facility. LPA reviewed 3 of 4 child's psychotropic medications and medication records. LPA interviewed 2 of 2 staff on site to discuss the facilities policies and procedures of operation. LPA interviewed no children currently on psychotropic medication, as they were in school at this time. LPA provided a copy of this licensing report to Shadi "Chad" Ahmad, Administrator. No deficiencies are being cited at this time. LPA conducted exit interview with Shadi "Chad" Ahmad, Administrator.

met_with: Shadi "Chad" Ahmad


summary: Facility Evaluation

raw_content:
Narrative:
On March 19, 2024, Licensing Program Analyst (LPA) Daiquiri Boyd went to the Short Term Residential Therapeutic Program, Sierra Vista- Woodbridge House, to complete an Annual Inspection. LPA was met by Shadi Ahmad, Administrator and Tiffany Page, House Supervisor. LPA reviewed Emergency Preparedness procedures with staff. LPA toured the home and found that there are no clients living at the home at this time. LPA found no food in the refrigerator. Chemicals were locked under the sink. No knifes were found at the facility. Hot water temperatures were within regulation. No client files were on the premises. LPA toured outside grounds and fence and yard were in good repair. All postings were visible and in sight of anyone who enters the home. LPA observed Administrator file. LPA spoke with Administrator about supplying an updated Plan of Operation and Program Statement and Administrator stated that he is currently working on it.

met_with: Shadi Ahmad, Administrator


facility_name: SOJOURNERS HAVEN GROUP HOME II

raw_content:
Narrative:
to hit C1. Confidential witness interviews resulted in conflicting information being provided to LPA. Confidential interviews revealed to LPA that S1 did not snatch the remote from C1, but S1 picked up the remote off the couch; whereas other confidential witness interviews revealed S1 did snatch the remote from C1's hand. Additional conflicting information received via confidential witness interviews was that S1 was not witnessed "putting hands up" at C1 as though S1 was going to hit C1. Confidential interviews disclosed that C1 charged S1 trying to get the remote back once S1 picked up the remote. In regard to the allegation that S1 is verbally abusive to C1, it was alleged that on June 28, S1 told C1 "Get the fuck out the car". Confidential interviews resulted in conflicting information being provided to LPA. Confidential witness interviews revealed that S1 never curses at clients, told C1 "you are being disrespectful, you can get out the car" and it was C1 who cursed at S1 telling S1 "Fuck you S1, you fat ass bitch"; whereas another confidential witness interviews disclosed S1 cursed at C1 all the time and S1 was verbally abusive. In regard to the allegation that minors are smoking marijuana on the patio, it was alleged that residents are allowed to smoke marijuana on the patio. Confidential interviews revealed that C1 and Client #6 (C6) had been seen smoking marijuana on the patio of the facility and staff attempted to redirect them but the clients did not listen. In addition, confidential interviews disclosed that smoking of marijuana was not allowed, staff would attempt to redirect clients and that clients were written up or given restriction. Confidential interviews also disclosed that staff did nothing to stop clients from smoking marijuana and would just watch the clients on the cameras from the staff office. CSW had no issues or concerns with the care and supervision provided by STRTP. Based on confidential interviews and document review, the allegations that S1 handled C1 in a rough manner, S1 is verbally abusive to C1 and minors are smoking marijuana on the patio, may have occurred, however are not supported or proven by evidence. Therefore, the allegations are unsubstantiated. A copy of this report, LIC 811, and appeal rights were provided to Executive Director.

Investigation Findings:
13On December 9, 2021 at 9:41 a.m., Licensing Program Analyst (LPA), Cindy Hamilton met with Sojourners Haven Group Home II (STRTP) Executive Director, Latrese Armstrong to deliver the findings for the above stated allegations. During the investigation, LPA Hamilton conducted interviews with six of six clients, three staff, County Social Worker and Administrator (ADM). LPA Hamilton and LPA Adaleyci Caballero conducted a health and safety inspection of the STRTP on August 6, 2021 at 2: PM and no safety concerns were noted. LPAs obtained and reviewed the facility's 15-minute log, placement agreements, needs and services plans, special incident reports, training documentation, client roster and staff schedules. On July 27, 2021, Community Care Licensing (CCL) received information stating that Staff #1 (S1) handled Client #1 (C1) in a rough manner, S1 is verbally abusive to C1 and minors are smoking marijuana on the patio. In regard to the allegation S1 handled C1 in a rough manner, it was alleged that on unknown date, S1 snatched the remote control from C1, grabbed C1's arm and S1 put S1's hands up as if S1 was going UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Cindy Hamilton 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 19-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, MAIN ST., SUITE FACILITY NAME: SOJOURNERS HAVEN GROUP HOME IIFACILITY NUMBER: VISIT DATE: 12/09/2021

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

met_with: Latrese Armstrong, Executive Director


raw_content:
Narrative:
Confidential witnesses stated that the air conditioning (AC) was not working since September 6, 2023, and the facility staff was not working to fix the issue. The confidential witnesses added that a company fixed the AC after September 6, 2023, but two days later the AC broke again, and the facility had not done anything to fix the issue. CSW3 stated that she had visited the facility recently and the facility temperature was comfortable. CSW4 stated that she visited the facility on September 19, 2023, and it was not uncomfortably hot. Other confidential witnesses stated that the facility was working to fix the AC and had several different companies attempt to fix the problem. Additionally, LPA was informed that portable AC units had been ordered for the clients' bedrooms. Regarding the allegation that the facility was purchasing spoiled fruit, confidential witnesses stated that the facility purchased fruit that was of low quality and would mold within a day of being purchased. Other confidential witnesses stated that the facility would purchase fruit that the clients did not eat and would eventually mold. Additionally, LPA was informed that all moldy and spoiled fruit was thrown out. LPA was unable to gather additional information. Based on confidential interviews and record review, the allegations that the facility was 86 degrees Fahrenheit due to the air conditioning unit not working and the facility purchased fruit that was spoiled may have occurred, however, there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated at this time. An exit interview was conducted, appeal rights explained, and a copy of this report was provided to Sherrae Smith.

Investigation Findings:
13On October 19, 2023, at 1: PM Licensing Program Analyst (LPA), Michael Almaraz, met with facility Administrator, Sherrae Smith, to issue the finding for the above allegations involving clients (C1, C2, C3, and C4) listed on the confidential names list (LIC 811) dated October 19, 2023. The complaint investigation was conducted by LPA M. Almaraz. On October 9, 2023, at 12: PM, LPA Almaraz inspected the facility. During LPA's inspection LPA conducted a safety inspection, reviewed four clients' records, and interviewed one staff. Additionally, LPA Almaraz conducted interviews with three additional facility staff, two county social workers, and four of four clients. On October 9, 2023, the Department received a complaint alleging staff do not maintain the facility at a comfortable temperature for the residents and staff do not serve the residents food of good quality. It was specifically alleged that the facility was 86 degrees Fahrenheit due to the air conditioning unit not working and the facility purchased fruit that was spoiled. (continued on page 2...) UnsubstantiatedEstimated Days of Completion: SUPERVISORS NAME: Abdoulaye Traore LICENSING EVALUATOR NAME: Michael Almaraz LICENSING EVALUATOR SIGNATURE: I acknowledge receipt of this form and understand my licensing appeal rights as explained and received. FACILITY REPRESENTATIVE SIGNATURE: This report must be available at Child Care and Group Home facilities for public review for 3 years. LIC9099 (FAS) - (06/04)Page: 1 of Control Number 19-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, MAIN ST., SUITE FACILITY NAME: SOJOURNERS HAVEN GROUP HOME IIFACILITY NUMBER: VISIT DATE: 10/19/2023

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

met_with: Sherrae Smith